Arthroscopic surgeries

microfracture

Small holes are made in areas with cartilage defects, and stem cells in the bone marrow are brought to the damaged area and a cartilage patch is formed there. It is a completely arthroscopic procedure. The damaged cartilage tissue is completely cleaned and living bone tissue is revealed. Then, using special equipment designed for this work, holes of 2-2 mm width and 1 cm depth are drilled at 1 cm intervals. Stem cells in the bone marrow come from these holes and attach to living bone tissue. These cells transform into cartilage cells due to the characteristics of the region where they are located and form a cartilage patch in the region.

Advantages;It can be done completely arthroscopically, does not require complicated equipment, is effective and inexpensive.

Disadvantages; The newly formed cartilage is structurally different and weaker than normal articular cartilage. Its effect is reduced in areas larger than 3 cm2.

The success rate is over 80%.

Osteochondral grafting (mosaicplasty)

It is an arthroscopic method and it is possible to obtain an osteochondral (bone-cartilage) graft from one’s own tissues (autograft) or from other individuals (allograft). However, if there is no special reason, it is provided from people’s own tissues. This operation is also called mosaicplasty. The procedure is to lay bone cylinders covered with cartilage, taken from healthy joint areas, to damaged areas. If an autograft is planned, the bone-cartilage cylinders should come from surfaces that have minimal contact with other non-weight-bearing bones. This fact causes restriction of the application surface. It is extremely effective in cartilage diseases under 2 cm2. In very large areas, allografts taken from suitable (donor) donors or genetically modified to reduce the possibility of graft rejection can be used. These grafts are laid on the damaged areas in mosaic form. It is an effective method for weight-bearing and relatively small defects. The success rate is around 80%.

Cartilage cell transplant (chondrocell transplant)

Cartilage cells are structurally the most mature cells. Therefore, they cannot reproduce themselves. In humans, cartilage cell production ends at the age of 1 year. In order to reproduce new cartilage cells, a series of genetic procedures in genetic laboratories and replication in culture are required.

A two-stage surgical procedure is required. In the first stage, the surgeon collects healthy cartilage cells from the non-weight-bearing areas of the knee joint with the arthroscopic technique. Collected cartilage cells are produced by culturing for 15 days after a genetic procedure. After these cells are prepared, the second stage operation is started. In the second operation, these cells are injected under the bone membrane sutured over the damaged area of ​​the knee cartilage. Cartilage tissue very close to the original cartilage tissue develops from these cells.

Since people’s own cells are used in cartilage cell transplantation, there is no danger and recovery is achieved in the majority of cases (approximately 70-80%). However, it cannot be applied to everyone. The size of the damaged area, the number and content of previous surgeries, the patient’s demands and expectations, the location of the damaged area and the presence of more than one lesion are important in order to make a decision in this procedure. While it is not applied to the elderly and people with other signs of osteoarthritis, young and post-injury patients with cartilage problems are good candidates. However, the area of ​​the transplant area should not be too large. Allografts are more advantageous as the chance of success decreases in enlarged areas.

Cartilage and Meniscus Allograft applications

It is a good alternative to knee prosthesis in young patients with extensive knee cartilage and bone damage. It can generally be applied in meniscus and cartilage disorders that involve the entire inner or outer part of the knee. After open technique operations where the entire meniscus is removed, or after arthroscopic operations where the entire meniscus must be removed due to large ruptures, the shock absorber role of the meniscus is eliminated. In this case, the direct contact of the articular cartilages in the weight-bearing areas causes wear and calcification over time. In the early stages of this event, the transplantation of meniscus taken from cadavers breaks this vicious circle and gives very good results.
In the later stages of this event or in the case of surface irregularities and losses after fracture-trauma, the damaged part of the knee is completely removed and a new-healthy joint surface is formed by transplanting the bone-cartilage-meniscus taken from the cadaver.

Living cells are destroyed in the transplanted parts from the cadaver, and thus the rejection problem of the graft is eliminated. The rejection rate does not exceed 5%. The living cells of the body migrate into the placed allograft and provide a complete adaptation in about 6-12 weeks.

In this technique, MRI or tomographic measurement is made for cadavers of appropriate size. It is an extremely radical operation with one session after finding the appropriate cadaver part.

Mesenchymal stem cell repair

The most recent technique under development is the use of mesenchymal stem cells (MSCs). MSCs are non-specialized cells that have the ability to transform into different tissues, similar to embryological cells. These cells are found in the bone marrow in adults and in the periosteum, a membrane that covers bones outside the joints.

Doctors hope that new cartilage formation will occur after MSCs, which will be taken by a simple bone marrow aspiration or biopsy, are placed in a gel, and then this gel is transferred to the damaged cartilage areas.

REHABILITATION AND EXERCISE PROGRAM AFTER KNEE ARTROSCOPIES

After knee arthroscopy, an exercise program that increases and strengthens knee movements is mandatory. Usually these programs form part of the program implemented by physiotherapists in physical therapy clinics.

There is an exercise program recommended especially after arthroscopic meniscus and knee cap external loosening. According to the recommendations of your orthopedist or physiotherapist, it can be used in ligament repairs, meniscus sutures and cartilage operations at certain stages and by restricting some movements.

For the rehabilitation program, your physiotherapist should be contacted and the program given by your physiotherapist should be performed at least 2-3 times a day. At the same time, a walking program should be added to these after a certain period. The intensity of the program should be increased gradually. If your knee swells or becomes painful, you should stop the program and consult your doctor or physiotherapist and act according to their recommendations. In these cases, we recommend that you take a break from knee movements first or reduce your intensity if your problem is minimal. In addition, resting your leg upside down, applying ice and applying an elastic bandage, if any, will also help reduce swelling.

You should start walking in the period and way recommended by your doctor or physiotherapist by gradually increasing the tempo and time, and you should start running according to the advice of your doctor or physiotherapist.

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