Depending on the severity of your cartilage lesion, its progression and other parameters (such as age, lifestyle, …), your surgeon might recommend other treatment options for cartilage lesions. Below you will find an overview of the most common treatment options besides Episealer.
Injured or diseased joints are often examined and treated through arthroscopy, i.e. orthopaedic keyhole surgery. A thin metal tube equipped with a light and a tiny video camera is inserted in the joint through a small hole. While the camera sends images to a monitor, some surgical operations can be conducted through another hole, using small instruments. Arthroscopic lavage and debridement are for example performed simultaneously with arthroscopy. This implies the removal of fragments of loose cartilage to reduce knee pain and increase the mobility of the joint, thereby often providing short-term relief.
Microfracturing is a biological method that can be carried out arthroscopically. The surgeon creates tiny fractures in the bone underlying the damaged cartilage surface, the so-called subchondral bone plate. Blood and bone marrow, containing stem cells, seep out of the fractures, creating a blood clot that promotes the growth of cells and builds cartilage-like tissue referred to as fibrocartilage (scar tissue), which has lower durability than natural articular hyaline cartilage. This treatment is not optimal for older patients or cartilage lesions larger than 1.5 cm in diameter. Results further tend to deteriorate with time.
During osteochondral autograft transfer, also referred to as mosaicplasty and OATS® (Osteochondral Autograft Transfer System), cutting instruments are used to harvest one or more cylindrical grafts of articular cartilage and underlying bone from a healthy, less weight-bearing area of the knee joint. These grafts are then implanted into the site of the lesion, to treat a focal lesion in the articular cartilage and possibly also in the underlying bone. A limited number of surgical institutions perform this procedure as it is technically challenging.
Autologous cell techniques
Autologous cell techniques, such as autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are therapeutic treatments consisting of two surgeries. During the first procedure, healthy hyaline cartilage cells are harvested from the knee. These cells are allowed to expand in-vitro in a specialised laboratory and are thereafter implanted back into the damaged area during a second surgery. This technique is still considered somewhat experimental, is expensive and requires long rehabilitation. There is a range of novel cell techniques that only require one surgery, however, there is generally a lack of published clinical results from these novel treatments.
When your articular cartilage damage is still limited to a small, contained area, your surgeon can opt for a so-called knee resurfacing surgery. During such a surgery, the cartilage lesion in the knee is replaced by a small resurfacing implant which will restore the cartilage surface, enabling the bones in the knee joint to articulate smoothly again. The aim is to directly recreate the original weight-bearing joint surface for pain relief, maximum mobility and minimum rehabilitation.
Knee prosthesis surgery
When osteoarthritis has reached a clinical stage with severe musculoskeletal pain, prosthetic replacement of the joint may become necessary. There are two main types of knee replacement techniques: total knee replacement (TKA, total knee arthroplasty) and partial knee replacement (UKA, unicompartmental knee arthroplasty/uni-prosthesis surgery). There are also different types of prostheses. The kind of prosthesis that is most suitable depends on several factors such as the nature of the damage, patient weight, knee size etc.
Some patients only suffer from lesions on one side of the knee joint, like the inside or the outside of the joint. In those cases a uni-prosthesis can replace one part of the knee only and a partial knee replacement is performed. This is primarily done on patients between 60 and 70 years of age. Patients with severely deteriorated knee joints need to undergo total knee-replacement surgery.
For most patients, the results of knee replacement surgeries are very satisfying. The purposes of these surgeries are to eliminate pain and increase the quality of everyday life. A knee prosthesis is, however, not a natural joint. Patients cannot expect to perform intensive exercise or engage in activities that put excessive stress on a replaced knee joint. Prosthetic knee joint replacements require the removal of large amounts of the patient’s bone prior to the implantation of the prosthesis. The rehabilitation period is rather long, often 6-12 months. The estimated life-time of a knee prosthesis is generally alleged to be up to 20 years. For young individuals, prostheses are less suitable, since they would need to be replaced during the patients’ life-time. The replacement of a worn-out prosthesis is a risky procedure and the rehabilitation is often difficult, therefore doctors generally try to delay knee replacement surgery as long as possible. As a result, there is a reluctance to offer patients younger than 65 years knee-replacement surgery.