I’ve been reading up on a type of surgery used to repair holes in the knee cartilage. I don’t mean the meniscus, but the cartilage that lines the joint surface. At least that’s how it’s been explained to me about what’s wrong with my knee. I discovered in my reading that European surgeons have a better method for using transplanted cartilage cells. Why don’t American surgeons use this too?

Significant (deep and wide) injury to the cartilage lining the surface of the knee joint can be treated with a transplantation of cartilage cells called chondrocytes. The transplanted chondrocytes usually come from the patient’s own knee — from another area that has little weight put on it. The procedure is called an autologous chondrocyte implantation or ACI.

Once the donor cells have been harvested, they are taken to a lab where more cells can be produced from the graft. When ready, the cells are placed in the defect (hole) and then covered over with a patch. The patch can be made of bone (the outer layer of bone called the periosteum) or it can be made of collagen. Collagen is the basic protein building block that makes up most soft tissue.

Collagen patches are available in the United States and approved for use by the Food and Drug Administration (FDA) but not for knee cartilage repairs. Right now they are only approved for rotator cuff repairs, tendon reconstruction surgery, and dental procedures. When used as a patch for autologous chondrocyte implantation, it is considered an “off-label” use. As you have found out, European surgeons have unlimited approved use of the ACI-collagen patches for chondral repair.

Studies have shown that about half of all ACI procedures done by U.S. surgeons are already being done with the collagen product instead of the periosteum. This off-label use of ACI-collagen patch for significant knee articular cartilage lesions has been proven cost-effective. It’s probably only a matter of time before enough studies show its value and the FDA approves it for this particular use.