Cartilage Surgery

 

WHAT IS CARTILAGE DAMAGE?

 The knee is the joint between the bottom of the femur and the top of the tibia. The joint surfaces are lined with a thin layer of cartilage 1 to 2 mm thick which allows the bones to glide smoothly over each other, reducing the friction and absorbing the pressure on the bone. The menisci are small C-shaped cushions between the cartilage of the femur and the tibia which improve the contact and act as shock absorbers. Ligaments are ribbons of varying elasticity which help maintain the stability of the knee.
Cartilage damage can occur following a blow, recurrent minor traumas, or due to a growth imperfection. The damaged cartilage comes away from its natural position alone or with a small piece of underlying bone. It can come away partially creating a flap, or completely leaving a fragment that can move around the joint. The area of damaged cartilage can vary in size and depth.
Cartilage damage can cause pain, locking, swelling and sometimes joint weakness, thus restricting walking and other activities. Ligament or meniscal damage can be associated with and participate in the symptomatology.

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In a normal knee, the patella glides up and down within a groove at the bottom of the thigh bone (femoral groove or trochlea) during movement. Weakening of the muscles that hold the patella in its correct position within the femoral groove causes instability of the kneecap. Instability can cause the patella to be pulled out of the femoral groove and towards the outer side of the knee known as patella subluxation. Patella subluxation causes maltracking of the patella resulting in significant discomfort and irritation at the front of the knee during knee movements. 

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WHY CAN IT REQUIRE AN OPERATION?

 The capacity of cartilage to repair and regenerate itself is very limited. A cartilage defect does not repair itself spontaneously, a partially detached lesion does not heal itself and a free fragment can get stuck between the joint, damage the healthy cartilage and eventually lead to its deterioration.
A small lesion can initially be treated medically. Surgery will be proposed in the case of a symptomatic flap or fragment, or a major cartilage defect. The objective of the operation is to restore a uniform sliding surface to relieve the pain, locking and swelling, and enable a return to normal walking and activities, thus preventing the progressive deterioration of the joint.

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WHAT IS CARTILAGE SURGERY?

Cartilage surgery concerns localised lesions. It aims to reattach or extract a partially or completely detached lesion. It also treats the zone of the defect by cartilage grafting or stimulating cartilage repair.

In the case of a deep, broad lesion in the form of an osteochondral flap or intra-articular fragment, reattachment can be considered to enable healing. After repositioning the fragment in its original site, it is fixed with a screw to enable the homogenous reconstruction of the cartilage surface. In the case of a shallow lesion, the chances of healing are minimal. The lesion is excised and the edges are rectified. If the cartilage defect is small and superficial, nothing else is done.

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Cartilage surgery is performed arthroscopically or an incision is made in the front of the knee. Arthroscopy consists in making two small 5-mm incisions in the front of the knee. An arthroscope, or small camera, is inserted through one of the incisions to view the joint, and in particular the damaged cartilage. Small instruments are inserted through the other incision to carry out the surgery.
Arthroscopic surgery is often used for cartilage reattachment as well as the microfracture technique. The operation lasts about half an hour. The operation is carried out under regional or general anaesthesia. Your anaesthesiologist will decide with you the best type of anaesthesia according to your state of health.
After the operation, the incisions are covered with a sterile dressing, which is left in place for 10 days. The pain will be managed and monitored very closely during the post-operative period, and the treatment will be adjusted accordingly.

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POST OPERATIVE CARE

You will begin rehabilitation with your physiotherapist after the operation. The objective is to maintain knee flexibility and muscle mass.
In the case of a reattachment or mosaicplasty, you will have crutches to help you move around for 6 weeks so as not to put too much weight on the knee.
Driving as well as returning to work can be envisaged in the 2nd month, depending on your profession; office work can be sooner. You can generally resume gentle sports activities such as cycling and swimming after the 3rd month.
In the case of microfractures, the non weight-bearing period is 3 weeks. Driving as well as returning to work can be envisaged in the 1st month, depending on your profession; office work can be sooner. You can generally return to gentle sports activities such as cycling and swimming after the 2nd month.
Whichever technique is used, it is necessary to wait 4 to 6 months before a full return to all sports activities

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RISKS AND COMPLICATIONS

• Joint stiffness can develop if the post-operative rehabilitation is not carried out properly.

• Exacerbated inflammatory reactions which sometimes correspond to algodystrophy. However, new treatments exist that can help manage this rare complication more easily.

• A haematoma may appear around the area operated on due to bleeding. According to the extent of the bleeding, drainage may be necessary.

• The occurrence of an infection, although rare (risk below 1 % in our establishment), is a serious complication and may require surgical revision and a course of antibiotics.

• Small blood clots can form and block the veins in the legs which will require an anti-coagulant treatment for several weeks.

• The mobilisation of a graft or the displacement of a fixed cartilage fragment can occur and require revision surgery.

 

This list of risks is not exhaustive. Your surgeon can provide you with any additional explanations and will be available to discuss the advantages, disadvantages and risks of each specific case with you.

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