Arthroscopic cartilage procedure- OATS, Microfracture and ACI

What are Arthroscopic Cartilage Procedures?

Arthroscopic cartilage procedures are minimally invasive surgeries performed using an arthroscope, a small camera inserted into the knee joint through tiny incisions. These procedures focus on repairing or regenerating damaged cartilage, which is essential for smooth and pain-free joint movement. By addressing cartilage damage early, these techniques can significantly improve joint function and delay the progression of degenerative joint diseases.

Why Are Arthroscopic Cartilage Procedures Needed?

Arthroscopic cartilage procedures are needed for several reasons, including:

– Pain Relief: To alleviate persistent knee pain caused by cartilage damage.

– Improved Function: To enhance knee joint function and mobility.

– Prevent Further Damage: To prevent or delay the progression of joint degeneration.

– Avoid More Extensive Surgery: To provide an alternative to more invasive procedures like knee replacement.

– Improve Quality of Life:  To allow patients to return to their normal activities and sports.

What is OATS (Osteochondral Autograft Transfer System)?

OATS is a surgical procedure used to treat focal cartilage defects in the knee by transferring healthy cartilage and underlying bone from a non-weight-bearing area to the damaged site. This technique is particularly effective for small to medium-sized cartilage defects and aims to restore a smooth cartilage surface, thereby improving joint function and reducing pain.

How is the OATS Procedure Performed?

The OATS procedure begins with the patient under anesthesia. The surgeon makes small incisions around the knee and inserts the arthroscope to visualize the joint. A cylindrical plug of healthy cartilage and bone is harvested from a non-weight-bearing area of the knee. This plug is then carefully inserted into the prepared defect site, fitting snugly to ensure stability and integration. The donor site is usually filled with a bone graft to promote healing. The incisions are closed with sutures or surgical staples, and a sterile dressing is applied.

What is Microfracture Surgery?

Microfracture surgery is a technique used to stimulate the growth of new cartilage by creating small fractures in the underlying bone. This procedure is suitable for treating small to medium-sized cartilage defects and aims to encourage the formation of new, healthy cartilage through the body’s natural healing process.

How is Microfracture Surgery Performed?

Microfracture surgery involves the following steps: The patient is placed under anesthesia, and small incisions are made around the knee to insert the arthroscope and surgical instruments. The damaged cartilage is cleaned and removed to expose the underlying bone. The surgeon then creates tiny holes, or microfractures, in the bone using a specialized tool. These holes allow blood and bone marrow cells to flow into the defect, forming a blood clot that eventually matures into new cartilage. The incisions are closed, and a sterile dressing is applied.

What is ACI (Autologous Chondrocyte Implantation)?

ACI is an advanced cartilage repair procedure that involves harvesting a patient’s own cartilage cells, culturing them in a laboratory to increase their number, and then implanting them into the cartilage defect. This technique is particularly effective for large or complex cartilage defects and aims to regenerate durable and functional cartilage.

How is the ACI Procedure Performed?

The ACI procedure is performed in two stages.

In the first stage, the patient undergoes an arthroscopic procedure to harvest a small sample of healthy cartilage from a non-weight-bearing area of the knee. These cells are then cultured in a laboratory for several weeks to multiply.

Autologous Chondrocyte Implantation

In the second stage, the patient returns for the implantation procedure. The surgeon makes an incision to expose the cartilage defect, prepares the site, and then injects the cultured cells into the defect. A membrane is placed over the cells to keep them in place while they integrate and form new cartilage. The incisions are closed, and a sterile dressing is applied.

What Are the Benefits of Each Procedure?

The benefits of arthroscopic cartilage procedures include:

OATS:

– Restores a smooth cartilage surface
-Uses the patient’s own tissue, reducing rejection risk
– Effective for small to medium-sized defects

Microfracture Surgery:

– Stimulates natural cartilage growth
– Minimally invasive with short recovery times
– Suitable for small to medium-sized defects

ACI:

– Regenerates durable, functional cartilage
– Effective for large or complex defects
– Uses the patient’s own cells, reducing rejection risk

How to Choose the Right Procedure for Your Condition?

Choosing the right procedure depends on several factors:

– Size and Location of the Defect: Larger or more complex defects may require ACI, while smaller defects can be treated with OATS or microfracture.

– Patient Age and Activity Level: Younger, more active patients may benefit from ACI or OATS, while older patients may find microfracture surgery more suitable.

– Overall Knee Health: The presence of other knee issues, such as ligament damage, may influence the choice of procedure.

– Surgeon’s Recommendation: The surgeon’s expertise and experience play a critical role in determining the best procedure.

What is the Recovery Process Like for Each Procedure?

Recovery from arthroscopic cartilage procedures involves several stages. Initially, the patient is advised to rest and avoid weight-bearing activities to protect the repaired cartilage. Pain and swelling are managed with medications and ice application. Physical therapy typically begins soon after surgery to restore knee mobility and strength. The rehabilitation program is tailored to each patient and includes exercises to improve range of motion, strengthen the muscles around the knee, and gradually increase activity levels. Full recovery and return to sports or strenuous activities can take several months, depending on the procedure and the patient’s adherence to the rehabilitation program.

What Are the Risks and Complications of Arthroscopic Cartilage Procedures?

Potential risks and complications of arthroscopic cartilage procedures include:

– Nerve or blood vessel damage

– Limited range of motion

– Reaction to anesthesia

– Graft failure or incomplete integration

– Delayed healing or incomplete recovery

How Successful Are Arthroscopic Cartilage Procedures?

The success rates of arthroscopic cartilage procedures are generally high, with many patients experiencing significant improvements in knee function and pain relief. The success of the surgery depends on several factors, including the type and location of the cartilage defect, the patient’s age and activity level, and adherence to the rehabilitation program. Studies have shown that OATS and ACI tend to have better long-term outcomes compared to microfracture surgery, particularly in younger, active individuals. However, each procedure can provide substantial relief and improved function when appropriately indicated and performed.
With advancements in minimally invasive techniques, these procedures offer a promising approach to managing cartilage damage and improving the quality of life for patients with knee joint issues.

Dr. Ponnanna is specialized in advanced arthroscopic cartilage procedures that effectively repair and regenerate knee cartilage, leading to improved joint function and pain relief. Book your appointment today for expert care and optimal results.