What is surgery to restore joint cartilage?

The bones in your joints are covered with a special type of cartilage. This layer of tissue helps the joint bones glide together smoothly.

When this tissue is damaged, the bones may rub against each other. And that causes pain.

Cartilage doesn't heal easily on its own. The goal of treatment is to get your body to grow new cartilage in the damaged area. This is done by placing healthy cartilage cells into the area. Over time, the cells multiply and replace the damaged cartilage.

The knee is the most common area for this type of surgery. Other areas include the ankle and the shoulder.

How is the surgery done?

You either will be asleep during the surgery or the area being worked on will be numb. Two common surgeries are:

• Osteochondral autologous transplantation (OATS).
  • During surgery, the doctor removes the damaged cartilage.
  • He or she also removes one or more samples, called plugs, of healthy bone and cartilage from another part of your body. Sometimes the plugs are taken from another donor instead of your own body. (This is called an allograft.)
  • The doctor cuts into your bone to make a socket, or hole, for each plug. Then the plug is inserted into the socket.
• Autologous chondrocyte implantation (ACI). This procedure has two steps.
  • Harvesting cells: The doctor takes healthy cartilage cells from one of your bones. You won't need to stay in the hospital for this. The cells are sent to a lab. In the lab, the cells increase in number. This takes several weeks.
  • Surgery. When the cells are ready, you will have surgery. The doctor removes the damaged cartilage. Then the doctor pulls at the layer of tissue that covers your bones over the joint area. This creates a pocket. He or she injects the new cells into the pocket.

These surgeries can be done in two ways:

• Arthroscopic surgery: If the damaged area is small, the doctor may use this method. It requires only small cuts (incisions). The doctor puts a lighted tube, called a scope, and other surgical tools through the cuts. The doctor is able to see the inside of your joint with the scope. You may be able to go home the same day.
• Open surgery: Your doctor will make one large cut over the joint. If you have open surgery, you will probably stay in the hospital overnight.

What can you expect after surgery?

You will need to wear a stiff brace for a short time. Then you will need crutches or a walker for a few months. Follow your doctor's instructions about how much weight you can put on the joint.

You will start doing exercises while you're still in the hospital. And you will need to do weeks or months of physical rehabilitation. Rehab will help strengthen the muscles of your joint and help you regain movement.

In time, most people are able to return to most of their normal activities, including sports.