Orthopedic Surgeons Deliver Advanced Joint Preservation Techniques

Specialists in the Orthopedic and Arthritis Center at Brigham and Women’s Hospital are offering advanced cartilage repair techniques for patients with localized defects, designed to preserve joints and maximize function. Orthopedic Surgeons Tom Minas, MD, Director of the Cartilage Repair Center, and Andreas H. Gomoll, MD, specialize in the treatment of complex cases, including patients referred for revision procedures.

The Center is dedicated to the care of patients in their late teens to early 50s with early arthritic disease and cartilage damage due to degenerative and traumatic conditions of the knee, shoulder, hip, and ankle that would otherwise require prosthetic joint replacement.

High-resolution Magnetic Resonance Imaging Contrast-enhanced MR imaging is routinely used to generate detailed images of cartilage defects for accurate diagnosis and treatment guidance, often eliminating the need for arthroscopy to outline articular cartilage injuries in the joints. MR imaging is also used for post-operative assessment of cartilage repair.

Pioneering Cartilage Transplantation
Specialists in the Cartilage Repair Center have extensive experience with advanced cartilage repair techniques. Dr. Minas performed the nation’s first autologous chondrocyte implantation (ACI) at Brigham and Women’s Hospital in 1995 and completed his 400th ACI procedure in June 2006 – the highest volume in the United States. The Center is also the only center in New England and one of few nationwide that offers osteochondral allografting. ACI is achieved by culturing cells obtained through arthroscopic biopsy of the normal cartilage from a non-weight bearing surface. These cells are then transplanted into the patient’s cartilage defect during a second procedure.

During transplantation, surgeons in the Center also repair underlying conditions contributing to cartilage damage and discomfort – including ligament laxity, maltracking of the kneecap, and lower extremity malalignment. Osteotomy (realignment) surgery, for example, is often used in conjunction with cartilage repair to alleviate pain, improve function, and maintain sporting activities in young adults in their 20s and 30s with single compartment damage.

The Cartilage Repair Center is currently collaborating with biotechnology companies in developing Phase I and Phase II trials of nextgeneration ACI using a collagen sponge to culture cartilage cells. The sponge is sized to fit the defect and may be implanted using an arthroscopic approach to enable a shorter recovery time. In addition to cartilage repair for defects in the knee, orthopedic surgeons at Brigham and Women’s Hospital also treat cartilage defects in the shoulder and the ankle.

Osteochondral allografting is used in patients who have cartilage defects associated with loss of underlying bone. This technique involves the transplantation of bone and cartilage tissue to successfully restore function in more than 80 percent of recipients.

For patients with cartilage disease that is too advanced for cartilage repair, orthopedic surgeons at Brigham and Women’s Hospital also offer Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) image shows medial femoral condyle four years after autologous chondrocyte implantation (ACI). innovative techniques in minimally invasive partial or total joint replacement.

Indications for Referral
Patients with the following conditions may be referred to the Cartilage Repair Center for evaluation and treatment:

• Congenital and degenerative conditions, such as osteochondritis dissecans;
• Early arthritic disease in patients in their late teens to early 50s;
• Traumatic injury resulting in cartilage damage, such as patella dislocations;
• Previously failed cartilage repair procedures.

Information and Referrals
For more information regarding cartilage repair and transplantation at Brigham and Women’s Hospital, or to refer a patient, please contact a Referral Coordinator at (617)