Cartilage Transplantation - Procedure, Outcomes, Costs, and Finding Specialists

As mentioned, cartilage damage in the large joints occurs primarily either due to wear and tear (osteoarthritis) or as a result of an accident. It is important to note that joint cartilage damage caused by osteoarthritis is not a candidate for autologous cartilage cell transplantation.

Depending on the extent of the cartilage damage, a wide variety of treatment options are available. Cartilage transplantation is primarily used for localized cartilage damage, for example in the area of the

• knee,
• ankle, or
• hip joint.

Localized cartilage damage primarily manifests as pain during weight-bearing activities and a tendency toward swelling caused by inflammation. Over time, excessive strain on the joint can lead to pain even at rest. The diagnosis is usually made using an X-ray or magnetic resonance imaging (MRI). In some cases, however, the doctor can only determine during arthroscopy (joint endoscopy) whether the extent of the cartilage damage can be treated with a cartilage transplant. In cases of localized cartilage damage, a cartilage transplant may be an option.

In autologous cartilage cell transplantation (ACT), cartilage is harvested from a non-weight-bearing area of the body during an initial arthroscopy. Using a specialized procedure, the fibers are then removed to expose the cartilage cells (chondrocytes).

The exposed cartilage cells can then be cultured in a test tube—some cartilage transplant centers use approximately 20 million cartilage cells as a suitable basis for further cultivation of grafts. In this process, the patient’s own cartilage is cultured in a laboratory on various carrier materials (matrices) to form a larger cartilage graft. This process usually takes several weeks.

The graft or matrix is transplanted to the damaged site—for example, in the knee—during a second procedure, which may be performed arthroscopically or via open joint surgery. In cases of deep defects—usually caused by trauma—that extend to or even into the bone, the bone may need to be reshaped using spongiosoplasty.

Over the course of the next few months, new cartilage that corresponds to natural cartilage develops from the cartilage cells of the graft. Joint areas well-suited for cartilage transplantation include:

• the femoral condyles of the knee joint,
• the posterior surface of the kneecap, and
• the talar articular surface at the ankle joint.

In cases of knee joint injuries, meniscus tears or cruciate ligament injuries must be treated surgically at the same time to prevent further joint damage after the operation. However, this requires an individualized treatment plan.

The main problems associated with cartilage transplantation are incomplete integration of the transplanted cartilage and a graft that cannot bear weight. Older individuals, those with pre-existing conditions, smokers, and patients who have previously undergone surgery on the same joint are at a higher risk of graft failure. In addition, repeated arthroscopy always carries the risk of infection with bacterial pathogens, which can significantly slow down the healing process.

The prognosis for healing is better for isolated, smaller defects than for larger ones. Cartilage damage caused by accidents has a better prognosis than cartilage damage caused by osteoarthritis. The autologous (from the patient’s own body) transplanted articular cartilage is superior in composition to other procedures involving artificial joint replacements. Better long-term results than with conventional therapies are expected for cartilage cell transplantation.

The freshly transplanted cartilage is not yet able to bear weight. It therefore requires a specific post-operative care regimen depending on the affected joint. This includes several weeks of weight-bearing restriction and limitations on range of motion.

The goal of autologous cartilage transplantation is to restore athletic ability in younger athletes with accident-related cartilage damage. Prerequisites for this include a graft that has healed stably, restored coordination, and good muscle recovery. Overall, studies show that postoperative athletic training conducted over a period of two to three years can significantly improve the chances of healing and long-term outcomes.

Compared to major surgery involving an artificial joint replacement, autologous cartilage transplantation offers significant advantages, such as:

• less pain due to a smaller surgical incision,
• restoration of the joint’s load-bearing capacity through natural cartilage,
• improved mobility through the restoration of the natural structures in the articular cartilage,
• regeneration of the body’s own cartilage layer, and
• avoidance of artificial joint replacement (endoprosthetics).

However, the cartilage cell transplantation procedure cannot be performed without restriction on all patients. The best results are expected under the following conditions:

• Age > 30–35 years,
• active athlete,
• no previous joint surgery,
• male,
• pain symptoms lasting no longer than 12 months,
• a defect of only minor size, and
• non-smoker.

The exact costs of a cartilage cell transplant can vary from person to person and also depend on the specific surgical and hospital costs. However, it can be assumed that the cultivation and multiplication of the cartilage cells in the laboratory alone costs well over 4,500–6,500 euros.

If the indication is correct, the responsible health insurance provider will generally cover the costs of an autologous cartilage cell transplant. Despite the expected high costs of the procedure, its cost-effectiveness has recently been demonstrated in studies from the U.S. and Germany. Furthermore, the procedure is also considered beneficial by the Joint Federal Committee (G-BA) in Germany.

Bone cell transplantation is a well-studied procedure in orthopedics and trauma surgery. However, in order for an orthopedic surgeon or trauma surgeon to be authorized to perform autologous cartilage transplants, extensive certification and continuing education are required.

Furthermore, the surgery involves a significant amount of bureaucratic effort, which is why only a few doctors and centers have specialized in cartilage cell transplantation. At Leading Medicine Guide, we list several specialists and orthopedic centers that offer autologous cartilage transplantation and possess expert knowledge and extensive surgical experience in this field.