Services

Cartilage Restoration

Cartilage Restoration in the Knee

At OrthoCare, we offer advanced surgical options for treating damaged cartilage in the knee. Cartilage restoration techniques have evolved significantly and can provide effective solutions for selected patients with focal cartilage defects.^{11 13 18}

The goal of cartilage restoration is to treat symptomatic areas of damaged cartilage, reduce pain, improve knee function, and help preserve the joint whenever possible. The most appropriate treatment depends on the size and location of the defect, whether bone is involved, prior treatment history, and the patient’s activity level and goals.^{13 14 15}

Matrix-Induced Autologous Chondrocyte Implantation (MACI)

MACI is a third-generation cartilage restoration technique that uses your own cartilage cells to repair damaged areas.^{1 2 3} This is a two-stage procedure:

1. First stage: a small sample of healthy cartilage is removed from your knee during arthroscopy
2. Second stage: your cartilage cells are grown in a laboratory, embedded into a biocompatible matrix, and then implanted into the damaged area

Clinical outcomes: MACI has demonstrated excellent long-term results with significant improvements in pain relief and knee function.^{1 2 3} Studies show that many patients maintain these improvements for 10 years or more, with low reoperation rates and low progression to knee replacement. At long-term follow-up, more than 90% of grafts remain intact and functional, with reported graft survival of 97.2% at 10 years in some series.^{1 2 4}

MACI has also been shown to perform better than microfracture for larger lesions, particularly lesions 3 cm² or greater, with significantly better pain and function scores maintained through 5 years.^{5 6}

Who benefits most: MACI is particularly well suited for younger, active patients with isolated cartilage lesions typically measuring 2 cm² or greater that do not primarily involve substantial underlying bone loss.^{1 2 7} It can be used for both tibiofemoral and patellofemoral defects, although tibiofemoral lesions may show slightly better long-term results in some studies.^{4 7}

Cartiform: Cryopreserved Osteochondral Allograft

Cartiform is a newer single-stage cartilage restoration option that uses donor cartilage tissue preserved through cryopreservation.^{8 9 10} It provides a scaffold containing viable cartilage cells and native cartilage matrix, allowing repair with a tissue-based implant rather than a two-stage cell culturing process.

Potential advantages of Cartiform include:

• a single-stage procedure
• a scaffold containing viable cartilage cells and natural cartilage matrix
• immediate restoration without the need for separate cell culturing
• the potential for hyaline-like cartilage repair

Clinical outcomes: Early and short- to mid-term results have been promising, with good defect fill, MRI evidence of graft incorporation, and significant improvements in knee function scores in selected patients.^{8 9} This can be a useful option in cases where a patient’s own tissue is not ideal or when a single-stage restorative approach is preferred.¹⁰

Osteochondral Autograft Transplantation (OAT)

Osteochondral autograft transplantation, often called OAT or mosaicplasty, involves transferring small plugs of healthy cartilage and bone from a non-weight-bearing area of your knee to the damaged site.^{11 12}

Best for: smaller cartilage lesions, generally less than 2 cm², especially when both the cartilage and underlying bone are involved.^{13 14 15}

Clinical outcomes: OAT is a single-stage procedure with high return-to-activity rates and excellent outcomes in appropriately selected patients. Meta-analytic data show strong results with graft survival reported at 88.2% at 5 years.¹²

Osteochondral Allograft (OCA)

Osteochondral allograft transplantation, or OCA, uses donor cartilage and bone to replace larger areas of damaged cartilage and subchondral bone.^{11 16 17}

Best for: larger lesions, typically greater than 2 cm², or cases in which autograft options are not feasible because of lesion size, location, or prior procedures.^{17 13 14 15}

Clinical outcomes: OCA can provide significant improvement in pain and function, with long-term graft survival rates reported in the 70% to 91% range at 10 years.¹⁷ More recent studies using improved preservation methods have reported success rates around 84% and revision rates as low as 5% in prospective cohorts.¹⁶

Choosing the Right Treatment

The most appropriate cartilage restoration technique depends on several important factors.^{11 13 14 18}

• Defect size: smaller lesions may be treated with OAT, while medium to larger lesions may be better suited for MACI or OCA
• Defect location: whether the damage is on the femur, tibia, trochlea, or kneecap
• Bone involvement: whether the damage extends into the bone beneath the cartilage
• Patient age and activity level: younger and more active patients may benefit from certain joint-preserving techniques
• Previous treatments: prior surgery and prior attempts at cartilage treatment can affect the best next step

When matched to the right patient and the right lesion, the major cartilage restoration techniques can all provide meaningful improvements in knee pain and function.¹¹ Systematic review data suggest that MACI, OAT, OCA, and related cartilage restoration procedures can all achieve clinically important improvement when appropriately selected.¹¹

What to Expect

Dr. Arianjam will perform a comprehensive evaluation that may include:

• physical examination
• imaging studies such as MRI and X-rays
• review of prior treatment and surgical history
• discussion of your symptoms, activity goals, and expectations

Based on this assessment, Dr. Arianjam will recommend the cartilage restoration technique best suited to your specific situation, with the goal of relieving symptoms, restoring function, and helping you return to the activities you enjoy.

For more information or to schedule a consultation, please contact OrthoCare.

References

1. Wang AS, Nagelli CV, Lamba A, et al. Minimum 10-Year Outcomes of Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review. Am J Sports Med. 2024;52(9):2407-2414.View source | Back to top ↑
2. Weishorn J, Wiegand J, Zietzschmann S, et al. Factors Influencing Long-Term Outcomes After Matrix-Induced Autologous Chondrocyte Implantation: Long-Term Results at 10 Years. Am J Sports Med. 2024;52(11):2782-2791.View source | Back to top ↑
3. Ebert JR, Fallon M, Wood DJ, Janes GC. Long-Term Prospective Clinical and Magnetic Resonance Imaging-Based Evaluation of Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med. 2021;49(3):579-587.View source | Back to top ↑
4. Ebert JR, Zheng M, Fallon M, Wood DJ, Janes GC. 10-Year Prospective Clinical and Radiological Evaluation After Matrix-Induced Autologous Chondrocyte Implantation and Comparison of Tibiofemoral and Patellofemoral Graft Outcomes. Am J Sports Med. 2024;52(4):977-986.View source | Back to top ↑
5. Saris D, Price A, Widuchowski W, et al. Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-Up of a Prospective Randomized Trial. Am J Sports Med. 2014;42(6):1384-1394.View source | Back to top ↑
6. Brittberg M, Recker D, Ilgenfritz J, Saris DBF. Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Five-Year Follow-Up of a Prospective Randomized Trial. Am J Sports Med. 2018;46(6):1343-1351.View source | Back to top ↑
7. Ebert JR, Schneider A, Fallon M, Wood DJ, Janes GC. A Comparison of 2-Year Outcomes in Patients Undergoing Tibiofemoral or Patellofemoral Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med. 2017;45(14):3243-3253.View source | Back to top ↑
8. Vangsness CT, Higgs G, Hoffman JK, et al. Implantation of a Novel Cryopreserved Viable Osteochondral Allograft for Articular Cartilage Repair in the Knee. J Knee Surg. 2018;31(6):528-535.View source | Back to top ↑
9. Desai B, Assid E, Jacobs G, et al. Viable Cartilage Allograft Outperforms Existing Treatments for Focal Knee Cartilage Defects. Knee Surg Sports Traumatol Arthrosc. 2024;32(3):636-644.View source | Back to top ↑
10. Linscheid L, Jones D. Cartilage Emerging Allograft Technologies. Clin Sports Med. 2025;44(3):565-570.View source | Back to top ↑
11. Nassar JE, Guerin G, Keel T, et al. Autologous Chondrocyte Implantation, Matrix-Induced Autologous Chondrocyte Implantation, Osteochondral Autograft Transplantation and Osteochondral Allograft Improve Knee Function and Pain With Considerations for Patient and Cartilage Defects Characteristics: A Systematic Review and Meta-Analysis. Knee Surg Sports Traumatol Arthrosc. 2024.View source | Back to top ↑
12. Trofa DP, Hong IS, Lopez CD, et al. Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-Analysis. Am J Sports Med. 2023;51(3):812-824.View source | Back to top ↑
13. Krych AJ, Saris DBF, Stuart MJ, Hacken B. Cartilage Injury in the Knee: Assessment and Treatment Options. J Am Acad Orthop Surg. 2020;28(22):914-922.View source | Back to top ↑
14. Chahla J, Stone J, Mandelbaum BR. How to Manage Cartilage Injuries? Arthroscopy. 2019;35(10):2771-2773.View source | Back to top ↑
15. Richter DL, Schenck RC, Wascher DC, Treme G. Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature. Sports Health. 2016;8(2):153-160.View source | Back to top ↑
16. Stannard JP, Cook JL. Prospective Assessment of Outcomes After Primary Unipolar, Multisurface, and Bipolar Osteochondral Allograft Transplantations in the Knee: A Comparison of 2 Preservation Methods. Am J Sports Med. 2020;48(6):1356-1364.View source | Back to top ↑
17. Nuelle CW, Gelber PE, Waterman BR. Osteochondral Allograft Transplantation in the Knee. Arthroscopy. 2024;40(3):663-665.View source | Back to top ↑
18. Jarecki J, Waśko MK, Widuchowski W, et al. Knee Cartilage Lesion Management—Current Trends in Clinical Practice. J Clin Med. 2023;12(20):6434.View source | Back to top ↑