Isolated cartilage injuries

Damage to articular cartilage is relatively common in recreational and professional athletes and can lead to loss of sporting performance and symptoms in day to day life. There are many options to treat isolated lesions but the only way to restore proper articular cartilage is a stem cell transplant. This is a highly specialised procedure and only available through a limited number of surgeons in the country. It is usually diagnosed on MRI but with some cases the first stage is an arthroscopy (keyhole knee operation) to confirm the diagnosis. If appropriate, MR Miles will then harvest stem cells from the pelvis and prepare them for implantation with specialist machinery only available at  The Royal National Orthopaedic Hospital. This picture shows an area of cartilage loss before it is grafted. The lesion has been tidied up to allow proper graft acceptance. The bright white area is articular cartilage, the base of the lesion is bone with no cartilage cover.

This picture shows a graft in place. The graft is made up of millions of cartilage cells and is initially quite delicate so the postoperative period involves six weeks of rest followed by a gradual return to sports. It takes a year to get back to contact sports like football/rugby. It is a long process but can have good results in the right patients so should be considered in cartilage injuries in patients below 50 years of age. It can be combined with meniscus surgery or cruciate surgery but not cases of advanced arthritis of the joint. There are other cartilage replacement techniques than can be considered in more widespread cases of damage. These include microfracture and scaffold grafts. Mr Miles is trained in all of these techniques and will make a detailed assessment with you of which is the correct option for your knee.

 

 

 

This biopsy shows live cartilage cells (chondrocytes) living in the cartilage substance that they have created after cartilage transplant in a patient of Mr Miles.

 

 

This picture is taken during an arthroscopy and shows the small holes created in the bone at the base of a knee injury where all of the cartilage was lost from a small area (microfracture technique).