Bone marrow-stimulating methods

How can cartilage tissue be regenerated?

Where there is cartilage damage up to a size of around two centimetres, cartilage-regenerating techniques can be useful in encouraging the regrowth of cartilage tissue. Specialist instruments are used to create holes in the cartilage defect that establish a connection with the underlying bone. Stem cells from the bone marrow can then migrate into the defect, allowing replacement tissue made from cartilaginous fibre to fill the cartilage defect.

Micro-fracturing and Pridie drilling

If the holes are created using special chisel-like instruments, the procedure is referred to as micro-fracturing, whereas the technique involving a drill or a fine Kirschner wire is referred to as Pridie drilling.

Because heat caused by the drilling can cause tissue damage to the cartilage, Pridie drilling has been widely superseded in recent years by micro-fracturing. If diseased bone is also present, a hole is made with a K-wire in order to reach the deeper-seated source of the problem.

New techniques with encouraging results

A further development in this field is matrix-associated chondroneogenesis (AMIC). With this technique, a thin membrane of collagen is stretched over the defect to protect it. This procedure is performed in addition to micro-fracturing and prior cartilage removal. The technique is also suitable for treating cartilage damage of more than two centimetres and there is no risk of migrated stem cells floating away prematurely. Initial results are encouraging, although no confirmed data is available yet regarding the technique's long-term success.

Abrasion arthroplasties are only carried out nowadays in exceptional cases

Abrasion arthroplasties are still carried out today to regenerate cartilage tissue, but only in exceptional cases. With this technique, the topmost layer of the exposed bone in a cartilage defect is removed and a connection established with the bone marrow. Following this, stem cells are able to migrate into the defect, forming fibrous replacement cartilage. Often, however, abrasion arthroplasty does not yield satisfactory results. Up to 99% of patients remain restricted in their everyday activities after the procedure, and only one in eight patients is free of symptoms five years later.