Cartilage restoration is a newer procedure that may be an alternative for patients who have cartilage damage in the knee, but are too young to have a knee replacement.
Dr. Whatley first gained experience with cartilage restoration during his fellowship at Harvard University / Brigham and Women’s Hospital in Boston, MA. There, he learned the MACI technique (Matrix-induced Autologous Chondrocyte Implantation) for cartilage restoration working with two of the leading MACI surgeons in the United States - Dr. Andreas Gomoll with Hospital for Special Surgery in Manhattan and Dr. Tom Minas with Paley Orthopedic Institute in Florida. This fellowship allowed Dr. Whatley to gain a tremendous amount of experience in MACI cartilage restoration before entering practice.
Who Is a Candidate for Cartilage Restoration?
Currently, MACI cartilage restoration is only used for patients with cartilage damage in the knee. In the right patients, cartilage restoration can be a great procedure that may help a patient delay or avoid the need for a total knee replacement. However, not all patients are good candidates for this procedure.
Candidates for cartilage restoration typically meet the following criteria:
- Younger - typically under the age of 60
- Cartilage damage in the knee that is not too extensive to be repaired
- No preexisting conditions like uncontrolled diabetes that may affect healing
- No smoking or excessive use of alcohol or corticosteroids
Dr. Whatley typically does not recommend cartilage restoration for patients over the age of 60. Current medical literature shows that total knee replacements can last 25 to 30 years; in patients over 60, knee replacements provide a more predictable result and will often last for the remainder of the patient’s life. In contrast, if a patient has a knee replacement in their 40s or 50s, they are more likely to need a revision knee replacement down the road to replace the old implants. Cartilage restoration is an option for these younger patients to hopefully avoid a more complex knee revision procedure when they are older.
What Happens During a Cartilage Restoration Procedure?
Simply put, MACI involves using the patient’s own healthy cartilage to create a “patch” to fill in the damaged cartilage in the knee. It’s a similar concept to filling in a pothole in the road.
Cartilage restoration is a staged process. First, Dr. Whatley orders an MRI to assess the damage in the knee to determine whether or not a patient is a candidate. He also uses arthroscopy, a procedure involving a small camera called an arthroscope, to further assess the knee through a small incision. If the patient is a candidate, he will also take two very small pieces of healthy cartilage from the knee (each about the size of a tic-tac). This is a minimally invasive procedure.
Those cartilage samples are sent off to a lab in Cambridge, MA, where they are used to grow new cartilage cells. The lab then applies the newly-generated cartilage cells to a thin film called a matrix, which will serve as the “patch” for the damaged cartilage in the patient’s knee. The matrix is sent back to Dr. Whatley to implant in the patient.
Dr. Whatley implants the matrix in the patient’s knee using a small open approach. The incision is smaller than the incision for a knee replacement. First, he cuts out all of the diseased cartilage in the knee, then he sews the membrane in place. This procedure may be coupled with an unloading osteotomy if there is instability or defects in the knee.
Recovering from Cartilage Restoration
Following a cartilage restoration procedure, most of Dr. Whatley’s patients stay at the hospital for one night. The patient’s leg is typically placed in a continuous passive motion (CPM) machine to begin moving the knee and prevent stiffness.
With cartilage restoration, a large part of the recovery process is just letting the cartilage graft and the osteotomy (if done) heal. Because cartilage restoration involves a biological process and significant amounts of healing, patients will not see the results right away. Unlike a knee replacement, patients cannot put weight on the knee right away. There are different protocols on weightbearing depending on the location of the cartilage graft; Dr. Whatley will advise when it is safe to begin weightbearing.
Patients also participate in physical therapy for about 8-12 weeks after surgery to work on range of motion, balance, and quadriceps strength. Patients are typically not cleared to play sports until about 9-12 months after the procedure. However, after full healing, most patients are able to return to their previous level of activity.
Cartilage Restoration in Zachary, New Roads & St. Francisville, LA
Dr. Adam Whatley is a board certified and fellowship trained orthopaedic surgeon who has been in practice for over 10 years. Though cartilage restoration is a newer procedure, Dr. Whatley has had experience with it since his fellowship at Brigham and Women’s Hospital, where he trained with two of the top cartilage restoration surgeons in the United States. Though cartilage restoration is not an appropriate option for all patients, it can be helpful for patients with knee arthritis who are too young to have a knee replacement.