Why It's An Option For You
Talking to your doctor about cartilage damage and treatment options can be confusing. Having answers to frequently asked questions may help you understand the process better.
Please note: osteochondral allograft = OCA
Common Questions From Patients:
Q: What is cartilage?
A: Cartilage is a flexible connective tissue that covers the ends of the bones forming a joint. Cartilage is very smooth and allows our joints to move freely and without pain. Cartilage is often thought of as a cushion or shock absorber between our bones and it acts like a teflon coating on the surface of a pot or pan.
Q: Why is cartilage so important?
A: Cartilage is very important because it allows our joints to move smoothly without pain. We only get one set of cartilage when we are born and it has to last our whole life. It is important to treat cartilage damage early because it can lead to a condition called arthritis as we get older. Cartilage damage is the most common reason that patients visit a doctor for joint pain. Doctors that specialize in the treatment of cartilage problems are called orthopaedic surgeons.
Q: What can cause cartilage damage?
A: Cartilage damage can occur through many ways. Common causes are sudden injuries from sports and accidents as well as repetitive activities over time. Many patients have pain and swelling at the time of injury, but some don’t have a problem for years after an injury. Patients may also have medical conditions that can cause cartilage damage as well.
Q: Can the body heal cartilage once it is damaged?
A: The body is not able to heal cartilage once it is damaged, unlike bone, which heals on its own. Cartilage does not have a good blood supply to repair itself, and damage can lead to pain in our joints and limit our ability to move. This is why damage to cartilage is such a serious problem and discussion with your doctor is important.
Q: What are the symptoms of cartilage damage?
A: Symptoms of cartilage damage range from pain and swelling to popping and clicking in a joint. Some patients will even experience locking or giving way of the joints. Symptoms can be constant or just happen every now and then depending on your activity level.
Q: What is the best way to evaluate cartilage damage?
A: Your doctor will often start with an x-ray to make sure the damage is not affecting the bone. To get additional information, the doctor will order a test called an MRI to get a better idea of the cartilage damage. It is also common for the doctor to look in the joint with a small camera, called arthroscopy, to get the best information about your cartilage damage before deciding on the best treatment.
Q: What determines the best treatment for my cartilage damage?
A: Treatment of cartilage damage is a complex decision process for doctors and many factors are considered when deciding on treatment. Doctors consider factors outside your joint such as: your age, work and athletic activities, joint alignment, weight and overall health. Doctors also consider factors inside your joint such as: the size and depth of the cartilage damage as well as the health of the surrounding cartilage and ligaments.
Q: What are the options for treatment of cartilage damage?
A: The options for treatment for cartilage damage are numerous and well beyond a simple answer. This question is often discussed and debated at scientific meetings, so there may not be an exact answer for every patient. In an effort to simplify the topic, doctors group treatment of cartilage damage into three categories. One category is palliative treatment, which may involve just shaving the cartilage to clean up the damaged area. A second category is reparative treatment, which may involve stimulating the bone or adding cartilage cells to fill the damaged area. The third category is restorative treatment, which involves transplantation of live cartilage and bone graft. This is also called an osteochondral allograft transplantation, or an OCA .
Q: What is cartilage restoration?
A: Cartilage restoration involves taking healthy cartilage and bone from one area to replace the damaged area of cartilage in your joint. Doctors will often call the borrowed bone and cartilage a graft. Grafts can be taken from your joint to replace small areas of cartilage damage. This is due to the limited amount of cartilage we have in our joints to borrow. If the area of cartilage damage is larger, the graft will be taken from a donor. If the graft is taken from your body, it is called an autograft. If the graft is taken from a donor, it is called an allograft or osteochondral allograft. “Osteo” means bone and “chondral” means cartilage. “Allo” means other than your body and “graft” means inserting tissue into your body.
Q: Am I a candidate for cartilage restoration?
A: The younger and healthier you are, the better candidate you are for cartilage restoration. If your cartilage damage is isolated to one area of the joint, you are a better candidate as well. Older patients with more extensive cartilage damage may be better suited for a joint replacement with metal and plastic parts.
Q: What does the process of allograft or donor cartilage involve?
A: The process of cartilage restoration with an OCA, or donor cartilage, involves measuring the size of the damaged area of cartilage in your joint and matching it to a donor with healthy cartilage. This process can take some time and you may be placed on a waiting list. Once a match becomes available, the donor undergoes extensive testing to make sure the donor is safe and free of all illnesses and diseases. Since the donor graft is alive, it has to be placed into your joint within a couple weeks to be successful. Once the graft has been placed in your joint, it takes months to grow into your body and extensive physical therapy to recover.
Q: Is the process of cartilage restoration with an OCA safe and successful?
A: The process of restoring cartilage with an OCA has stood the test of time. There are scientific studies showing patients with successful recovery lasting over 20 years and the chance of disease transmission or infection is less than 1 percent. It is important to make sure your surgeon is familiar with the graft company that provides the donor cartilage and bone and has experience in cartilage restoration surgery. Additionally, there are extremely strict criteria for tissue donation including a thorough review of the donor’s medical records and social history to maximize the tissue quality and minimize the risk of recipients.
Q: What are the chances that my body will reject the donated tissue? Do I need to take medication to prevent rejection?
A: Unlike live organ transplants, tissue rejection is not a concern with bone and cartilage transplantation; therefore, you will not need to take anti-rejection medication.
Q: What should I expect after cartilage restoration surgery with an OCA?
A: Surgery to restore cartilage with an OCA graft can be done arthroscopically with a camera or with an open incision. This may depend on the size of the damaged area in your joint. This surgery can be done safely as an inpatient (where you stay overnight in a hospital), or as an outpatient (where you have surgery and go home the same day). Patients are often placed on crutches and not allowed to walk on their leg if the graft is placed in their hip, knee or ankle. The graft takes time to grow into your bone and rehabilitation is slow at first and speeds up once the graft heals. Patients need extensive physical therapy to regain the full motion and strength in their joint. Most patients do not return to full participation in work or sports for 9 months to a year.
Q: Why doesn’t my doctor recommend a joint replacement for my cartilage damage?
A: Joint replacement involves removing the cartilage and bone from you and replacing it with metal and plastic parts. These mechanical parts have a given life span and wear out just like the parts in your car. This is why doctors try to recommend joint replacement as a last resort and later in life. If you are young and active, doctors try to save your knee by replacing the bone and cartilage with a living osteochondral allograft that grows into your body. You may still need a joint replacement later in life, but the goal of cartilage replacement is to buy you time until you are the appropriate age for a joint replacement.