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Knee articular cartilage damage / osteoarthritis

What is articular cartilage?

Articular cartilage is the soft white cartilage that covers the ends of the bones and helps joints to move smoothly.  It also helps to absorb the forces throughout the knee.

Articular cartilage injury/damage

This articular cartilage surface can be damaged by trauma such as a sports injury. Normal use, including running, won’t wear out the cartilage unless it’s been previously injured or if the meniscus cartilage has been removed. Bone malalignment or being overweight can also contribute to damage. The diseases of osteoarthritis and inflammatory arthritis can directly damage the cartilage surfaces as well.

Once damaged, articular cartilage will not heal on its own.  Over time, the cartilage breaks down and the underlying bone reacts. As the bone stiffens and develops bone spurs, (osteophytes) the joints become inflamed and swollen, which damages the cartilage even more, leading to pain, swelling or loss of motion. This is traumatic osteoarthritis.

Knee osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Untreated, it is usually a progressive degenerative disease in which the joint cartilage gradually wears away.

Articular cartilage damage is graded according to its severity.

  • Grade 0: Normal healthy cartilage.
  • Grade 1: The cartilage has a soft spot or blisters.
  • Grade 2: Minor tears visible in the cartilage.
  • Grade 3: Lesions have deep crevices (more than 50% of cartilage layer).
  • Grade 4: Exposed underlying bone.

Our unique approach to articular cartilage repair

Early identification and treatment of articular cartilage damage can have a significant effect on outcomes for patients.  We address cartilage damage as part of our biologic joint replacement procedure. By repairing or replacing the damaged cartilage before it completely wears out, the arthritic damage can be reversed and the joints preserved.

If this step is not taken, eventually the cartilage wear will progress so much that the bones will touch on each side of the joint, called bone on bone wear.  At this stage, artificial joint replacement  becomes necessary.

Read more about The Stone Clinic’s new treatment paradigm for arthritis.

Articular Cartilage Paste Graft

At The Stone Clinic we have a unique procedure for repairing articular cartilage: the Articular Cartilage Stem Cell Paste Graft, designed by Dr. Stone in 1991.

Articular cartilage paste grafting (often abbreviated as art cart or paste grafting) uses your own bone, cartilage and stem cells to  regenerate your damaged cartilage. It is a minimally-invasive, single arthroscopic procedure that stimulates regrowth of damaged articular cartilage surfaces.

The arthritic area of the knee, or the area where there is missing cartilage, is morselized by the surgeon to create a fresh blood supply and to bring stem cells to the surface. The graft is harvested from the intercondylar notch (a non-weight bearing part of the knee), crushed into a paste, and packed into the fractured chondral defect. The result is a repair technique that can provide durable cartilage repair tissue with long-term improvement in function and diminishment of pain.

Dr. Stone says ...

Articular cartilage paste grafting has provided my patients with tremendous relief and permitted a return to sports for many arthritic joints that were thought to require joint replacement. Our  published peer reviewed long-term outcome studies have matched or exceeded any other published work.  Paste grafting has been a great tool for salvaging failed microfractures and other cartilage procedures.

Articular cartilage paste graft independent study

A study carried out by independent researchers proves that the paste graft produces superior tissue to an alternative cartilage regeneration procedure, the microfracture.

Outcome studies show great long-term results

In order to constantly improve our techniques we follow up on many of our paste graft patients.

Articular cartilage paste graft surgery in action

Fix a meniscus to avoid arthritis
A recent study suggested that meniscus surgery doesn't help. Studies can be misleading. Even small losses of meniscus tissue lead to big changes in force concentration on the tibia (shin bone) and eventually arthritis.
In orthopedics training, we used to joke that the only purpose of the heart was to provide blood supply to the knees.
If you have osteoarthritis, or if you think you may develop it later, you don’t have to just “suck up” the symptoms or change your life to manage the disorder. There is something that you can do about it, especially if you catch it early.
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Kevin R. Stone · Jonathan R. Pelsis · Scott T. Surrette · Ann W. Walgenbach · Thomas J. Turek 

Stone, K.R., A.W. Walgenbach, A. Freyer, T.J. Turek, and D.P. Speer. 2006.