Leading expert in cartilage transplantation and knee surgery, Dr. Pablo Gelber, MD, explains how fresh osteochondral allografts treat severe knee joint trauma, detailing the three primary indications: patellofemoral injury, femoral condyle osteochondritis, and tibial plateau fractures. He emphasizes that outcomes are best for condylar lesions over two square centimeters, which is considered the gold standard, while also highlighting the critical need for concomitant procedures like ligament reconstruction, meniscal transplantation, and joint realignment to protect the graft and ensure long-term success.
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Cartilage Transplantation for Knee Trauma: Indications and Outcomes
Jump To Section
- Patellofemoral Injury Transplant
- Femoral Condyle Osteochondritis
- Tibial Plateau Fracture Transplant
- Gold Standard Cartilage Transplant
- Concomitant Knee Surgery Procedures
- Meniscal Transplantation Experience
- Knee Joint Realignment Importance
Patellofemoral Injury Transplant
Cartilage transplantation can be applied to patellofemoral joint injuries, a common but challenging area to treat. According to Dr. Pablo Gelber, MD, patellofemoral syndrome has a very complex biomechanical behavior. This complexity makes it the least thankful problem for any kind of treatment, including cartilage transplantation procedures.
Femoral Condyle Osteochondritis
Femoral condyle problems are a primary indication for cartilage transplantation, often seen in very young patients. Dr. Pablo Gelber, MD, explains that osteochondritis dissecans in the condyles can result from trauma, excessive meniscal resection, or knee joint misalignment. These factors cause an overload in the knee compartment, leading to osteochondral defects that often require surgical intervention.
Tibial Plateau Fracture Transplant
The tibial plateau is the third major area where cartilage transplantation is indicated, typically following a fracture. Dr. Pablo Gelber, MD, notes that when a tibial plateau fracture is not perfectly reduced, it can cause a depression and irregularity in the knee joint. In these specific cases, osteochondral transplantation becomes a viable treatment option to restore the joint surface.
Gold Standard Cartilage Transplant
Fresh osteochondral allograft transplantation provides the best outcome for large knee joint injuries and is considered the gold standard. Dr. Pablo Gelber, MD, clarifies that this treatment is not proposed for small injuries. For defects larger than two square centimeters in size, fresh cartilage transplantation offers superior clinical outcomes compared to all other available cartilage restoration methods.
Concomitant Knee Surgery Procedures
Cartilage transplantation is rarely performed in isolation and often requires additional knee surgery to address associated problems. Dr. Pablo Gelber, MD, states that procedures like anterior cruciate ligament (ACL) reconstruction, posterior cruciate ligament (PCL) reconstruction, and lateral ligament reconstructions are frequently necessary. These combined approaches are essential for a comprehensive solution to complex knee trauma.
Meniscal Transplantation Experience
Meniscal transplantation is a critical adjunct procedure that Dr. Pablo Gelber, MD, and his team have extensive experience with. He reports having transplanted more than 300 meniscal grafts over the last 20 years. This high volume of experience underscores the importance of addressing meniscal deficiency to protect the joint and any transplanted cartilage.
Knee Joint Realignment Importance
Proper knee joint alignment is mandatory for the long-term success of a cartilage transplant. Dr. Pablo Gelber, MD, emphasizes that a well-aligned lower limb is crucial to protect the transplanted graft from excessive load. Osteotomy procedures to correct alignment are therefore a fundamental part of the surgical plan for many patients undergoing these complex restorative operations.
Full Transcript
Dr. Anton Titov, MD: What knee problems can cartilage transplantation solve? What knee joint injury problems are less amenable to cartilage transplantation?
Dr. Pablo Gelber, MD: Good question. There are three big knee trauma areas where cartilage transplantation can be applied.
One knee problem, as we were commenting on before, is a patellofemoral injury. Although it is pretty frequent, it is the least thankful problem to treat with cartilage transplantation. Patellofemoral injury is not only difficult for cartilage transplantation, but it is difficult to do any kind of treatment in patellofemoral syndrome because it has a very complex biomechanical behavior.
That’s one area for cartilage transplantation in the knee. The other knee problem area is more commonly seen in young patients. This problem affects the femoral condyles.
Femoral condyles are these two things. You see, one condyle here, one condyle here. This is usually seen in very young patients with osteochondritis.
Osteochondritis is a knee condition that is very typically seen in young patients. It can be seen due to trauma or due to a previous excessive meniscal resection. It can also be seen because of misalignment of a knee joint.
There is an overload in that knee compartment. So it’s very frequent to see osteochondral problems in the condyles. In those areas, fresh osteochondral allograft transplantation provides the best outcome.
This is considered the gold standard of cartilage transplantation in the knee. Again, when we see a small knee joint injury, we don’t propose cartilage transplantation. We don’t think that osteochondral transplantation is the best alternative.
But the knee joint trauma could be big enough, more than two square centimeters in size. Fresh cartilage transplantation then is the gold standard of treatment. Clinical outcomes, as I said before, are the best among all the different cartilage transplantation methods that are available.
And then here is the third indication for cartilage transplantation in the knee. It is for the tibial plateau transplantation. This is the tibia; we call this a tibial plateau.
Usually, this knee problem is more commonly seen after a tibial plateau fracture. Sometimes the tibial plateau fracture couldn’t have been perfectly reduced. This sometimes causes a kind of depression and irregularity in the knee joint.
In those cases, we will also provide this kind of treatment. There are three categories of knee problems where we offer this kind of treatment. Patellofemoral joint problems result in the least good outcomes.
Cartilage transplant for medial and lateral femoral condyle problems provides the best result of all. And the third is tibial plateau transplantations.
In most of these cases, when we do cartilage transplantation, we also have to treat different problems. For example, anterior cruciate ligament reconstruction, posterior cruciate ligament reconstructions, lateral ligament reconstructions, meniscal transplantation.
We are very experienced in meniscal transplantation. We have transplanted more than 300 meniscal grafts in the last 20 years. And finally, we also do knee joint realignment.
As I said before, proper joint alignment is mandatory for a well-aligned lower limb to protect what we are transplanting.