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Damaged cartilage in the knee can cause problems now and in the future. Cartilage restoration procedures can repair the damage and improve your long-term outlook.

In some cases, advanced knee cartilage restoration procedures such as matrix-induced autologous chondrocyte implantation (MACI) and osteochondral allograft transplantation may be necessary.

Those procedures can help restore cartilage, reduce pain, and decrease the risk of long-term damage.

“As technology has advanced over the last couple of decades, our ability to preserve and restore cartilage, especially in younger people, has really advanced,” says John Kunkel, DO, orthopaedic sports medicine surgeon, UPMC in North Central Pa. “That’s what a lot of the cartilage preservation or restoration procedures that I do are aimed at.”

Learn more about advanced knee cartilage procedures and their impact on patients.

What Is Knee Cartilage?

Cartilage is the tissue found where bones come together to form joints. Knee cartilage helps to provide cushioning, allowing you to move easier.

Knee injuries, such as ligament tears, can also damage your cartilage. Wear and tear over time also can cause your cartilage to break down.

Damaged cartilage can cause pain and difficulty moving. As cartilage wears away, arthritis can develop.

“As you get older or your cartilage degenerates and you lose a lot of your cartilage, then you have arthritis, and you’re talking about knee replacements,” Dr. Kunkel says. “And, obviously, those are great, but they’re not your knee. And, so, if we can push those off or prevent those, especially in younger people, then that’s the best option.”

Advanced Cartilage Restoration Procedures

Your body can’t make new cartilage on its own, but surgical techniques can help preserve or restore cartilage. Cartilage restoration procedures can lead to less pain and better function for patients. They also can help lower the risk of arthritis.

These surgeries often take place along with other knee procedures like ligament repair.

Matrix-induced autologous chondrocyte implantation (MACI)

Matrix-induced autologous chondrocyte implantation (MACI) is a two-part cartilage restoration procedure. It uses your own cells to help restore damaged cartilage.

In the first part of the procedure, a surgeon removes a sample of healthy knee cartilage tissue. The sample then goes to the lab, where it is allowed to grow.

After about a month, the lab-grown cells are brought back. They are trimmed to match the patient’s cartilage defect and are reimplanted in the knee. Over time, the new tissue integrates with your existing cartilage.

According to the Arthritis Foundation, MACI has an 80% to 90% success rate in repairing cartilage.

Osteochondral allograft transplantation

Patients with injuries to both the cartilage and underlying bone may not be candidates for the MACI procedure. In that case, osteochondral allograft transplantation is an option.

The osteochondral allograft transplantation implants a sample of bone and cartilage tissue from a donor cadaver into a patient’s knee. Over time, the donor tissue integrates with the existing cartilage.

Dr. Kunkel often performs this procedure along with other procedures, such as osteotomy or ligament reconstruction.

An osteotomy is a procedure that involves the cutting of bone to better align the joint. It can address problems like misaligned joints, which can cause cartilage injury in the first place. Ligament reconstruction, meanwhile, can address joint instability, also a potential cause of cartilage damage.

“The osteotomy and ligament reconstruction are really backing up and making sure that our cartilage restoration procedure is protected so we’re not dealing with the same thing again in the future,” Dr. Kunkel says.

Who Is a Candidate for These Procedures?

Cartilage restoration procedures are most successful in younger, more active patients. Older adults with long-term cartilage damage may not be good candidates.

Recovery After Cartilage Restoration

The recovery process after cartilage restoration procedures can take several months to a year. The exact timeframe can depend on factors like the patient’s overall health and activity level and whether additional procedures were performed.

For the first six to eight weeks after surgery, patients are typically on crutches to avoid putting weight on their knee. After that, they can begin gradually increasing their weight-bearing and activity level. They also go through physical therapy to regain strength and flexibility in their knee.

Over the course of several months to a year, people can return to sports or daily activities. Recovery from the MACI procedure can take longer.

The goal of recovery is to allow people to return to sports or daily activities with less pain and better function. Dr. Kunkel says patients can play a significant role in whether their recovery is ultimately successful.

“I think outcomes can really be affected by the patient’s understanding of their injury, what the surgery is, what the risk involved is, and then what the post-op process is going to look like and where they have to take ownership and start really working hard in rehab,” Dr. Kunkel says.

Choosing UPMC for Advanced Cartilage Restoration

Cartilage damage can have significant short-term and long-term effects. It can cause pain, make it difficult to play sports or perform daily tasks, and put you at higher risk of arthritis. Seeing an experienced surgeon can lead to better outcomes.

UPMC Sports Medicine provides expert care for a wide range of orthopaedic injuries, including cartilage damage. Our surgeons have years of experience in using advanced techniques. The expert care is available in many of the communities UPMC serves, so you don’t have to travel far from home.

“The difficulty with traveling for those surgeries is all the follow-up,” says Dr. Kunkel, who offers advanced treatments for people in north central Pennsylvania. “Here, you get (your surgery) done and you follow up with me in the office, right where you live. And we can see you multiple times throughout the recovery process.”

To find UPMC orthopaedics and sports medicine care near you, visit our website.