Title: Cartilage, Part 4
Tags: knee osteoarthritis
Blog Entry: So far we have discussed non-operative at home cartilage solutions, the non-operative cartilage remedies you must get from a doctor and a surgical technique for small cartilage lesions called micro-fracture. As we discussed last time, micro-fracture has good outcomes for small cartilage holes, and doesn’t burn any bridges for future cartilage work, if needed, but fills in the defects with “scar cartilage” called fibro- cartilage. The next cartilage “fix” is called OATS. No, we are not talking about multi-grain here. OATS stands for Osteoarticular Transplant System. Essentially, we take plugs of cartilage and bone from a part of your knee that does not bear weight and transfer it to the area of cartilage wear that does bear weight. It’s like robbing Peter to pay Paul….except it is in the knee. The beauty of this procedure is that we transfer healthy “hyaline” cartilage instead of the fibro-cartilage that grows after microfracture. We have instruments that literally take a plug of cartilage and bone out en bloc and then transfer the whole block to the new site and tap the plug in. This technique works best in small cartilage holes in the femur (thigh bone) and less well in the tibia (shin bone). It is not a great solution for the knee cap. Multiple plugs can be used in the same cartilage hole. When this is done it is called “Mosaicplasty.” The outcomes of the OATS procedure seem to work best in knees that are less than 50 years old. Again, as with microfracture, the rehab from this procedure is long, with six weeks on limited weight bearing and three to six months of rehabilitation prior to returning to all out sports. The purpose of this procedure is to provide pain relief and improve function when a knee replacement is not warranted.
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