An osteotomy is a procedure that realigns the knee joint to shift weight away from the damaged cartilage area. This is most often used when cartilage damage is associated with abnormal alignment, such as bow-legged or knock-kneed positioning.

During the procedure, Dr. Gazzaniga carefully cuts and reshapes the bone, typically the tibia, to redistribute forces across the knee. By unloading the damaged area, the cartilage is protected from further wear, and pain is reduced.

Osteotomy is often combined with cartilage restoration procedures to improve long-term outcomes. It is particularly useful in younger, active patients who are not ideal candidates for joint replacement.

Recovery involves a period of protected weight-bearing and physical therapy. While it requires patience, this procedure can significantly extend the life of the knee joint.

Microfracture is one of the most commonly used techniques for smaller cartilage defects. It was popularized by Dr. Steadman who Dr. Gazzaniga trained with in Vail, Colorado. It is performed arthroscopically through small incisions using a camera and specialized instruments.

Dr. Gazzaniga creates tiny holes in the bone beneath the damaged cartilage. This allows bone marrow cells to enter the area and form a new type of cartilage-like tissue. While this new tissue is not identical to original cartilage, it can provide a smoother surface and reduce symptoms.

Microfracture is best suited for smaller defects and younger patients. It is less effective for larger or more complex injuries. Recovery includes a strict rehabilitation program, often with limited weight-bearing initially to allow the new tissue to form properly. Results can be good in the right patient, but durability may decrease over time, especially in high-demand individuals.

Cartilage transplant procedures aim to replace damaged cartilage with healthy tissue. There are different approaches depending on the size and type of defect.

In some cases, small plugs of cartilage and bone are taken from a non-weight-bearing area of the patient’s own knee and transferred to the damaged area. This is known as an autograft transfer. It is typically used for small to medium defects.

This approach provides immediate structural support and uses the patient’s own tissue, which may increase the ability to incorporate. However, it is limited by how much tissue can safely be harvested.

For larger defects, an osteochondral allograft may be used. This involves transplanting cartilage and underlying bone from a donor into the damaged area of the knee.

This procedure is particularly useful when the defect is too large for other techniques or when previous treatments have failed. The donor tissue is carefully matched to the patient’s anatomy to restore the joint surface as closely as possible.

An allograft provides mature cartilage, which can offer better durability compared to some other techniques. It also allows for treatment of complex or deep defects that involve both cartilage and bone.

Recovery can take several months, with a structured rehabilitation program to protect the graft while it integrates into the patient’s knee.

MACI is an advanced cartilage restoration technique designed for larger or more complex defects. It is a two-stage procedure that uses the patient’s own cartilage cells.

In the first stage, a small sample of healthy cartilage is taken from the knee. These cells are then grown in a laboratory and placed onto a specialized scaffold. In the second stage, the scaffold with the cultured cells is implanted into the defect.

The goal of MACI is to regenerate cartilage that more closely resembles natural cartilage compared to other techniques. This can provide improved durability and function, especially for larger defects.

MACI requires a longer recovery process, including a carefully guided rehabilitation program. Patients must be committed to the process, but outcomes can be very favorable when performed in the right setting.