Some treatment methods
Injections with hyaluronic acid are mostly a temporary solution to treat the symptoms until a surgery becomes necessary. The increasing friction of the joints caused by the cartilage defect can be reduced by an hyaluronic acid treatment for some months. The disorders become alleviated, usually the cartilage defect stays the same.
Microfracturing is the most commonly used method for treating cartilage defects up to 2 cm2. The bone becomes perforated in small spaces with the help of special chisels and trephines. This leads to bleeding in the affected area. The included cells form usually a scar-like tissue of poor quality, which is softer and less reliable compared to native cartilage.
Autologous Osteochondral Cylinder Transplantation (OCT)
This operation technique is also named bone-cartilage-transplantation. With a punch, whole cylindrical pieces of bone-cartilage are extracted from a less burdened area of the joint and transplanted into the cartilage defect. When several cylinders are placed side by side it resembles a mosaic. That’s why this technique is also named mosaic-plastic. It´s problematic that gaps reside between the implanted cylinders, which can not be closed and hence cannot fill up the cartilage defect. Additionally disorders and even degenerative changes can occur at the extraction areas.
Autologous Chondrocyte Transplantation (ACT/MACT)
For more than 10 years the transplantation of autologous cartilage cells has been successfully practised. During the first surgical procedure (arthroscopy) a biopsy of cartilage tissue is taken. The included cartilage cells are isolated and multiplied in a special laboratory. In general the cells are attached on an implant matrix which will be reimplanted during a second surgery 3 weeks after. As time goes on, the cells will rebuild the matrix into a hyaline-like cartilage tissue. The production costs are expensive and sometimes are not covered by health insurances.
Artificial joint replacement
If the cartilage defect is in an advanced stage which none of the treatments mentioned above can treat, the last therapeutic treatment is the implantation of an artificial joint made of metal or plastic. The durability of an artificial joint replacement is confined. It is necessary to have enough structural bone for a successful anchoring. Prostheses cannot just simply be replaced, because the bone substance decreases after the first implantation. Because of that this method should be applied only to older patients.