Articular Cartilage Paste Graft
Performed by Kevin R. Stone, MD · 2014 · San Francisco, CA
Quick Facts
- Procedure Type
- Cartilage Restoration
- Graft Source
- Autologous (Intercondylar Notch)
- Technique
- Arthroscopic, Single-Stage
- First Developed
- 1991
- Published Follow-up
- Up to 23 years
Related Research
View Cartilage StudiesSummary
Articular cartilage paste grafting is a technique developed by Dr. Stone in 1991 to replace arthritic surfaces in the knee joint. This single-stage, arthroscopic procedure uses the patient's own cartilage and bone to regenerate damaged joint surfaces.
The Technique
The knee joint has two types of cartilage: articular cartilage (the covering on the end of the bone) and meniscus cartilage (the shock absorber). When the joint becomes arthritic, the articular cartilage wears down to bone. The paste graft technique addresses this by creating a regenerative environment.
First, the arthritic surface is prepared by creating small holes to release marrow cells from the bone. Articular cartilage and underlying cancellous bone are then harvested from the intercondylar notch where they're not needed, morselized into a paste containing marrow stem cells, and packed onto the prepared surface.
Long-Term Results
Published data on 125 patients with 2-12 year follow-up demonstrated strong cartilage regeneration. Patients have now been followed for more than 17 years, continuing to play sports on paste-grafted surfaces with excellent pain relief.
Transcript
[00:01]
Here we demonstrate a medial femoral condylar lesion in an athletic bicycle racer. The lesion is mortalized with a chondral awl to create a bloody bed. This lesion had been present for years and had stopped him from participating in bicycle racing. He had previously undergone a medial menisectomy, which most likely contributed to the degeneration of this medial femoral condyle.
The dead areas of bone are removed with the arthroscope. The lesion is shaved to remove loose pieces of cartilage. Care is taken to ensure that a bloody bed is created.
Graft is harvested with a rongeur from the intercondylar notch, taking care to capture a small amount of articular cartilage and underlying bone. The graft is taken out of the knee, formed into a paste, and then impacted into the lesion with the rongeur.
[01:16]
No effort is made to completely fill the lesion as these usually hypertrophy during the healing phase. Loose pieces that fall off into the joint are removed with an arthroscopic grasper.