Autologous Chondrocyte Implantation
The Most Common Source of Chronic Knee Pain - the Knee Cap
Does your knee hurt when you go up and down stairs? Does your knee crackle and pop like "Rice Krispies"? Do you have pain sitting for prolonged periods of time? And, do you feel like you are too young to have arthritis? You may have chondromalacia patella!
Chondromalacia is an injury of the articular cartilage. Articular Cartilage is the firm resilient covering on the ends of bones. It can occur in different severities. Grade I is just softening, Grade II is fraying, Grade III is cracking, and Grade IV is fissuring down to bone. Eventually the surface can completely break down to expose the bone under the cartilage. The cascade of events can occasionally take years to develop. Or, by simple acute trauma, injury can occur and start symptoms. The cascade toward deterioration can sometimes be avoided by appropriate treatment early in the process. Often, injury done "today" does not materialize in symptoms until many years later. The knee cap, or patella, is a very common location for this problem. It can also occur in the notch, called the trochlea, in which the patella tracks.
Injury and symptoms occur in a variety of ways. It is very common in adolescent female patients. As girls go through their maturity, their anatomy changes. Their hips get broader and this creates an angle on their knees that causes stress on the patella. X-rays can show an abnormal alignment as the patella engages the notch. Sometimes the patella will slip out of place or dislocate completely. This mal-alignment may be retained even after symptoms are treated. The type of chondromalacia in these patients is usually Grade I and is self limiting. Many times by simple conservative treatment, symptoms resolve by the time patients reach late adolescents or young adult hood.
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Often, chronic overuse of the knee causes the injury. It often occurs as a result of many years of poor mechanics. For example, it can occur with poor weight training techniques. Leg extensions as an exercise often leads to this problem. Many times, leg extensions with heavy weights, done as an adolescent while training for sports will lead to a breakdown of the knee as a young adult. Then in your mid-life, you begin having problems and pain.
Chondromalacia can be very disabling. It can cause pain with routine every day activities. Routine sitting, standing, climbing a ladder, gardening, playing with the kids and many other innumerable activities all can be effected. When you injure the patella or its notch, it can lead to many various symptoms. These may include, giving way, locking, catching, crackling, popping, pain with stairs, inclines and declines, swelling as well as several other less specific symptoms.
The treatment of Chondromalacia is as varied as the problem. The treatment is based on the severity of the symptoms, the patient's disability, and underlying grade of injury. Treatment can range from simple exercises with or without anti-inflammatories to bracing and physical therapy to surgery.
There are many operative procedures that have been created to address these problems. Many surgeons do not tend to operate on adolescent females because chances are that their symptoms will slowly resolve. In older patients, both male and female, once symptoms become more prominent, surgery is indicated. In very select cases where the patella has abnormal tilting, simple release of soft tissue can relieve symptoms. However, if the patella is slipping out of place, the muscles on the inside of the patella may need to be tightened. If the symptoms of giving way and slippage or dislocation are too severe, realigning of the bone itself may have to be done.
There are also operative procedures which have been devised to address the articular cartilage itself. In Grade I or II injuries, simply cleaning the joint surface with an arthroscopic shaver usually relieves symptoms. In Grades III and IV the treatment is usually more significant. Bone realignment to take pressure off of the patella, to decompress the patella, may be indicated. Scraping of the patella to create a healing response is occasionally done.
One of the most successful operative procedures for long term results is the Autologous Chondrocyte Implantation (ACI) technique. This is a two stage operation. A small piece of normal articular cartilage is harvested from your knee and sent to a special laboratory. Here, the cells call chondrocytes are cultured and grown. Then at a second operative procedure, they are re-implanted into your knee. They will grow into almost normal articular cartilage recreating the joint into its former pre-injury condition. FDA approved in 1995 in the USA and now done routinely at Arlington Orthopedic Associates, this operative procedure has shown great promise in allowing patients to return to high level pain free function.
Chondromalacia is a complicated spectrum of pathology and symptoms. The key to treatment is to correctly identify the problem and create a treatment option specific for the patient. Patients who have new symptoms can often be treated conservatively. For severe symptoms, patients who have suffered for as long as twenty years have been relieved by ACI implantation and joint restoration. Consult your orthopedic surgeon at Arlington Orthopedic Associates and become symptom free, with pain free function.