Joint preservation is about keeping your own knee for as long as possible by preventing arthritis from getting worse and, when we can, even reversing some of the damage.
I think about many of my patients as “young people with old knees.” They are not really candidates for knee replacement yet, but their pain and swelling are significant enough that ignoring it is no longer an option.
My husband, Dr. Andreas Gomoll, and I recently made a short video discussing joint preservation.
When Cartilage Damage Is Small
Sometimes the problem inside the knee is just a small defect, almost like a little flap of cartilage peeling away from the surface.
In those cases, we can often use relatively minor interventions such as a gel injection or an arthroscopic chondroplasty, where I go in with a camera and small instruments to gently clean up that flap so it no longer catches and causes swelling.
When Defects Are Larger
Larger cartilage defects behave less like a flap and more like a pothole in the road that really needs to be filled in properly.
To address those, we use cell-based treatments: during arthroscopy I take a tiny piece of your cartilage (about the size of a fingernail clipping), send it to a lab where they grow more cells, and then we place those cells back into the defect so they can grow, a bit like seeding new grass.
One approach is called MACI, which uses your own cells, and another is de novo, where juvenile cartilage cells from a younger organ donor are transplanted into your knee to encourage new cartilage growth.
Osteochondral Options
For some patients, an osteochondral approach is more appropriate, where we transplant a plug of cartilage and bone either from you (autograft) or from a donor (allograft).
When we use a donor graft, we carefully size-match it to your knee so the plug fits the defect as closely as possible, and one key advantage is that the cartilage is already fully formed and can survive in another person’s body without the type of rejection issues seen in a heart transplant, though the bone beneath still has to heal and grow in.
If seeding grass is a good analogy for cell-based treatments, osteochondral options are more like laying sod: the cartilage is already mature, but it needs time for the “roots” (the bone) to heal and integrate.
Newer Techniques: CartiHeal
We also have newer techniques such as CartiHeal, which uses a coral-based material placed into cartilage defects to act as a scaffold for your body to heal itself.
The body is actually quite good at working with cartilage when we give it the right environment, and implants like this aim to guide that healing process in a more predictable way.
If you have knee pain, swelling, or cartilage damage and have been told you are too young for a knee replacement, joint preservation may give you options that match the size and type of your defect rather than jumping straight to replacement.