by Dr. Stefan Tarlow Biologic treatments are best for knee disease or injury. Biologic treatment restores the knee to a near-normal state. Meniscal repair, reconstruction of the ACL (anterior cruciate ligament), and anatomic knee fracture repair are 3 of the types of biological surgical repairs that work well for knee injuries. Orthopedists as well as patients often find managing a full-thickness, symptomatic chondral lesion of the knee to be problematic. Injury that leads to articular cartilage cell death is well treated by restoration of the surface cells of the joint. The shiny white surface that composes all the joints in the body is the articular cartilage or surface cell layer of the joint. Four separate treatment options are possible: Osteochondral Allograft, Microfracture, Osteoarticular transfer system (OATS), and Autologous Chondrocyte Implantation (ACI). Click here for more on Arthroscopy of the Knee . In a young patient, a small lesion can be treated with Microfracture surgery. In this method, a pick-like tool is used to enter the marrow of the knee under the chondral defect. Multiple entries stimulate the bone marrow, which, in turn creates repair tissue. This tissue fills the chondral defect with fibrous cartilage tissue. The patient will use crutches for about 6 to 8 weeks. He or she must forgo sports for half a year to a year. It may take as much as 18 months for complete relief of pain to be achieved. There is a procedure that can restore the knee surface to almost normal condition. This is called autologous chondrocyte implantation

(ACI). This procedure is used in the case of large knee defects. Articular cartilage cells harvested from the healthy part of the injured knee are used in ACI. This surgery may be used under very specific conditions. Here are the surgical indications for ACI. First, the injury must be a full-thickness, symptomatic, weight-bearing chondral injury of the femoral articular surface. Second, the patient must be physiologically young. Third, the patient must agree to cooperate with the rehabilitation process for eighteen months. There is no guarantee of successful surgery to the tibia and patella. In fact, insurance companies will often refuse to pay for this type of surgery. It is important to note that ACI is not a workable procedure for the treatment of osteoarthritis. In this condition, two reciprocal joint surfaces experience damage. X-rays will reveal narrowing of the joint space. Additionally, bone spurs will be in evidence. 3T MRI (magnetic resonance imaging) may be used to assess for ACI. By using this procedure, the proper treatment can be determined. Click here for more on Dr. Stefan Tarlow, a leading Phoenix knee surgeon . About the Author: Dr. Tarlow is a Board Certified Orthopaedic Surgeon with over 20 years specializing in knee surgery. He opened his own clinic, Advanced Knee Care, with a focus on specialty patient care. Click here to learn more about Dr. Tarlow, knee surgery in Phoenix and Knee Arthroscopy in Phoenix, Arizona .

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Surgery of the Knee: Cartilage Restoration – Osteochondral Allograft, OATS, Microfracture, and ACI