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Our Highly Skilled Surgeons Perform the Very Latest Procedures to Help Restore Articular Cartilage

Michael Benke, M.D., Oscar Vazquez, M.D., and Michael Gross, M.D. specialize in breakthrough cartilage restoration techniques that are vastly improving the lives of our patients by relieving pain and allowing better function. These new procedures aim to stimulate new cartilage growth or to replace or resurface the existing cartilage. Cartilage stimulation techniques include microfracture, Biocartilage (Arthrex) and Cartiform (Arthrex). Cartilage resurfacing techniques include DeNovo NT (Zimmer), Autologous Chondrocyte Implantation (ACI), Osteochondral Autograft Transplantation, and Osteochondral Allograft Transplantation. In many cases, these procedures can delay or prevent the onset of arthritis.

Working together to share knowledge and experience, the Active Orthopedics & Sports Medicine team is comprised of highly trained physicians in every area of orthopedics and sports medicine. They each bring a breadth of expertise that other orthopedic practices simply can’t match, including advanced procedures such as cartilage restoration.

The knee is the most common area for cartilage restoration. Ankle and shoulder problems may also be treated. The most common procedures for cartilage restoration are:

• Microfracture Drilling
• Biocartilage implantation (Arthrex)
• Cartiform (Arthrex)
• DeNovo NT (Zimmer)
• Autologous Chondrocyte Implantation (ACI)/Matrix Autologous Chondrocyte Implantation (MACI)
• Osteochondral Autograft Transplantation
• Osteochondral Allograft Transplantation

Oscar Vazquez, MD
Sports Medicine
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Michael T. Benke, MD
Sports Medicine
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Michael L. Gross, MD
Sports Medicine
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Articular Cartilage Restoration

Helping You To Restore Mobility

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Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Healthy cartilage in our joints makes it easier to move. It allows the bones to glide over each other with very little friction. Articular cartilage can be damaged by injury or normal wear and tear. Because cartilage does not heal itself well, doctors have developed surgical techniques to stimulate the growth of new cartilage. Restoring articular cartilage can relieve pain, allow better function, and delay or prevent the onset of arthritis.

Surgical techniques to repair damaged cartilage are still evolving. It is hoped that as more is learned about cartilage and the healing response, surgeons will be better able to restore an injured joint.

Microfracture

Helping To Relieve Symptoms

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Microfracture is a single-stage, arthroscopic procedure used to treat small, full-thickness cartilage defects. After the cartilage defect is prepared, small drill holes are made in the bone penetrating into the bone marrow elements. These natural growth factors and stem cells enter into the cartilage defect and promote new cartilage growth. Microfracture is most useful for small, full-thickness cartilage defects in younger patients.

Biocartilage, Cartiform

Safely Improve Cartilage Repair

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Microfracture was developed in the 1980s and while it has been a powerful technique to help treat cartilage defects, recent advances have led to the development of other techniques to enhance microfracture. Biocartilage is a cartilage extracellular matrix made of dehydrated allograft cartilage. This is mixed with platelet rich plasma (PRP); concentrated growth factors obtained from the patient’s own blood. This mixture of Biocartilage and PRP is placed in the cartilage defect after microfracture and sealed with fibrin glue. The Biocartilage creates a scaffold and an environment better suited for articular cartilage to form.

Cartiform is an osteochondrol allograft composed on cartilage cells, growth factors, and extracellular matrix proteins. This can be trimmed to size and is anchored into a prepared, full-thickness cartilage defect to promote articular cartilage formation. Both Biocartilage and Cartiform are used in conjunction with microfracture to stimulate more hyaline (articular) cartilage and less fibrocartilage (scar), which is more typical of microfracture alone. Cartiform is often used to treat somewhat larger defects than Biocartilage.

DeNovo NT, Autologous Chondrocyte Implantation (ACI)

Regain Function

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Denovo NT is a particulated, juvenile articular cartilage allograft implant. The cells are placed into a full-thickness cartilage defect and sealed with either fibrin glue or a biologic patch. These cartilage cells then grow and differentiate into the patient’s own articular cartilage.

ACI is a two-step procedure in which new cartilage cells are grown and then implanted in the cartilage defect. First, healthy cartilage tissue is removed from a non-weightbearing area of the bone. This step is done as an arthroscopic procedure. The tissue, which contains healthy cartilage cells, or chondrocytes, is then sent to the laboratory. The cells are cultured and increase in number over a 3 to 5-week period.

An open surgical procedure, or arthrotomy, is then done to implant the newly grown cells. The cartilage defect is prepared. A biologic patch is sewn over the area and is sealed with fibrin glue. The newly grown cartilage cells are then injected into the defect under the patch. These cells grow and mature into healthy articular cartilage.

Newer generation ACI techniques, including MACI (matrix assisted autologous cartilage implantation), allow for improved implantation. Also a two-stage procedure, the harvested cartilage cells are grown on a porcine collagen membrane that can be cut to size and sewn into the cartilage defect.

ACI has the advantage of using the patient’s own cells, but does have the disadvantage of being a two-stage procedure.

Microfracture, Biocartilage, Cartiform, DeNovo NT and ACI are cartilage restoration techniques designed to treat full-thickness articular cartilage defects (ACD).

Osteochondral Autograft and Osteochondral Allograft Transplantation

Return To Your Old Lifestyle

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When the cartilage injury involves the underlying bone, the problem is now considered an “osteochondral defect” (OCD). These injuries require a different type of treatment where both the articular cartilage and the damaged bone are resurfaced. For smaller defects, a small plug of cartilage and bone is taken from a non-weight bearing area of the patient’s knee and is transplanted into the defect. This is called an osteochondral autograft. When the area of damaged cartilage is larger, an osteochondral allograft is used. In this case, a perfectly matched donor will be used and a plug of cartilage and bone is transplanted into the damaged area.

Your cartilage injury is unique and the surgeon will take many factors into account when choosing the best treatment. Cartilage injuries are complex problems. At Active Orthopedics, cartilage restoration is one of our specialties and areas of interest and focus. We will work together to ensure the best outcome.