CARTILAGE RESTORATION SURGERY – DONOR GRAFT
The ends of the femur, tibia, and undersurface of the patella (kneecap), the knee bones, are capped with a smooth surface called articular cartilage. Cartilage protects the ends of bone; it can withstand a significant amount of impact and is significantly smoother than ice, which allows smooth motion in the knee joint. An articular cartilage injury (or “chondral” injury), may occur following a twisting injury to the knee, a direct blow to the knee, or wear and tear as a one ages. Some patients with cartilage injuries can be treated with a combination of activity modification and other non-surgical options, such as a focused physical therapy program. Other patients with persistent symptoms or larger defects may require surgery.
Surgical treatment options for isolated cartilage injuries include the use of donor cartilage to replace the damaged area of cartilage. Donor cartilage is cleaned and stored in a way that preserves the health of the donor cartilage cells. There are two techniques available to Dr. Welch. In one technique – the DeNovo technique – Dr. Welch matches the shape of the donor cartilage tissue to the area of damaged cartilage and then places the donor graft into the defect in the patient’s knee. Dr. Welch then seals the cartilage tissue with fibrin glue. In the second technique – the ProChondrix technique – Dr. Welch places a pre-shaped donor graft made of cartilage cells and natural scaffolding into the damaged area of cartilage in the knee. The donor graft is then sealed with fibrin glue. Following surgery, the healthy donor cartilage tissue matures over many months and replaces the area of damaged cartilage.
Following surgery, patients are placed in a hinged brace that is locked straight. Dr. Welch recommends no weight-bearing for 4-6 weeks in the brace. When the patient is sitting or lying down, Dr. Welch encourages knee range of motion exercises with the brace removed. Dr. Welch also recommends intermittent icing and straight leg raise exercises to strengthen the quadriceps muscles. Dr. Welch recommends starting physical therapy two weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee. Most patients can start full weight bearing on the affected leg 6-12 weeks after surgery, depending on the location of the defect. Most patients start cutting activities and sporting activity approximately 4-6 months after surgery.