Defect > Treatments
The decisions you make and the actions
you take before your surgery can be every bit as important
as the procedure itself in ensuring a healthy recovery.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
use of any anti-inflammatory medicine, especially aspirin,
a week prior to surgery, to prevent excessive bleeding
during the surgical procedure.
reduce the risk of infection, try to refrain from smoking
for at least a week before surgery.
possible, practice walking with your crutches in case
you need to use them after surgery.
insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your cartilage transplant surgery. If your surgery is
going to be inpatient, there may be a separate department,
so be sure to ask your doctor. After you have checked
in to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your knee area may be shaved (this
is not always necessary). You will wear a hospital gown
and remove all of your jewelry. You will meet the anesthesiologist
or anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
Then, you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of shorts or sweatpants with a zipper or
buttons on the side that will fit comfortably over a
knee brace when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
Cartilage transplant surgery for osteochondral
defect usually takes one to two hours to perform. You
are typically put under general anesthesia or numbed
from the waist down with spinal anesthesia. Smaller
osteochondral defect transplants can be done with an
arthroscope, a tiny camera, and small surgical instruments
that are inserted through three- to four-millimeter
incisions. Larger defects require the knee to be opened
with a larger, approximately four-inch incision. There
are three types of surgeries:
OSTEOCHONDRAL AUTOGRAFT TRANSFER
osteochondral defect is cut away, including all damaged
cartilage and the underlying subchondral bone, to make
a recipient socket.
cut an intact, matching piece of cartilage and bone
from a non-weight bearing area, typically the side of
the thighbone's tip.
generally transfers a complete piece of hyaline cartilage
attached to subchondral bone.
attach the bone into the recipient socket with small
pins, screws, or sealant. The repaired cartilage generally
blends seamlessly into the surrounding cartilage.
generally do not transfer intact pieces of cartilage
and bone that are bigger than two centimeters in diameter.
For larger osteochondral defects, mosaicplasty may be
frayed cartilage and the underlying subchondral bone
is cut away to make a recipient socket.
of one intact piece, surgeons take multiple small plugs
of cartilage and bone from various non-weight bearing
areas of your knee.
recipient socket is filled in like a mosaic painting
with many plugs. The plugs are kept about one millimeter
apart, leaving space that gets filled in over time with
a different form of articular cartilage (fibrocartilage).
CARTICEL - AUTOLOGOUS CULTURED CHONDROCYTE
is a two-part surgical procedure that requires two hospital
first step is an arthroscopic outpatient procedure,
in which your surgeon makes small incisions, inserts
a tiny instrument, and takes a sample of your healthy
articular cartilage. You usually leave the hospital
within a few hours after arthroscopy.
physician sends the sample to a special laboratory,
where the cartilage is cultured for about five weeks.
Your cartilage cells multiply outside of your body.
About 12 million new cartilage cells are sent back to
your surgeon for use in the implant.
the second surgery, an incision is made down the front
of the knee, about four to seven inches in length. The
frayed cartilage is cut away, leaving the underlying
layer of the skin that covers all your bones (periosteum)
is sewn over the exposed bone, creating a pocket.
new cartilage cells are injected into the pocket between
your bone and the layer of bone-skin. The Carticel cells
continue to grow, eventually blending with the surrounding
all cartilage transplant procedures, incisions are sewn
up and the patient is taken to the recovery room.
After cartilage transplant surgery for osteochondral
defect, you usually stay in the recovery room for at
least two hours while the anesthetic wears off. General
anesthesia wears off in about an hour and spinal anesthesia
may take about two hours to wear off. You will be given
adequate pain medicine, either orally or through an
IV (intravenous) line, as well as instructions for what
to do over the next couple of days. In addition, you
will be given an appointment to return and a prescription
for pain medicine. Your knee will be bandaged and may
have ice on it. You may have significant pain early
on and you should take the pain medicine as directed.
Remember that it is easier to keep pain suppressed than
it is to treat pain once it becomes present. When you
feel the pain coming on, take another pill, as long
as it is within the time limit on the bottle. You should
try to move your feet while you are in the recovery
room to improve circulation. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital or, if necessary,
be admitted for an overnight stay.
| Post-op in Hospital
After cartilage transplant surgery, some patients remain
in the hospital for as long as 24 hours. As soon as
possible after surgery is completed, you will begin
doing continuous passive motion exercises while in bed.
Your leg will be flexed and extended to keep the knee
joint from becoming stiff. This may be done using a
continuous passive motion (CPM) machine. The CPM is
attached to your bed and then your leg is placed in
it. When turned on, it takes your leg through a continuous
range of motion. There will likely be pain, and you
can expect to be given pain medication as needed. Be
sure to ask for medication as soon as you feel pain
coming on, because pain medication works best on pain
that is building rather than on pain that is already
present. The nurses will not give you more than your
doctor has prescribed and what is considered to be safe.
Ice also helps control pain and swelling. Physicians
generally suggest that you walk with crutches, keeping
all weight off your injured leg, for about six to eight
weeks. Your knee is usually immobilized in a stiff brace
for a short period of time, which varies based on the
size of the osteochondral defect. You will not be able
to drive, so be sure to have arranged for a ride home.
Most people spend about seven to ten days at home after
cartilage transplant surgery. Your knee may be partially
immobilized in a removable, hinged brace, which may
be locked to allow the knee to only bend and straighten
a few degrees. This can make movement around the house
difficult. Doctors strongly recommend that you avoid
any movement that twists your knee. For example, getting
your foot stuck under a table leg and twisting around
can cause severe pain. Here is what you can expect and
how you can cope after cartilage transplant surgery:
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
as needed. Many patients may be given a narcotic painkiller
and an anti-inflammatory.
may be some minor drainage since fluid may have accumulated
during the surgery. Expect some blood to show through
your bandage during the first 24 hours.
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your ankle. Icing
your knee for 20 or 30 minutes a few times a day during
the first two days after surgery also will reduce pain.
until you can stand comfortably for 10 or 15 minutes
at a time before you take a shower. Once you can, put
your leg in a plastic bag and tie the top around your
leg above the knee bandage to keep the bandage dry.
Ask your physician about the best place to buy plastic
shower bags in your area.
dressing on your knee is usually removed the next day
after cartilage transplant surgery.
a week after surgery, patients typically are able to
lift their leg without assistance while lying on their
back. However, you should walk with crutches for up
to eight weeks. Putting weight on your knee while it
is healing may dislodge the transplanted cartilage.
soon as possible after surgery, you should begin doing
exercises using a continuous passive motion (CPM) machine
while in bed. Your doctor can arrange to get you a CPM
machine for use at home, which helps flex and extend
the leg and prevents the joint from becoming stiff due
two or three weeks after surgery, you may experience
night sweats and a fever of up to 101. Your physician
may suggest acetaminophen, coughing, and deep breathing
to get over this. This is common and should not alarm
to call the doctor after surgery
After up to eight weeks on crutches, physicians generally
suggest that you progress through rehabilitation slowly.
The transplanted cartilage plug needs to stay intact.
Too much movement after surgery may hinder the healing
process. Your physical therapist can help you learn
the proper combination of rest, gentle movement to stimulate
blood flow and healing, and light exercises. It is important
not to twist or bend in ways that may grind cartilage
together until your physician is certain the osteochondral
defect has healed. After the osteochondral defect has
healed, physical therapy generally helps return healthy
young athletes to sports at full strength. Arthritis
may complicate the rehab process, especially for older
athletes, but the physical therapy program generally
recommended by physicians can be broken into three basic
phases for everyone.
NON WEIGHT BEARING - SIX TO EIGHT
Let the osteochondral defect heal. To restore movement
and basic coordination, your physical therapist will
help you begin moving your knee and teach you an exercise
program to perform on your own.
RESTORING RANGE OF MOTION - TWO TO FIVE MONTHS
Rehab progresses into stretching and strengthening exercises
that focus on the quadriceps and hamstrings - the main
stabilizing muscles for your knee. Physicians suggest
you gradually increase the amount of weight as your
leg muscles get stronger. Strengthening exercises require
dedication because results often take weeks and pain
RETURNING TO ACTIVITIES -SIX TO NINE MONTHS
The focus of rehab turns to increasing your coordination.
After a few months of rehab, physical therapy can become
activity oriented as you regain the ability to perform
complicated movements, using stationary bikes, elliptical
machines, and cross-country skiing machines. Once the
muscles of your injured leg are about 90 percent as
strong as the uninjured leg, you can usually return
strengthening exercises: Cartilage injuries
Physicians generally suggests you continue strength
training even after your knee has been rehabilitated.
Adequate leg muscle strength is the best way to keep
the bones in your knees from grinding into each other
and prevent recurrence of osteochondral defect. Physicians
usually suggest that you continue strength training
even after your knee has been rehabilitated. Have your
physician periodically check your knee. Weight control
is also important. One extra pound of body weight translates
into three or four pounds of weight across your knee
every time you take a step. Lightening the load on your
knees helps them to last longer. After an osteochondral
defect, you may be at risk of suffering arthritis later
in life. Depending on how well your knee heals, you
may want to consider cutting back or avoiding repetitive-impact
activities, like long-distance running, and contact
sports, like football. Many of the exercises and activities
that are popular for fitness put stress on your knees.
To prevent osteochondral defects it is important to
learn knee-sparing exercise techniques by dividing your
activities into three components.
living - The average person takes between 12,000 and
15,000 steps a day, with each step exerting a force
between two and five times your body weight on your
knees. After a knee injury, take it easy on your knees
during the day whenever possible to save them for activities
and exercise. Avoid stairs when there is an elevator,
take the shortest path when walking, and consider wearing
athletic shoes designed to absorb shock rather than
strengthening and conditioning - Activities themselves
are not a substitute for conditioning. Your need for
special conditioning to prepare for activities increases
with age. The best strengthening programs are low-impact
and non-weight-bearing, like stationary bikes and certain
weightlifting programs, so that the knees do not have
to absorb shock.
- Sports that require twisting and quick direction changes
put great strain on your knee. To prevent injury, stick
to light, non-impact activities for your recreation
after arthroscopic fragment fixation. If you decide
to return to sports like football and basketball, a
physician should carefully examine your knee to make
sure you have a proper coating of cartilage over your
If pain recurs after rehab, physicians usually suggest
you stop your activities and return for a check-up.
Pain could be a sign that the fragment has not healed
properly. Large osteochondral defects may make it difficult
for some people to return to competitive athletic activity.