Cartilage is the smooth tissue that covers the ends of our bones where they come together to form joints. Healthy cartilage enables our bones to glide over one another with minimal friction, making it easier for us to move. Cartilage, like other parts of our bodies, can be damaged by normal wear and tear or by traumatic injury. It is even possible for damaged cartilage to wear away completely and leave the bone unprotected. Unfortunately, cartilage does not repair itself well without surgical intervention, or a cartilage replacement. The following surgical procedures are used by Dr. Hubbard to relieve patients’ pain and improve their foot and ankle joint function. Such surgical procedures, described below, also have significant value in delaying or preventing the development of arthritis.
Bone marrow aspirate concentrate (BMAC) is a biologic product produced by harvesting a patient’s own bone marrow. The aspirate is obtained with a needle and then spun in a centrifuge to concentrate the cells. The end product is rich in stem cells and growth factors. The BMAC can then be injected during a surgical procedure in the foot or ankle to increase the rate at which healing takes place. Typically, BMAC is used for non-unions of fractures, difficult fusions, or healing of cartilage lesions in the ankle.
Bone marrow stimulation, also known as microfracture surgery, is an arthroscopic procedure performed to repair damaged ankle cartilage. Bone marrow stimulation works by creating tiny fractures in the underlying bone, through which blood and bone marrow begin to form. This results in the development of something known as a super clot, which contains growth factors that will lead to the development of new cartilage. The procedure is arthroscopic and minimally invasive. Bone marrow stimulation is typically used on young, athletic patients, and, in most patients, provides effective long-term relief.
Fresh Osteochondral Allograft Transplantation
The osteochondral allograft technique involves transplanting bone and cartilage, harvested from a donor (cadaver) to a damaged joint. Prior to the procedure, the donor cartilage replacement is sterilized and prepared, and tested to prevent any possible disease transmission. When cartilage has been restored through the allograft procedure, it can help to delay or prevent the onset of arthritis. The allograft procedure is ideal for patients with focal areas of cartilage damage. Widespread cartilage damage cannot usually be treated with this procedure, since the graft may not provide enough material to completely rebuild the cartilage of the joint.
Juvenile Allograft Transplantation
Juvenile allograft transplantation, sometimes known as the DeNovo natural tissue graft implantation, is a fairly new surgical technique, performed to replace damaged cartilage in the ankle with a cartilage replacement from a donor. Juvenile allograft transplantation received its name because the healthy cartilage tissue used for the procedure is harvested from donors under the age of 13. Juvenile tissue contains a greater quantity of chondrocytes, or healthy cartilage cells, than adult tissue, giving the patient a better chance of joint healing. While most cartilage used in juvenile allograft transplantations comes from cadavers, the cartilage may also be taken from living patients. In some cases, juvenile bovine cartilage material may be used instead.
Platelet-rich plasma (PRP) injections use components of the body’s own blood to stimulate healing in the cartilage. Platelets, most commonly associated with clotting, are also, according to recent research, able to assist in mending and strengthening damaged tissues by increasing certain growth factors. During the normal healing process, the body uses platelets to promote the growth of new tissue and repair injuries. By supplementing platelet content, the healing process is accelerated. As with the bone marrow aspirate procedure, a blood sample taken from the patient is processed in a centrifuge to concentrate the platelets. The created plasma is up to five times more concentrated with platelets than natural blood.
Watch Dr Hubbard’s lecture about Osteochondral Lesions of the Talus »