What are articulate cartilage defects ?
The surface of the knee joint is lined with a thick white layer of hyaline cartilage, which keeps the joint moving in a smooth pain free manner.
Damage to this cartilage lining of the knee can result in pain, instability and locking within the knee , and is one of the most common reasons that a patient seeks medial help from a knee surgeon.
What is the difference between osteoarthritis and a cartilage surface defect ?
A cartilage surface defect (Chondral flap or Osteochondral lesion) is when a particular cartilage area within the knee peels off the surface and the underlying bone is exposed …leading to pain and instability.
Osteoarthritis is when both sides of the cartilage on “touching surfaces” rub off, exposing bare bone , and there is bone-on-bone contact.
What can be done to repair cartilage defects ?
Some cartilage defects are best treated without surgery, particularly if they are early stage, and not unstable.
Keyhole surgery in the form of arthroscopy is pretty good and working out the true extent of the unstable defect (often better than MRI) and minor trimming procedures to trim and smoothen surface defects can be successfully done through keyhole techniques.
Various cartilage stimulation techniques have developed over the years with varying success rates. These include micro fracture procedures (which stimulate new fibrocartilage growth on the defect), micro fracture plus a procedure to cover the defect (with minute membranes, tissue glue etc.) , Chondrocyte implantation procedures (ACI and MACI procedures) which involve growing new cartilage and implanting it on the defect, and newer techniques to cover the defects with artificial surfaces (eg. Hemicap, Episurf etc.)
Occasionally, joint resurfacing procedures are warranted to treat a particularly large or painful surface defect.
Mr.Rajaratnam is an expert on treating cartilage surface defects and seeks to balance the need to embrace new techniques (with may be innovative and exciting but relatively unproven), with older proven techniques (which have been extensively studied, are known to be safe and whose success rates are known).
He feels that “Cartilage repair” is the most exciting pioneering frontier in orthopaedic surgery of the knee.
Every patient needs to be assessed individually and be given bespoke advice and treatments for this challenging condition.