DeNovo Cartilage Repair

Updated 12/21/2017
deNovo for Cartilage replacement, University Foot and Ankle Insitute Los Angeles

One of the most vexing problems in podiatric surgery over the past few decades has been surgical cartilage repair.

 

The surgeons at University Foot and Ankle Institute are pleased to offer a revolutionary technique, DeNovo cartilage repair. This new technology has shown promise in improving short term and long term outcomes of ankle joint surgery.

 

The DeNovo graft requires only one surgery, which can be performed arthroscopically and offers remarkable regenerative powers. Patients can expect a shorter hospital stay compared to open surgery, and should be back to work in about 4-6 weeks.

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Cartilage is the thick, rubbery material that coats the ends of the bones at the joint. It enables joint mobility and protects the bone from friction caused by movement. An injury can damage the cartilage, which fractures into slivers that may “float” around the joint. The defect is what’s called an osteochondral lesion, and it can cause pain and swelling in the joint and ultimately could develop into osteoarthritis.

 

Traditional Methods to Ankle Cartilage Replacement

The traditional method to repair an osteochondral lesion involves drilling tiny holes in the joint, deep into the bone marrow. The holes stimulate the bone marrow to start generating new cartilage cells to fill in the holes and repair the lesion. This technique is known as “microfracture.”

 

The tricky part of the microfracture method is that cartilage is notorious for its inability to re-generate healthy tissue on its own. Damaged cartilage, even with a boost from bone marrow, can only grow a thin and weak scar tissue, and over time, symptoms will tend to redevelop or worsen. The problem is even more likely to return if the original lesion was particularly large or deep.

 

Another method involves borrowing a sample of cartilage from another place in the patient’s body – usually the knee – and grafting it to the ankle joint. This method can be effective, but it does have its downsides. It requires two open surgeries: one to harvest the healthy cartilage, and another six weeks later to repair the damaged cartilage. This means the patient will have two surgical sites, increasing the risk for complication and increasing the amount of time it takes to full recovery.

 

The DeNovo Cartilage Repair Technique

Cartilage repair that utilizes the patients’ own tissue is what’s known as an autograft. The DeNovo technique instead employs an allograft – that is, a graft of natural, healthy cartilage donated from a cadaver. The DeNovo technique uses cartilage from a young donor, which has a “much larger capacity for self-repair” when compared to mature cartilage, explains Dr. Bob Baravarian.

 

“The DeNovo graft requires only one surgery, which surgeons can perform arthroscopically.” Dr. Baravarian is one of the world’s leading experts on minimally-invasive podiatric surgical techniques. The allograft is secured with fibrin, a biomedical adhesive. Patients can expect a shorter hospital stay compared to open surgery, and should be back to work in about 4-6 weeks.

 

The Regenerative Advantage of DeNovo Cartilage Repair

Immature cartilage has remarkable regenerative powers. Much denser than fully mature cartilage, immature cartilage is packed with cells, which begin to multiply soon after implantation. This new technique has already demonstrated its healing potential in lesions large and small, and even in those problematic lesions that don’t respond to microfracture techniques.

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