Knee surgeon, Peter Thompson responds to questions about articular cartilage repair.
Transcript of the interview:
Regarding suitability of a cartilage defect for cartilage repair...
"Well it depends on a number of factors but one of the biggest factors is how big the area is and we’ve got a number of different options to treat joint surface damage.
"If it is a well isolated area and it’s quite small, less than say, 2 square centimetres, then the main treatment that people would go to is some form of marrow stimulation technique and that involves making some small holes in the joint surface so that it bleeds through onto the joint surface, the stem cells come through, and it tries to regrow an area with fibrocartilage. It used to be called microfracture but there is some second generation instrumentation that hopefully gives us a better result and slightly smaller holes on the joint surface.
"Bigger size lesions we tend to go to some form of cell repair process and that either involves taking the patient’s own chondrocytes which are the cells in the joint surface and culturing those and then coming back as a second procedure to patch up the joint surface or doing a one stage procedure where we use their own stem cells and those can be taken as an aspirate either through the bone at the end of the femur or from the iliac crests at the top of the pelvis and then putting those stem cells onto a small patch and then patching up the area.
"Slightly bigger sized lesions can then be treated with osteochondral allografts which are fresh areas of joint surface from a donor and transferring those into the patient and that’s a new technique that’s really become available in this country. It’s been used in the States for quite some time but there’s now availability in the UK and that’s an area that I’m interested in developing."
Regarding associated injuries...
"Yes, it’s important that we’re not just thinking of one part of the knee. You need a decent meniscus which acts as a load distributor in the knee to help protect the joint surface and we have options for scaffold replacements of the meniscus and also for meniscal transplantation. So that’s again taking a donor meniscus from somebody and transplanting it into the knee to rebuild, to replace, lost meniscal tissue."
Regarding associated leg alignment issues...
"The final part of that really is the correct alignment of the patient and it’s vital that we correct any deformities. So if the patient is particularly bow-legged or knock-kneed, that we correct their alignment at the same time to give these procedures a chance of working."