Joint, or articular, cartilage covers the ends of bones and allows for joints to glide smoothly with minimal friction. Cartilage damage, or chondral defects, can be caused by acute trauma, such as a bad fall or sports-related injury, or by repetitive trauma, such as general wear over time. Unlike other tissues in the body, joint cartilage has no innate ability to repair itself, making any injury permanent. Left untreated, even a small chondral defect can expand in size and progress to debilitating arthritis, ultimately necessitating a joint replacement procedure.
Debridement and microfracture procedures are the most frequently performed surgical procedures for treatment for cartilage damage. Debridement does not repair cartilage damage, as its only goal is to improve symptoms. Microfracture is considered the current standard of care for severe chondral defects due to its simplicity, its short-term success in improving symptoms in many patients, its safety profile and the lack of other viable alternatives. However, microfracture has been unsuccessful in reliably solving the underlying problem of cartilage damage because the repair tissue formed by the procedure is incapable of withstanding the normal shock and shear forces that joint cartilage sustains.
In addition to its inability to solve the underlying problem – damage to the articular cartilage – microfracture is associated with numerous other drawbacks and limitations, including the following:
- Modest Efficacy
- Limited Long-Term Patient Benefits
- Extended Patient Recovery
ACI and osteochondral grafting have drawbacks and limitations similar to those affecting debridement and microfracture, and also are associated with the following:
- Technically Demanding Surgeries
- Negative Safety Profile