What is BioCartilage Regeneration?
BioCartilage regeneration is a surgical technique to induce cartilage regeneration in areas of articular cartilage defects, typically in a joint such as a foot and ankle. BioCartilage contains the extracellular matrix that is native to articular cartilage including key components such as type II collagen, proteoglycans, and additional cartilaginous growth factors that stimulate growth and healing in the cartilaginous cells. BioCartilage is a dehydrated, micronized allogeneic cartilage that is designed to act as a scaffold over an articular cartilage defect after a technique called microfracture is performed. BioCartilage has traditionally been combined with a biologic such as bone marrow concentrate (BMC) or platelet-rich plasma (PRP), then pressed into a contained defect, and sealed with a fibrin glue to further enhance the regeneration of hyaline cartilage.
Indications for BioCartilage Regeneration
Your physician may recommend BioCartilage regeneration for surgical repair of osteochondral lesions when joint structures, such as foot and ankle sustain cartilage damage. A joint is an articulation (junction) between two or more bones in the body. The articular surfaces of the body’s joints are lined by hyaline cartilage, a smooth tissue that serves as a shock absorber and allows easy movement of the bones within the joint. An injury from a bad fall, a traumatic injury during a sports game, or normal wear-and-tear can damage and cause defects in the cartilage, resulting in irregular articular surfaces that interfere with movement, causing pain, swelling, and disability.
When you injure yourself and sustain a bruise or a cut, the cells in your body heal and regenerate to bring health back to the injured area. Unfortunately, this is not the case with cartilage. Cartilage is not able to regenerate on its own once it has been damaged due to its avascular nature (absence of blood supply). This deficiency is counterbalanced with the use of BioCartilage.
Preparation for BioCartilage Regeneration
Preparation for BioCartilage regeneration may involve the following steps:
- A review of your medical history and physical examination is performed to check for any medical issues that need to be addressed prior to the procedure.
- You may also need to undergo diagnostic tests such as blood work to help detect any abnormalities that could compromise the safety of the procedure and imaging of the joints such as a foot and ankle to plan the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of current medications or supplements you are taking, or any recent illnesses or conditions you have such as a heart or lung disease.
- Your physician may alter the dosage of your medications or ask you to stop taking certain medications, such as blood thinners for a defined period if contraindicated for the procedure.
- You should refrain from alcohol and tobacco for at least a few days prior to surgery and several weeks after, as these can hinder the healing process.
- You should not consume any solids or liquids at least 8 hours prior to the surgery.
- You should arrange for someone to drive you home after the procedure.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for BioCartilage Regeneration
BioCartilage regeneration of the affected joint such as a foot and ankle is usually performed using a minimally invasive arthroscopic approach under general or regional anesthesia. Prior to the application of BioCartilage in the area of articular defect, a procedure called microfracture of the joint is performed first. In general, BioCartilage regeneration of the foot and ankle joint will involve the following steps:
- You will be placed on the procedure table in a position that provides the best operative angle for your surgeon to perform the surgery.
- The skin around the foot and ankle joint is cleaned with an antiseptic solution, and two to three small incisions (arthroscopic portals), about a half-inch in length, are made over the joint.
- An arthroscope, a slender tubular device fitted with a light and small video camera, is inserted through one of the incisions into the joint.
- The video camera transmits the image of the inside of your joint onto an external monitor for your surgeon to view the gravity of the articular cartilage defect.
- Your surgeon inserts miniature surgical instruments through the other incisions and performs microfracture of the joint. This involves creating numerous tiny holes in the injured joint surface. The holes are made in the bone under the cartilage, called the subchondral bone. This creates a new blood supply to the cartilage, which stimulates the growth of new cartilage.
- A BioCartilage matrix created with a donor articular cartilage powder and combined with PRP or bone marrow concentrate is then injected into the area of articular cartilage defect in the joint, and sealed with a fibrin glue to further promote cellular growth and tissue healing. The properties of BioCartilage promote cellular growth and tissue healing within damaged regions over the microfracture. The principle of BioCartilage is to serve as a scaffold over a microfracture defect, providing a tissue network that can potentially signal autologous cellular interactions.
- This procedure involving BioCartilage is effective for small areas of cartilage damage and can help remove the need for joint fusion or replacement.
- Finally, the scope and the instruments are withdrawn, and the skin incisions are closed and bandaged.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after the BioCartilage regeneration procedure will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover from the effects of anesthesia.
- The treated foot and ankle joint will be immobilized with the help of splints and a bulky dressing. You are advised not to bear weight on your foot for at least 6 weeks and use crutches for walking.
- You may notice pain and swelling in the foot area. This is managed with prescription pain medicines, applying ice packs, and elevating your foot above heart level while resting.
- Antibiotics may also be prescribed to address the risk of surgery-related infection.
- An individualized physical therapy regimen will be started once you are off crutches to strengthen your foot and ankle muscles and optimize joint function.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for a defined period. A gradual increase in activities is recommended, with your doctor’s guidance.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
BioCartilage regeneration surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Postoperative pain
- Damage to surrounding structures
- Stiffness or restricted joint motion
- Blood clots or deep vein thrombosis (DVT)
- Adverse reactions to anesthesia