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Cartilage restoration: A knee replacement alternative

man on a motorcycle

​​​​​​If a sore knee causes you to cut back on your favorite activities, delaying treatment can limit your joint repair options.

Cartilage restoration may be an alternative for knees with cartilage damage not severe enough for knee replacement. Your knee's overall health factors heavily into considering this approach.

"Cartilage restoration involves removing damaged cartilage that's replaced by healthy cartilage," said Orthopedic Surgeon and Sports Medicine Physician Darren Corteen, M.D., Marshfield Clinic Marshfield Center. "Good candidates for this approach have a localized area of damaged knee cartilage caused by an injury or a degenerative change from overuse or arthritis."

An orthopedic surgeon may use one of three techniques to restore cartilage:

  • Microfracture
  • Transplanting cartilage cells generated from a sample of your cartilage
  • Transplanting your own cartilage or donor cartilage 

The first procedure involves removing unhealthy cartilage and stimulating underlying bone to promote new tissue growth.

"This approach may be a good first step, but may not be the best for the long term," Dr. Corteen said. 

In the second, a surgeon transplants cartilage cells into the knee for regeneration. This two-step procedure includes harvesting cells from the patient's healthy cartilage and introducing regenerated cells to the damaged site later via injection.

The third technique is like the second. However, it uses cartilage taken from a healthy site of the patient or a donor and transplants it to the site needed for regeneration. This is useful for smaller defects.

"These techniques, coupled with other procedures can achieve a more durable result," said Dr. Corteen. "Transplant techniques involving the patient's cartilage are more common."

Joshua Matson, 22, of Stetsonville underwent surgery three years ago on his right knee. His surgery combined cartilage restoration with other knee repair procedures. Severely bowed knees had affected Matson since childhood, making it painful to walk and do other physical activities.

"I developed such a high tolerance for pain that I didn't realize how much of my knee cartilage was gone," Matson said. "It took me almost a year to fully recover from the surgery, but I've been able to return to farm work and now have a factory job. I can do things I couldn't do before the surgery, such as ride my bike."

Overall condition of the joint is key for considering cartilage restoration. Age and arthritis can decrease integrity of the joint and surrounding ligament and tendon structure. If the overall knee joint has deteriorated too much, cartilage restoration is less of an option.

"A restorative approach is preferred especially for younger patients," Dr. Corteen said. "Cartilage restoration may last longer and delay a full joint replacement procedure 10 to 15 years."

Recovery includes no weight-bearing activities for two to three months, then physical therapy.

"Patients can get back to higher-level activities in about eight to 10 months and within a year, to do what they did before," Dr. Corteen said. "Restored cartilage can make it possible to continue in their sport and their life." 

 Cartilage restoration surgeons

Marshfield Clinic orthopedic surgeons providing cartilage restoration procedures include: 

Darren Corteen, M.D., Marshfield Center 

Albert Cecchini, D.O., Merrill and Wausau centers 

Roxanne Wallace, M.D., Chippewa Falls and Eau Claire centers

For more information, check here.