Articular Cartilage Paste Grafting

Minimally Invasive Cartilage Repair & Regeneration

RELEVANT LINKS:
Articular Cartilage Links Page
Clinical Results for Paste Grafting
Biologic Joint Replacement
Articular Cartilage Paste Grafting - Surgical Technique Video
Rehabilitation for Articular Cartilage Transplantation
Stem Cells - A Primer

Kevin R. Stone, M.D.
Ann W. Walgenbach, RNNP
Michael J. Mullin, ATC, PTA

INDICATIONS - This procedure is designed to regrow articular cartilage in the knee that has been damaged by trauma or arthritis. The technique involves harvesting the patients own cartilage and transplanting the tissue to the defective area. It is all performed through arthroscopic surgery and in only one surgical procedure.


image 1: MRI	image 2: Arthroscopic Lesion View

PROCEDURE - The area of chondral damage is first detected by MRI, image 1. At arthroscopy the lesion is then evaluated, image 2, and treated by microfracture, image 3. Microfracture produces small holes in the lesion and stimulates bleeding to create a healing bed for the graft. An osteocartilaginous graft is then harvested from the intercondylar notch in the center of the knee, image 4. The graft is then morselized into a paste and then inserted into the prepared area defect, image 5. The lesion is then re-examined six months to one year later and usually is well healed, image 6, with new reparative tissue evaluated by biopsy, image 7. Healing is also monitored by MRI, image 8.


image 3: Microfracturing the Lesion	image 4: Harvesting the Graft


image 5: Paste Insertion	image 6: 6 Months Later


image 7: Biopsy	image 8: Healing MRI

SPECIAL INSTRUCTIONS - Postoperatively, the knee is to be kept non weight bearing for 4 weeks. A CPM (continuous passive motion) machine is used for 6 hours a day everyday for 4 weeks. A hinged neoprene brace is used for support and to guard the knee in case of a fall. Deep water workouts, stationary bike immediately for the non involved side and after two weeks for both legs are encouraged. Strengthening excercises that are non weight bearing for the involved side are introduced and continued strengthening for the opposite side is also performed. Gradual return to full sports is permitted after three months, although impact excercises are discouraged as pain relief and graft maturity improves during the initial 12 months.