One of the most vexing problems in podiatric surgery over the past few decades has been the surgical repair of cartilage. Cartilage is the thick, rubbery material that coats the ends of your bones at the joints. Hyaline cartilage, found on most joint surfaces, enables joint mobility and protects the bones from friction caused by movement.
While cartilage tissue is made up of cells, it cannot repair itself due to a lack of blood vessels and an adequate blood supply. Therefore, cartilage restoration is often needed to repair damaged articular cartilage.
Trauma can damage the cartilage, which fractures into slivers that may “float” around the joint. These defects are referred to as articular cartilage lesions and can cause pain and swelling in the joint. Ultimately, injured articular cartilage and articular cartilage defects can develop into osteoarthritis, which may require even more invasive procedures, such as osteotomy, if left unaddressed.
What is DeNovo cartilage repair?
Dr. Baravarian is pleased to offer the revolutionary Zimmer Biomet DeNovo cartilage repair technique. This new biologic treatment has shown promise in improving short-term and long-term outcomes of ankle joint surgery.
The DeNovo NT natural tissue graft single-stage procedure requires only one surgery, which can be performed arthroscopically and offers remarkable regenerative powers. Patients can expect a shorter hospital stay compared to open surgery and should return to work in approximately four to six weeks.
What are the traditional methods of ankle cartilage repair?
The traditional method to repair a cartilage injury involves drilling tiny holes in the joint, deep into the bone marrow. The holes stimulate the bone marrow to generate new cartilage cells to fill the voids and repair the lesion. This technique is known as “microfracture.”
Although arthroscopy makes microfracture a minimally invasive procedure, it still has a disadvantage. Cartilage is notorious for its inability to regenerate healthy tissue on its own. Even with a boost from bone marrow, damaged cartilage can only grow into thin and weak scar tissue. Over time, symptoms will redevelop or worsen. The problem is even more likely to return if the original lesion is particularly large or deep.
Another (less conservative) method of cartilage ankle surgery involves harvesting a sample of tissue, cells, or a periosteal flap from another part of the patient’s body, typically the patellofemoral joint in the knee, and grafting it to the ankle joint. Cartilage repair utilizing the patient’s tissue is known as an autograft.
Cartilage transplantation can be effective, but it does have its downsides. It requires two open surgeries: one to harvest the healthy cartilage and another six weeks later for cartilage implantation. This means the patient will have two surgical sites, increasing the risk of complications and increasing the amount of time it takes for full recovery.
The DeNovo cartilage repair technique — from Dr. Bob Baravarian
Instead of autograft cartilage transplantation, the DeNovo technique employs an allograft – a graft of natural, healthy cartilage donated from a cadaver. The arthroscopic DeNovo technique relies on juvenile allograft cartilage, or cartilage from a young donor with a “much larger capacity for self-repair,” explains Dr. Bob Baravarian.
“The DeNovo NT graft requires only one surgery, which surgeons can perform arthroscopically.” Dr. Baravarian is one of the world’s leading experts on minimally invasive podiatric surgical techniques. The particulated juvenile cartilage is secured with fibrin glue, a biomedical adhesive. Patients can expect a shorter hospital stay compared to open surgery and see significant improvement sooner, often returning to work in about four to six weeks.
What is the regenerative advantage of DeNovo cartilage repair?
Juvenile chondrocytes (healthy cartilage cells) are particularly useful for an osteochondral allograft because they are much more efficient at generating articular cartilage than mature tissue. Much denser than fully mature cartilage, immature cartilage is packed with cells, which begin to multiply soon after implantation of the cartilage graft.
This new ankle cartilage repair technique has already demonstrated its healing potential in lesions of all sizes, including those that are problematic and don’t respond to microfracture techniques. Clinical trials have reported significant improvement in patient function, quick return to activity, and decreased pain.
This means a safer, shorter, and less painful recovery for patients, with the added advantage of world-class orthopedic educators and specialists.
What can I expect during and after DeNovo cartilage repair?
Generally, Dr. Bob will begin with a physical exam to assess the extent of your pain and injury. Magnetic resonance imaging (MRI) or a CT scan can obtain a clearer picture of the cartilage lesions. If Dr. Bob needs further to discern the severity and size of the chondral defect, he may recommend a diagnostic arthroscopy procedure.
During the DeNovo ankle cartilage replacement procedure, you’ll be placed under general anesthesia. The arthroscopic technique involves a small incision through which Dr. Bob can remove the damaged ankle cartilage (debridement), thereby creating space for healthy allograft tissue. Fibrin glue is applied to this created space, followed by the allograft. Another layer of fibrin glue helps seal in the healthy tissue, ensuring no migration. Finally, the incision will be closed, and the transplanted cartilage will be left to integrate and fuse with your cartilage, producing new, healthy articular cartilage tissue.
Why choose Dr. Baravarian for your repair of articular cartilage?
Dr. Bob is nationally recognized for his advanced treatment techniques in healthcare, including the DeNovo tissue graft cartilage repair procedure. He has decades of experience managing the special circumstances and concerns surrounding ankle injuries and instability.
For a consultation, please call (855) 557-5400 or make an appointment online now.
Dr. Bob Baravarian is conveniently located in Los Angeles, near Cedars-Sinai Medical Center, providing expert foot and ankle care for patients throughout Southern California.
DeNovo Ankle Cartilage Repair FAQs
Can cartilage damage be reversed?
While you can take steps to limit further trauma to your cartilage, cartilage damage, such as lesions, often requires ankle surgery because mature, adult cartilage is usually incapable of regenerating and repairing itself. Without surgical intervention, you could risk osteoarthritis and the gradual breakdown of the joint.
Can cartilage tissue be rebuilt naturally?
Adult cartilage tissue that is damaged cannot be regenerated naturally due to low chondrocyte count and poor blood supply. Juvenile cartilage has 10 times the number of chondrocytes as more mature tissues, making it an excellent choice for the DeNovo cartilage repair allograft technique.
How long does recovery from cartilage regeneration and repair take?
Generally, you will wear a rigid splint and use crutches to avoid putting pressure on the joint for at least the first two weeks. After this, you may be outfitted with a removable boot and advised to start physical therapy or sports medicine rehabilitation, which typically lasts for another four to six weeks. Most patients can return to work in four to six weeks, but full cartilage integration and recovery usually require 6-12 months.
Sources
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Cole B, Farr J, Tabet S, Gold G, Carlson C, Margerrison E. Clinical, Radiographic and Histological Outcomes following Cartilage Repair with Particulated Juvenile Articular Cartilage: A 2-Year Prospective Study. Am J Sports Med. 2014 Jun;42(6):1417-25. doi: 10.1177/0363546514528671. Epub 2014 Apr 9.
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Frisbie DD, Lu Y, Kawcak CE, et al. In vivo evaluation of autologous cartilage fragment-loaded scaffolds implanted into equine articular defects and compared with autologous chondrocyte implantation. Am J Sports Med. 2009;37:71S–80S
