Dr. Richard Cunningham is a board-certified orthopedic surgeon who specializes in knee and shoulder sports medicine at Vail-Summit Orthopedics & Neurosurgery. Knee cartilage damage is a prevalent issue that can cause persistent pain and severely hinder one’s active lifestyle. Over the last 20 years of his career, Dr. Cunningham has cared for a large number of patients in need of knee cartilage repair. He hopes to empower patients with the information they require to make informed decisions about how best to treat this difficult problem.

Understanding Knee Cartilage Damage

Dr. Cunningham specializes in addressing various forms of knee cartilage damage, including:

• Meniscus Tears: The medial and lateral meniscus cartilages are rubbery, crescent-shaped, shock absorber cartilages that act to cushion the coating cartilage on the ends of the femur and tibia. Preserving the meniscus cartilages is critical to preventing knee arthritis.
• Articular Cartilage Damage: The smooth white cartilage which caps the ends of our bones can wear away as we age or can be damaged due to an injury. As this surface wears away, there is friction, pain, and swelling.
• Osteoarthritis: The end result of articular cartilage damage leading to pain and stiffness.

Exploring Knee Cartilage Repair Surgery

When necessary, surgery may be required to address various types of cartilage damage. There are a variety of surgical options, including:

• Meniscus Repair: Meniscus tears should be repaired whenever possible in order to preserve this important shock absorber, which will help prevent articular cartilage loss.
• Microfracture: This minimally invasive procedure creates small punctures in the bone to help stimulate the growth of fibrocartilage.
• Osteochondral Autograft Transplantation (OATS): Healthy plugs of bone and overlying cartilage from the periphery of one’s knee is transplanted to the damaged area. For bigger lesions, donor plugs of bone and cartilage can also be utilized.
• Autologous Chondrocyte Implantation (ACI): A small amount of cartilage cells from the periphery of the knee are harvested and then sent to a company that will grow and multiply these cartilage cells in culture. The cells are then embedded into a collagen membrane which is implanted into the damaged area.

Who is a Candidate for Meniscus Repair Surgery?

Dr. Cunningham is aggressive about fixing any tears of one’s meniscus as it is such an important shock absorber cartilage. However, the meniscus has limited blood supply. Only tears in the periphery of the meniscus where there is adequate blood supply have the ability to heal if sewn together. Rehab after a meniscus repair is very important. Initially, patients are placed in a hinged brace that holds their knee straight whenever walking. When not walking, the brace can be removed and patients can work on fully bending and straightening their knee.

Who is a Candidate for Articular Cartilage Repair Surgery?

If patients have persistent pain and swelling due to articular cartilage loss and defects, they may be a candidate for articular cartilage repair surgery. One consideration is assessing one’s bony alignment. If one is excessively bow legged or knock kneed then they may need a corrective osteotomy to straighten their alignment in order to allow the cartilage procedure to be successful. Any associated ligament issues also need to be addressed. Finally, having healthy meniscus tissue is key to off load any articular cartilage procedure. Dr. Cunningham favors Autologous Chrondrocyte Implantation (ACI) in some cases as this can repopulate the area of cartilage loss with a fibrocartilage layer. In other cases, doing an allograft OATS procedure in which a plug of donor bone and overlying cartilage is a good option for focal cartilage defects.

Navigating the Patient Experience

When you come to see Dr. Cunningham, he will conduct a comprehensive evaluation and order advanced imaging studies (suuch as special xray views, MRI, and CT) to assess the extent of the damage. We’ll discuss potential outcomes and associated risks. Surgery is done with a peripheral nerve block and a light general anesthetic. His expert care team will kickstart your rehabilitation soon after the procedure, with physical therapy beginning within the first few days. The focus will be on enhancing range of motion and strength. As you progress, we’ll introduce advanced exercises aimed at promoting joint stability and function.

Tailored Care for Athletes

At our practice, we care for a large number of athletes, from amateurs to professionals, and our extensive sports medicine expertise backs it up. Athletes often seek Dr. Cunningham out for his experience and proficiency in knee cartilage repair. If you’re an athlete looking to make a strong return to full activity post-surgery, your rehabilitation will be intensive and tailored to meet your sport-specific needs. The duration of rehabilitation will hinge on the extent of the surgery, and we’ll adhere to a gradual return-to-sport protocol, encompassing progressive strength, endurance, and agility training. It’s of utmost importance to heed our guidance and avoid rushing back into high-impact activities to prevent re-injury.

Setting Realistic Expectations

What can you expect from knee cartilage repair surgery? In the short term, you can anticipate a reduction in pain and improved knee function. However, full recovery may take many months. In the long term, the benefits can be profound. Patients often experience restored mobility, reduced pain, and an improved quality of life. Successful surgery can potentially delay or even eliminate the need for future joint replacement.

Mitigating the Risk of Re-injury

To reduce the risk of re-injury, please follow these recommendations:

• Diligently adhere to your rehabilitation program.
• Attend all scheduled follow-up appointments.
• Refrain from engaging in high-impact activities until you receive clearance from your surgeon.
• Manage your weight to alleviate stress on the joint.
• Do not smoke

With his extensive experience in knee cartilage repair, there is hope for those grappling with knee cartilage damage. Through the recommended surgery and your commitment to rehabilitation, the patient-surgeon partnership in knee cartilage repair surgery can truly be a life-changing experience. Don’t hesitate to request a consultation with Dr. Cunningham today.