Articular cartilage is the white, slippery material that covers all joint surfaces in the body. In the knee it covers and protects the ends of bones and acts as shock absorber to reduce friction. There are many reasons articular cartilage may be damaged – including knee injuries (forceful impacts, joint dislocations, ligament tears, or meniscus tears) and rheumatoid arthritis. Patients with cartilage damage often report a locking sensation in the knee joint, as well as the sensation the knee is about to give way. Damage to articular cartilage in the knee limits mobility and causes significant pain and swelling.
For patients less than 45 years old and with serious injuries to knee cartridge, Dr. Shani performs two types of cartilage repair orthopedic-surgery. For smaller injuries to the cartilage (2 cm squared and under), Dr. Shani performs Microfracture surgery. In this procedure, Dr. Shani makes precise cracks in the bone underlying the damaged cartilage. The body responds by sending blood and bone marrow to the area, both rich with cartilage-building cells to promote new cartilage growth. This is an outpatient arthroscopic surgery, performed with miniature medical instruments though small incisions made around the knee. For larger areas of injured cartilage (2 cm squared and over) or lesions that have failed the Microfracture procedure, Dr. Shani performs Osteochondral Allograft or Autograft transplantation. Dr. Shani replaces the bone cap at the bottom of the thighbone with either an allograft (from a donor) or an autograft (from the patient) bone cap topped with a healthy layer of articular cartilage. After healing, this new bone cap with cartilage acts as a reliable shock absorber for the knee.
Dr. Shani also discusses with patients innovative non-surgical techniques to promote the natural healing process. Both Stem Cell treatments and Plasma Rich Platelet treatments have been shown to kick start natural repair of articular cartridge in the knee, significantly speeding up the healing process. While in their early stages of use, Dr. Shani will discuss the results these treatments have shown in patients with articular cartilage damage.
Patients work with Dr. Shani and a physical therapist for at least six months to return knee is to pre-injury mobility levels. For Microfracture surgery, a Passive Motion Machine is used to gently bend and extend the knee directly after surgery, and for at least six weeks all weight is kept off the knee. Most patients return to light sports such as biking and swimming after five months, and return to the majority of sports after six months of physical therapy and consultations with Dr. Shani. For Osteochondral Allograft/Autograft orthopedic-surgery, patients may return to pre-injury level in some sport after six months, but impact sports such as running should be avoided until cleared to return by Dr. Shani.