Cartilage repair Glendale: which choice fits the knee?

What can you change at home?

Try brief walks on level ground and easy leg strength work. Stop when sharp soreness, fresh swelling or catching starts.

Hard floors, worn shoes and repeated stairs can add strain. Change one daily task, then check the knee that evening.

Keep the change for several days if the knee feels calmer. Tell the clinician exactly which task improved and which one still hurt.

What does microfracture surgery do?

Microfracture surgery opens small holes in the bone below the worn spot. Marrow from inside the bone fills them and forms repair tissue.

That tissue is more fibrous and less smooth than original cartilage. It may wear down sooner, so the damaged spot's size and place matter.

When might a graft or the two-operation MACI repair come up?

A graft moves healthy cartilage and bone into one damaged area. The tissue may come from the same knee or from a donor.

MACI grows your own cartilage cells on a sheet for a second operation. Both repairs need a close exam of the whole knee and recovery planning.

What if fewer steps don't calm the soreness?

When home changes don't help, QC Kinetix provides regenerative treatment options made from your blood. Concentrated platelet-rich plasma keeps extra platelets, the blood pieces that aid clotting.

Ask if the aim is less soreness, steadier walking or easier stairs. Also ask when the provider will check those daily tasks again.

Sources

1. A JBJS evidence-based review of chondral lesions of the knee sets management by lesion size, location, limb alignment and rotation, and patient demand rather than by product: osteochondral autograft transfer is described as durable and predictable for smaller lesions (under 2 cm2) in young active patients, while lesions of 2 cm2 or more are typically treated with osteochondral allograft transplantation, particulated juvenile articular cartilage, or matrix-associated chondrocyte implantation, with favourable mid- and long-term results reported for allograft or MACI in large lesions of 3 cm2 or more.

   Dekker TJ, et al. — Chondral Lesions of the Knee: An Evidence-Based Approach.. J Bone Joint Surg Am, 2021. DOI: 10.2106/JBJS.20.01161.

2. The original autologous chondrocyte transplantation series treated 23 patients with full-thickness knee defects of 1.6 to 6.5 cm2. At two years, 14 of 16 femoral condyle transplants were good to excellent, but only 2 of 7 patellar transplants were excellent or good, three were fair and two poor, with two patellar cases needing reoperation. Location mattered from the very first paper.

   Brittberg M, et al. — Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.. N Engl J Med, 1994. DOI: 10.1056/NEJM199410063311401.

3. The Cochrane review of surgical interventions for isolated cartilage defects of the knee in adults found only three randomised trials, all comparing mosaicplasty with microfracture, reporting 133 participants in total with a mean defect area of 2.8 cm2. It found NO randomised trials of allograft transplantation or drilling at all, judged every trial at high or unclear risk of bias, and rated the quality of evidence very low for every outcome.

   Gracitelli GC, et al. — Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults.. Cochrane Database Syst Rev, 2016. DOI: 10.1002/14651858.CD010675.pub2.

4. FDA biologics licence BL 125603 (Vericel) describes MACI verbatim as "an autologous cellularized scaffold product indicated for the repair of symptomatic, single or multiple full-thickness cartilage defects of the knee with or without bone involvement in adults." The licensed indication is a two-stage surgical implantation for full-thickness DEFECTS of the knee in adults. It is not an injection, it is not licensed for osteoarthritis, and it is not licensed for any joint other than the knee.

   U.S. Food and Drug Administration — MACI (autologous cultured chondrocytes on porcine collagen membrane). FDA, Center for Biologics Evaluation and Research, 2024.

5. The first long-term randomised comparison of autologous chondrocyte implantation with mosaicplasty followed 100 patients with large lesions (mean about 4 cm2) for a minimum of ten years. Failure had occurred in 10 of 58 ACI patients (17%) versus 23 of 42 mosaicplasty patients (55%), and functional outcome among surviving grafts was significantly better after ACI.

   Bentley G, et al. — Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee.. J Bone Joint Surg Br, 2012. DOI: 10.1302/0301-620X.94B4.27495.

6. In the SUMMIT randomised trial, 144 patients with at least one symptomatic Outerbridge grade III-IV knee defect of 3 cm2 or more (mean lesion 4.8 cm2, mean age 33.8) were randomised to MACI or microfracture. At two years, improvements in KOOS pain (37.0 to 82.5 versus 35.5 to 70.9) and function (14.9 to 60.9 versus 12.6 to 48.7) were significantly greater with MACI.

   Saris D, et al. — Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-up of a Prospective Randomized Trial.. Am J Sports Med, 2014. DOI: 10.1177/0363546514528093.

7. FDA's consumer alert states verbatim of stem cell products, exosome products, adipose-derived stromal vascular fraction, umbilical cord blood, Wharton's Jelly and amniotic fluid products: "None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain." The only stem cell products carrying FDA licensure are blood-forming cells derived from umbilical cord blood, licensed only for disorders of blood production, and there are currently no licensed exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA, Consumers (Biologics), 2020.

8. In the RESTORE randomised trial, 288 people aged 50 or over with symptomatic mild-to-moderate medial knee osteoarthritis received three weekly injections of leukocyte-poor PRP or saline placebo. At 12 months there was no significant difference in knee pain (-2.1 versus -1.8 points) and none in medial tibial cartilage VOLUME (-1.4% versus -1.2%). Twenty-nine of 31 prespecified secondary outcomes also showed no difference.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

9. A four-arm phase 2/3 randomised trial assigned 480 patients with knee osteoarthritis to autologous bone marrow aspirate concentrate, allogeneic umbilical cord tissue mesenchymal stromal cells, autologous adipose stromal vascular fraction or a corticosteroid injection. At one year, no cell injection was superior to another or to the corticosteroid control, and NONE of the four groups showed a significant change in the MRI osteoarthritis score from baseline.

   Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial.. Nat Med, 2023. DOI: 10.1038/s41591-023-02632-w.

10. Forty-five people who had had a partial medial meniscectomy 3-5 years earlier were randomised to four months of supervised exercise three times weekly or to no intervention. The exercise group improved cartilage glycosaminoglycan content measured by dGEMRIC relative to controls (+15 ms versus -15 ms; P = 0.036), with a strong dose-response to reported activity. Adult cartilage can adapt its composition to loading - which is not the same as filling a hole in it.

    Roos EM, et al. — Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis.. Arthritis Rheum, 2005. DOI: 10.1002/art.21415.