CARTILAGE RESTORATION AND TRANSPLANTATION

The Articular Cartilage is the smooth gliding surface found within the joints of the body.  It is made of different molecules and living cells, which help create a nearly frictionless surface.  This allows the joints to bend, glide, and absorb shocks.  The surface of the cartilage can sustain damage from trauma, aging, or overuse.  There is a wide spectrum of cartilage injuries, ranging from localized defects to end-stage osteoarthritis.    

Dr. Elkin specializes in cartilage restoration procedures, which aim to repair or replace the damaged cartilage in order to restore normal joint function.  Depending on the type of cartilage injury present, we can oftentimes improve the function of dysfunctional joints, while relieving pain and preventing the progression of arthritis.  

Nonoperative treatments

Nonoperative treatment is often the first step in managing cartilage injuries and can be very effective at reducing pain and improving function. Treatment typically begins with activity modification, adjusting or avoiding high-impact activities that place excessive stress on the joint while maintaining overall fitness through low-impact options such as cycling, swimming, or elliptical training. Physical therapy plays a central role, focusing on restoring motion, improving flexibility, and strengthening the muscles around the joint—particularly the quadriceps, hamstrings, and core—to improve joint mechanics and reduce load on damaged cartilage. Weight management is also important, as even modest weight loss can significantly decrease stress across weight-bearing joints. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may help control pain and inflammation when used appropriately. In some patients, injections—including corticosteroids, hyaluronic acid, or biologic options such as platelet-rich plasma—can provide additional symptom relief. Together, these nonoperative strategies are individualized to help patients stay active, manage symptoms, and potentially delay or avoid surgery.

Arthroscopic Chondroplasty

Chondroplasty is a minimally invasive surgical option used to treat symptomatic cartilage damage by smoothing and stabilizing frayed or unstable cartilage surfaces within the joint. The goal is to reduce mechanical irritation, improve joint function, and relieve pain, particularly for smaller or more superficial cartilage lesions. In many cases, chondroplasty also serves an important role as a staging procedure, allowing the surgeon to directly visualize the knee, identify additional sources of pain such as meniscal injury or ligament pathology, and accurately assess the true size and depth of cartilage damage. This is especially important because cartilage lesions seen on MRI are often underestimated and are typically at least 20% larger when evaluated surgically. By defining the full extent of cartilage injury and overall joint health, chondroplasty helps guide decision-making and plan appropriate future cartilage restoration procedures when needed.

Autologous Chondrocyte Implantation (ACI) - MACI

This specialized procedure implants a patient’s own cartilage cells back into their knee.  It is performed in two stages:  First, we perform an arthroscopy to assess the area of damage and clean any loose edges.  A biopsy is also taken of the normal cartilage and then sent to a lab where it can be stored and later expanded.  For the second stage, we take your own cartilage and implant it into the area of cartilage loss.  The benefits of ACI are that it can be utilized for irregularly sized defects, very large defects, and multiple defects.  The newest generation is called MACI.  more information

Osteochondral Allograft Transplantation

This is a single-stage cartilage transplantation, where a plug is taken from a size-matched donor and transplanted into the patient’s knee.  The plug is made of both cartilage and the underlying bone, which allows this technique to replace the underlying bone if it is damaged.  The healthy plug of cartilage and bone is harvested from the donor (cadaver) and transplanted into the recipient.  Generally, we perform this type of transplantation when there is underlying bony involvement or when other cartilage restoration procedures have failed (such as after microfracture).  When planning for this procedure, we perform measurements based on your MRI scan and Xrays, which are matched with a donor.  Once a match is found, there is usually a short window of a couple weeks when the graft can be implanted.  Even though it is a transplantation from another individual, there is no need to take any rejection medications afterwards, and all of the grafts are rigorously tested to ensure there will be no disease transfer.    

Comparisons between MACI and Osteochondral Allografts - including rehabilitation timelines.

Cartilage Repair

Some cartilage injuries may be amenable to a repair surgery.  These are most commonly those associated with patella dislocations and juvenile OCD lesions.  Repair procedures use screws, tacks, or anchors to secure the patient's native cartilage back in place.

Unloading Osteotomies

In some situations, the alignment of the joint may be abnormal, which may exacerbate cartilage damage.  To unload the area of damage an osteotomy can be utilized to realign the joint.  An osteotomy involves cutting the bone, realigning it, and securing the bone in its new position with metal hardware.  If there is a critical alignment issue, we will often recommend an osteotomy to help preserve a cartilage restoration procedure.  Some of the more common osteotomies are the Tibial Tubercle Osteotomy to unload the patella, High Tibial Osteotomy to correct bow-legging (varus), and Distal Femoral Osteotomy to correct knock-knees (valgus).