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The Secret Life of Cartilage - Part II

This blog is the second installment in my two-part series, “The Secret Life of Cartilage.”  I suggest that you read the first installment before you read this one.

Cartilage-- a beautiful thngs

Yes, both installments are a big ol’ love-fest about the amazing natural substance called cartilage, and more to the point, the amazing mechanisms of our feet and ankles. This is my life’s work as a surgeon, so don’t be surprised. I live for new breakthroughs in surgical techniques which can reduce pain and restore mobility for my patients. And if you’ve ever been laid up with an ankle fracture or debilitating arthritis, you may feel the same way: waiting for a breakthrough in treatment.

The OATS procedure (osteochondral autograft transfer) may change lives for people with ankle injuries. It’s been hot news for a while in the area of knee surgeries, and consists of grafting cartilage from somewhere else to the ankle joint or knee joint. The OATS procedure is an extensive operation, but it offers new hope for people—especially NBA players who constantly suffer what are called microfractures and cartilage lesions as the result of competitive jumping on hardwood floors (and, who are we kidding? They play on asphalt in their off-time. Not good!).

Golden State Warriors  v Los Angeles Lakers

The OATS procedure (osteochondral autograft transfer) may change lives for people with ankle injuries. It’s been hot news for a while in the area of knee surgeries, and consists of grafting cartilage from somewhere else to the ankle joint or knee joint. The OATS procedure is an extensive operation, but it offers new hope for people—especially NBA players who constantly suffer what are called microfractures and cartilage lesions as the result of competitive jumping on hardwood floors (and, who are we kidding? They play on asphalt in their off-time. Not good!).

For decades, microfracture surgery consisted of pricking holes in the bone to stimulate tissue regrowth. But surgeons who performed this surgery on the knee learned that the fibro-cartilage that forms in response to this technique is stiffer and less flexible than the original hyaline cartilage—meaning that the patient lost some degree of mobility and explosive power. For a pro athlete, this is career-ending news.

The current thinking is that the OATS method implants enough of the collagen-rich hyaline necessary to restore the power of the original joint.

Other surgical options being explored now include something called autologous chondrocyte implantation (ACI) which requires harvesting cartilage from the patient and culturing the cells in a lab for several weeks. The new cells are then placed on a biodegradable matrix and glued to the damaged area. The two-step process requires open surgery and up to a year of rehab. The good news is that it’s a long-lasting fix.

There is also a one-step version of this procedure now being perfected by many European surgeons—it’s matrix-induced ACI, called MACI. Our hope as surgeons, not only in the field of sports medicine, by the way, is that microfracture could become obsolete with the perfection of next-gen cartilage implants and procedures.

Even if you are not a pro athlete, be grateful for your cartilage. And be aware that as we all age, our cartilage becomes more precious and a bit more precarious. Cartilage is about 80% water. It serves as cushion, lubricant and shock-absorber. As we age, the water content in our cartilage naturally decreases, so we all become prone to damage. A few cartilage-preserving tips, especially if you’re 50, 60 plus:

  • Exercise is good for mobility – just be sure that you warm up and cool down before strenuous activity.

 

  • Daily moderate exercise is much better for you than over-exerting yourself in an extreme way to try to “catch up” or make up for lost time.  Don’t be a hero or a weekend warrior, please!

 

  • Gelatin may help cartilage hang in there. You don’t have to make Jello – you can just take it as a supplement, or pour it into your favorite coffee or tea.

 

Written by admin on November 17, 2014 @ 9:19 pm
Filed under: From The Desk of Dr. J
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