Have you ever heard of cartilage transplants for knees in older adults? I’m not ready for a total knee replacement. I thought maybe I could have one of these transplants to help delay the full knee surgery but my surgeon says I’m too old. Is this really the case? Are these transplants only for young people?

Full-thickness cartilage defects (down to the bone) in the knee come with two major problems. First, cartilage doesn’t heal well. Second, treatment often results in failure. One of the newer treatment options is autologous chondrocyte implantation (ACI).

In this procedure, chondrocytes (cartilage cells) taken from normal, healthy joint tissue are used to make more chondrocytes. The new cells fill in the hole where the defect exists in the damaged cartilage. It works well, but it has been limited mostly to younger patients. Older adults (45 years old and older) have been excluded from this approach.

Studies on the use of autologous chondrocyte implantation (ACI) among older adults are very limited. And there’s a basic philosophy that by age 45 or older, the patient would do better to have a total knee replacement instead of ACI. Recovery is faster with fewer problems. But a new study reports that cartilage implantation was just as successful in older patients as it is in younger ones.

And, in fact, comparing results of ACI in younger versus older patients in this study showed similar results. The success and failure rates were about the same between the two groups. Young or old, the same types of exclusions should remain in effect. These include the presence of inflammatory joint disease, metabolic or crystal disorders, ligament instability, and poor knee joint alignment. ACI is not an option in such cases or if X-rays show 50 per cent (or more) loss of joint space in the knee.

ACI may be extended to older adults who are healthy and active and who don’t want a total knee replacement just yet. They may find that pain relief and improved joint function available after ACI makes it possible to return to their previous social and recreational activities.

Careful patient selection (young or old) remains a key factor in the success of the ACI procedure. Age does not have to be an immediate strike against you. Obesity, noncompliance with the rehab program, tobacco use, and loss of joint space are major risk factors for failure. Such patients must be screened for and excluded from this type of surgery.