Features April 2007 Issue

Cartilage Paste Grafting Reduces Knee Pain

A small study shows promise in easing the pain of knee osteoarthritis through cartilage revitalization.

Articular cartilage paste grafting may be a long-term option for patients with knee osteoarthritis, according to a study published in the March 2007 issue of Arthroscopy.

Marty Bee Illustration

In paste grafting, surgeon creates small holes (microfractures) in the bone beneath the cartilage (1). Articular cartilage is then harvested from knee’s condylar notch (2) and crushed into a paste. The paste is then injected into the lesion (3) to stimulate cartilage growth.

The procedure begins when the damaged surface of an arthritic knee is treated with microfracture surgery. a procedure in which small holes are made in the surface of the bone beneath the cartilage. Then a "paste," derived from the patient’s cartilage and bone, is injected into the area that is bleeding. The paste is thought to to improve the supply of blood to the damaged area and stimulate normal cartilage growth, thereby enhancing the healing process.

While a variety of surgical procedures has been developed to promote regrowth of cartilage and help patients with degenerative cartilage changes in the knee—including cartilage debridement, bone-marrow stimulation, and cartilage resurfacing none has consistently been shown to improve formation of normal articular cartilage.

The

Arthroscopy study involved 145 patients with a mean age of 46 (range 17-73 years); 34 percent were women and 66 percent were men. All participants were diagnosed with full-thickness defects of the knee, primarily in the cartilage covering the bottom surface of the femur, the long bone that extends from the hip to the knee. Results were monitored over a period of two to 12 years. More than 83 percent of the procedures were considered a clinical success, based on perception of pain, stiffness, daily function, and the ability to walk up and down stairs.

The study’s authors concluded that articular cartilage paste grafting is a cost-effective, one-stage arthroscopic treatment that offers long-lasting pain relief, restored functioning, and the likelihood of tissue regeneration for individuals suffering from osteoarthritis of the knees.

Cautions Brian Donley, M.D., vice chairman of the department of orthopaedic surgery at Cleveland Clinic, "Although this study shows promise in providing pain relief for patients suffering from arthritic knees, further investigation—more research involving a larger number of patients and longer followup—is needed."