Cartilage Transplantation

By Clayton Nuelle, MD
Friday, March 30, 2018

Joint pain and swelling are common complaints for patients of all ages. These symptoms are often a result of damage to the joint (or articular) cartilage, which can be extremely painful and debilitating. Whether the damage occurs as the result of an acute trauma or degeneration over time, it can be difficult to manage for both the patient and the clinician.

Clayton Nuelle, MD

Conservative treatments — such as oral and topical medications, physical therapy, braces and joint injections — can be beneficial to help relieve the acute pain and symptoms, but they do not provide a long-term solution to the underlying cause of the problem. Fortunately, advances in surgical techniques now afford surgeons the ability to replace the damaged joint cartilage — and resolve the underlying problem — with a cartilage transplant.

There are many forms of cartilage transplants. They may consist of cartilage cells (chondrocytes) alone, or they may contain cartilage cells attached to their underlying subchondral bone (an osteochondral transplant).

For small areas of damage, a surgeon can take a portion of the patient’s own healthy cartilage (an autograft) from a nonweightbearing, nonaffected area and transplant it directly to the area where there is damage. This is called an osteochondral autologous transplantation. This procedure is often performed arthroscopically, making it very minimally invasive.

For larger areas of damage, there are two primary transplant treatment options: autologous chondrocyte implantation and allograft osteochondral transplantation.

  • Autologous chondrocyte implantation (ACI) is a two-stage procedure incorporating the patient’s own cartilage cells. In the first stage, a very small amount of the healthy cartilage cells is removed from the patient’s joint and then grown and expanded in a nutrient-rich medium over a period of weeks, creating more cells. In the second stage, those cartilage cells are implanted back into the patient’s joint, where the cartilage is damaged, beneath a synthetic tissue scaffold.
  • Allograft osteochondral transplantation involves precisely matching the patient’s joint surfaces to a recent cadaver donor based on X-rays. The allograft tissue is cut to precisely match the area and depth of the patient’s cartilage damage. The unhealthy cartilage is then cut from the patient’s joint and the healthy, fresh allograft is transplanted in its place. This type of transplant is similar to other types of transplants (e.g.., organ transplant) in that it contains living cartilage cells and bone and becomes incorporated into the patient’s joint over time as it receives blood supply from the surrounding joint surfaces. It is different from most organ transplants, however, in that it is nonimmunogenic. Thus, it does not require the patient to take any type of antirejection medication and there is very minimal risk of immune response or host rejection.

In my practice at TSAOG Orthopaedics, I specialize in the treatment of joint pain and cartilage pathology. If you have questions about cartilage transplantation or you have a patient that you think may be a candidate, please don’t hesitate to contact me at 210-804-5995.