| Conservative approaches to osteoarthritis of the | | | | intercondylar notch of the knee (a non |
| knee include non-steroidal anti-inflammatory drugs, | | | | weight-bearing area). The plug is then placed into the |
| good quality forms of glucosamine and chondroitin, | | | | cartilage defect in the femur. While this is good for |
| physical therapy, corticosteroid injections, | | | | localized defects, it is not useful for large defects due |
| viscosupplementation (injections of lubricant into the | | | | to osteoarthritis. |
| knee), and bracing. | | | | Autologous cartilage implantation is a procedure |
| For people who do not respond to these measures, | | | | where a plug of cartilage is removed from the |
| there are more aggressive approaches available. The | | | | intercondylar notch of the knee (a non |
| first is arthroscopy. This is a procedure where small | | | | weight-bearing area). The plug is then used to |
| telescope is inserted into the knee. Using specialized | | | | provide cartilage cells which are grown in a laboratory. |
| cutting instruments, damaged and diseased tissue is | | | | The patient then undergoes a second surgery where |
| removed and flushed out of the knee. For many | | | | the cartilage defect in the weight-bearing part of the |
| patients this affords relief. | | | | knee is carefully debrided (cleaned), then a patch is |
| If the arthritis damage is limited to one side of the | | | | placed over this defect and cartilage cells grown from |
| knee, an osteotomy (removal of a wedge of bone | | | | the first harvesting procedure are injected |
| to help the bones of the knee line up better) can be | | | | underneath the patch. Cartilage cells then grow over |
| a very good option. This procedure is best done in | | | | a period of several months. This procedure is good |
| patients under the age of 60 who are active and | | | | only for isolated cartilage defects and not for |
| who do not have severe inflammatory changes. The | | | | generalized osteoarthritis of the knee. Patients must |
| only disadvantage is that because bone is removed, it | | | | not bear any weight on the leg for at least six |
| may make subsequent knee replacement surgery | | | | months. |
| more difficult because there is less bone to anchor | | | | Synthetic cartilage plugs can also be inserted. The |
| the replacement in. | | | | plug is made of synthetic biodegradable material that |
| Resurfacing is a procedure where a thin layer of the | | | | permits the patient's own cartilage cells to grow |
| femur (upper leg bone) and a thin layer of the tibia | | | | within the defect. This procedure is best used for |
| (lower leg bone) are removed. A layer of metal is | | | | younger patients (50 or younger) who have a |
| applied to the femur and a layer of plastic is applied | | | | localized defect. It takes several months for the plug |
| to the tibia. Sometimes the back of the patella | | | | to take hold. |
| (kneecap) is also resurfaced. This type of procedure | | | | Patients who have a damaged meniscus (cartilage |
| is good for people who only have a moderate | | | | cushion) due to arthritis can have a replacement |
| amount of damage and who have relatively good | | | | meniscus donated from a cadaver source. These |
| bone stock. | | | | grafts can last about 4-5 years. The one danger is |
| A relatively new procedure is paste grafting. Here, a | | | | that the body may reject them. |
| hole is drilled in an area of arthritis to expose bleeding | | | | Total knee replacement is a procedure where the |
| tissue. A paste consisting of crushed up bone and | | | | end of the femur and the end of the tibia are |
| cartilage cells is then placed in the hole and the | | | | removed and replaced with appliances consisting of |
| patient is not allowed to bear any weight on the | | | | metal capped with ceramic or plastic. Knee |
| repaired knee for several months. The paste is | | | | replacements last 12-15 years. A revision of this |
| supposed to promote regeneration of cartilage. | | | | replacement may be required if the knee |
| Preliminary data is encouraging. | | | | replacement is older than 15 years. Recent data |
| Cartilage plug grafting is a procedure used when | | | | indicates that a an exercise program instituted before |
| there is a single localized defect in the cartilage of the | | | | surgery greatly enhances the chance of success. |
| femur. A plug of cartilage is removed from the | | | | |