What is Cartilage / Meniscus Transplantation?
Individuals who have arthritis have the surface cartilage of their bone worn away. The surface cartilage at the end of your bones in a joint (i.e., shoulder, knee, ankle, elbow) is smooth and marble-like in appearance. This marble-like covering allows the joint to move smoothly and if this covering is lost, bone is exposed causing pain. This is the definition of arthritis.
Surface cartilage on the end of the bones that make up a joint has very little ability to heal. Therefore, there are procedures designed to transplant cartilage plus a small piece of bone to areas where the cartilage is lost. This is called Cartilage / Meniscus Transplantation. For small areas, this cartilage can be taken from an area that is "nonessential" within the same knee. Oftentimes this cartilage can be taken from the opposite knee from a nonessential area. For very large areas where the cartilage is missing, this cartilage is taken from an allograft. An allograft is bone and cartilage taken from an individual who has died. This individual is screened for all diseases. Once the screening process takes place, a piece of cartilage and bone is taken from the "allograft" and transplanted into the patient. Currently at the University of South Alabama we have performed close to one hundred twenty (120) Cartilage / Meniscus Transplantations. Our ongoing database registry has indicated significant success with these procedures.
Who is a candidate for Cartilage / Meniscus Transplantation?
Individuals who are active and/or who have localized areas of osteoarthritis are candidates for Cartilage / Meniscus Transplantation. This means individuals who have well localized areas within the knee, ankle, elbow or shoulder, rather than global arthritis. "Global" means arthritis throughout the joint. Such patients are better suited for a total joint replacement. To better understand whether you are a Cartilage / Meniscus Transplantation candidate, please contact the USA Joint Restoration Service or your physician for a referral.
Types of Cartilage / Meniscus Transplantation
• Autograft refers to a patient's own cartilage and, as previously mentioned, this cartilage is taken from the same knee or from the opposite knee from a nonessential area.
• Allograft - this is cartilage and bone that is taken from a person who died and who was screened for diseases.
Other surgical procedures performed alone or in conjunction with Cartilage / Meniscus Transplantation
In addition to Cartilage / Meniscus Transplantation, certain other procedures may be performed at the same time. These procedures include ligamentous reconstruction. If your anterior cruciate ligament (or posterior cruciate ligament) is torn at the time of injury, then the knee will need to be stabilized by reconstructing these ligaments. These procedures are frequently done at the same time. In addition, if you are missing a meniscus, which is the fibrous, or rubbery, type cartilage between the two bones in your knee joint, then this cartilage can be transplanted at the same time that the surface cartilage is transplanted within your knee.
Finally, if you are a candidate for Cartilage / Meniscus Transplantation and it is noted that your cartilage is worn away as a result of abnormal forces within your knee, another procedure may also need to be performed. For example, if you walk bowlegged, the majority of weight is being borne on the inside of your knee. If Cartilage / Meniscus Transplantation is to take place, you could wear away that cartilage transplant by continuing to walk with most of your weight being put on the inside of the knee. Therefore, at the time of Cartilage / Meniscus Transplantation your doctors may want to "realign" your knee so that you walk on the center or the outside of your knee. This unloads the area where the Cartilage / Meniscus Transplantation takes place. Such a procedure is called a high tibial osteotomy and it is performed by making a small incision below your knee joint. The bone is cut and a piece of graft is placed in this area along with a small plate, to straighten your leg from a bowlegged to a straight appearance. This procedure is done less frequently than ligamentous reconstruction or transplanting a meniscus. However, it is occasionally required at the same time of Cartilage / Meniscus Transplantation. You should contact your physician to see if you are a candidate for this procedure.
USA Cartilage / Meniscus Transplantation Registry
This registry refers to a database, or list, of patients who have undergone Cartilage / Meniscus Transplantation either from their own cartilage or from donor cartilage (allograft). This information is kept anonymous at USA, enabling physicians to follow those patients who have undergone these transplantations and determine how they are doing. If you are a candidate for Cartilage / Meniscus Transplantation and agree to this surgical procedure, you will complete a questionnaire. This data will be anonymously entered into a database. Each year information will be entered from specific questionnaires. A physical examination will be performed to assess how you are doing after your Cartilage / Meniscus Transplantation. It is critical that the physicians know prior to transplantation how you are doing so that a comparison can be made after your surgical procedure. For more information on Cartilage / Meniscus Transplantation registry, please contact Dr. Pearsall's office at (251) 665-8200.