There is a current research study going on in Norway. What these investigators are looking to do is figure out if patients who show improvement after autologous cartilage implantation or arthroscopic debridement of the knee are getting better because of the surgery OR the rehab. This is what the investigators are suggesting:
“Various surgical treatment options are available, (for cartilage injuries) however no statistically significant differences have been found between the different surgical treatments. This supports the suggestion that the improvement might be a result of the post-operative rehabilitation rather than the surgery itself.” 1
This may be why doctors are still trying to figure out which surgery works best for cartilage damage in the knee. Read between the lines here of another study and see if this research agrees with the above study:
“Articular cartilage injuries of the knee are a common finding in patients with knee pain. Select patients who fail a comprehensive nonoperative treatment program and are willing to comply with demanding postoperative rehabilitation may be candidates for chondral restoration techniques. “ 2 You can get the surgery if you are willing to submit to demanding rehabilitation. Maybe it is the rehab and not the surgery?
Numerous surgical techniques have been developed to address cartilage defects. Cartilage treatment strategies are characterized as:
- Palliation (eg, chondroplasty (surgery to smooth out of cartilage) and debridement (power washing the the knee cartilage), repair (eg, drilling and microfracture [MF]),
- or Transplants restoration (eg, autologous chondrocyte implantation [ACI], osteochondral autograft [OAT], and osteochondral allograft [OCA]).
In this cited study the authors concluded: These techniques may improve patient outcomes, though no single technique can reproduce normal hyaline cartilage.3
No single surgery will regrow cartilage
The markedly limited healing potential of articular cartilage often leads these patients to continued deterioration and progressive functional limitations.4
The problem with surgery is that it cannot do what most athletes want most – repair and regrow damaged tissue. For surgeons the answer was obvious, bring something into the surgical procedure that could..
Stem cells and Platelet Rich Plasma Therapy for osteochondral defect
The definition of osteochondral is that it is related to the cartilage and bone. In the knee joint cartilage protects the shinbone, the thighbone, and the back of the knee cap – the patella. A healthy knee has all its surfaces glide smoothly atop these cartilages for pain free, efficient, and in the case of athletics – explosive movement.
As pointed out in the above literature – No single surgery will regrow cartilage – stem cells and blood platelets can.
“Advances in the understanding of tissue repair mechanisms and the pivotal role of growth factors have stimulated the use of platelet-rich therapies by orthopaedic surgeons and sports physicians, mainly with the aim of stimulating and enhancing tissue healing.” 5
This would seem like the best of both worlds – surgery and a healing agent that regrows cartilage. Unfortunately there are many studies that say PRP and surgery do not work well together. 6 Possibly due to the damage created by the surgery itself and recent research that warns doctors against using injectables following arthroscopic surgery because the arthroscopic fluids greatly dilutes the benefits of solutions. 7 If ever there were a double edged sword – the surgery is causing damage and the surgical fluids are diluting the beneficial healing factors.
Have a question? Ask Dr. Darrow
1. Randsborg PH, Brinchmann J, Løken S, Hanvold HA, Aae TF, Årøen A.nck RC Jr, Wascher DC, Treme G. Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature. Sports Health. 2015 Oct 12. pii: 1941738115611350.
2. Camp CL, Stuart MJ, Krych AJ. Current Concepts of Articular Cartilage Restoration Techniques in the Knee. Sports Health. 2014;6(3):265-273. doi:10.1177/1941738113508917.
3. Richter DL, Schenck RC Jr, Wascher DC, Treme G. Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature. Sports Health. 2015 Oct 12. pii: 1941738115611350. [Epub ahead of print]
4. Campbell AB, Pineda M, Harris JD, Flanigan DC. Return to Sport After Articular Cartilage Repair in Athletes’ Knees: A Systematic Review. Arthroscopy. 2015 Oct 30. pii: S0749-8063(15)00706-9. doi: 10.1016/j.arthro.2015.08.028. [Epub ahead of print]
4. Kane P, Frederick R, Tucker B, Surgical restoration/repair of articular cartilage injuries in athletes. Phys Sportsmed. 2013 May;41(2):75-86. doi: 10.3810/psm.2013.05.2017.
5. Sánchez M, Anitua E, Orive G, Mujika I, Andia I.Platelet-Rich Therapies in the Treatment of Orthopaedic Sport Injuries. Sports Medicine: 1 May 2009 – Volume 39 – Issue 5 – pp 345-354 doi: 10.2165/00007256-200939050-00002
6. Ehrenfest DM, Bielecki T, Mishra A, Borzini P, Inchingolo F, Sammartino G, Rasmusson L, Evert PA. In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes. Curr Pharm Biotechnol. 2012 Jun;13(7):1131-7.
7. Stopka SS, Wilson GL, Pearsall AW. Dilution Effect of Intra-articular Injection Administered After Knee Arthroscopy. Dilution Effect of Intra-articular Injection Administered After Knee Arthroscopy.