Q & A on Advanced Cartilage Restoration for the Knee with Dr. Katherine Coyner

Connecticut sports medicine specialist Dr. Katherine Coyner answers questions about advanced cartilage restoration.

Q. When do you recommend advanced cartilage restoration for the knee?

A. Typically, I recommend it for young, active patients who have an isolated cartilage defect. Usually these are sporting injuries, such as from twisting your knee, or from trauma, such as a car accident or a fall.

Cartilage damage can be very debilitating, as far as causing pain, stiffness, and swelling and limiting their range of motion. We first try to manage the condition through physical therapy, and if that isn’t helping, surgery is available. For young patients, advanced cartilage restoration offers a lot of different options.

In older patients, cartilage damage is most often from degenerative joint disease. These patients are less likely to be candidates for cartilage restoration because the damage is more diffuse.

Q. What does advance cartilage restoration involve?

A. The goal of cartilage restoration procedures is to stimulate growth of new hyaline cartilage within the patient’s knee. Historically, we’ve done that through a procedure called microfracture, in which we scrape the defect out and poke holes in the underlying bone. This causes the cells in the bone marrow to form a fibrocartilage scar. It’s not exactly the cartilage you were born with, but it’s a decent alternative.

I specialize in more advanced options. I hold advanced certifications in several newer treatments that we offer at UCONN, including autologous chondrocyte implantation (ACI). This is a two-stage process: In the first procedure, cartilage is harvested from the patient’s knee and then proliferated in the lab. In the second procedure, it is secured back into the patient’s knee with a periosteal flap. This helps to form new, healthy cartilage.

We also offer DeNovo, which is a single-stage process that doesn’t require a flap. I have experience with a wide range of other cartilage restoration options, so I can find the ideal treatment for each patient. Specific treatment depends on several factors, such as the patient’s age and activity level and the severity of the injury.

Q. What are some of the benefits of advanced cartilage restoration when compared to other treatment options?

A. Cartilage restoration offers many benefits, including less pain, restored range of motion and function, and a lower chance of the patient later developing arthritis. Previously, microfracture was the gold standard for cartilage restoration, but we have found that the microfracture tends to break down over time, which produces shorter-term results. Our newer options restore more normal anatomy, instead of just prompting the body to form a scar. The latest options provide longer-term benefits, as well as a higher level of functioning.

Q. Are most patients able to return to normal activity following advanced cartilage restoration?

A. Yes. However, with higher-functioning athletes, especially professional athletes, cartilage damage is still a so-called “bad actor,” and we don’t have as successful results as we have with, say, an ACL reconstruction.

Loss of cartilage can cause significant disability in the knee, which makes returning to the game a challenge for many athletes. But we can still significantly improve their lifestyle.