Knee Cartilage Reconstruction: A Frontier in Regenerative Medicine Knee cartilage reconstruction represents a cutting-edge frontier in regenerative medicine, offering significant improvements for those suffering from pain and limitations due to the deterioration of joint cartilage.
Through innovative methods and state-of-the-art technologies, it is possible to restore knee functionality, thereby improving patients’ quality of life.
We explore this topic in the following sections:
Knee Cartilage Reconstruction Surgery
Cartilage reconstruction surgery has significantly evolved in recent years. The procedure may range from minimally invasive techniques to more complex interventions, depending on the extent of the damage and the patient’s specific needs.
Based on the characteristics and severity of the lesion, including whether the subchondral bone is involved, various treatment options are available:
- Cycles of hyaluronic acid injections with variable molecular weight
- Use of pulsed electromagnetic fields [1]
- Injection of stem cells from adipose tissue, harvested from the patient’s abdomen (via liposuction)
- [2] Injection of PRP (Platelet-Rich Plasma), taken from the patient’s blood
- [3] Cartilage shaving, microfractures, autologous chondrocyte transplantation via arthroscopy
- [4] Autologous osteochondral grafts (mosaicplasty) via arthroscopy
- [5] Biomimetic scaffolds such as “Maioregen” [3]
Knee Cartilage Reconstruction: The Scaffold
A video produced by the NaBi – Nanobiotechnology Laboratory – of the Rizzoli Orthopedic Institute illustrates the sequence of scaffold implantation in an osteochondral lesion of the knee.
The lesion is first prepared to receive the scaffold, which is then inserted and covers the entire area. The treatments listed above may be combined or used individually, depending on the lesion’s location and size.
The technique used will depend closely on the type of lesion and the patient’s characteristics. Each treatment option is followed by a specific period of rest and a tailored rehabilitation physiotherapy protocol.
For non-conservative procedures, return to high-impact sports may take 4 to 12 months. [4]
Knee Cartilage Reconstruction with Stem Cells
One of the most promising methods for cartilage reconstruction is the use of stem cells. This technique involves harvesting stem cells from the patient—or donors—then cultivating and injecting them into the knee, where they differentiate into cartilage cells, promoting tissue regeneration.
An innovative option that does not require long cell cultivation periods is the injection of cryopreserved micro-fragmented adipose tissue (LIPOBANK).
A portion of adipose tissue, taken from the patient in a single procedure, is micro-fragmented and injected into the joints. The remaining tissue is frozen and remains viable for up to 5 years, allowing for scheduled injections to control joint inflammation.
Knee Cartilage Deterioration
Articular cartilage is a tough, smooth connective tissue that covers joints and plays a key mechanical role in reducing friction and cushioning impact, thanks to its high water content and specific proteins.
Although it contains specialized cells called chondrocytes, the tissue lacks blood vessels and nerves, resulting in minimal regenerative capacity.
Knee cartilage, located both between the femur and tibia and between the femur and patella (femoropatellar joint), is continuously exposed to mechanical stress. Athletes in particular endure high mechanical loads, which can damage cartilage due to trauma or repetitive stress. When cartilage loses its properties, we speak of a lesion. The most commonly used classification identifies four types:
- Chondromalacia (softening);
- Fissure affecting < 50% of cartilage thickness;
- Fissure affecting > 50% of cartilage thickness;
- Exposure of subchondral bone (complete cartilage loss).
The repair process often results in fibrous tissue that only partially resembles the original cartilage. Lesions may be asymptomatic (in some cases, severe degeneration is observed with little or no pain) or may cause pain, swelling, or sensations of locking or instability in the knee.
Joint function is first impaired by pain, then by loose cartilage fragments within the joint cavity, leading to swelling and blockage. Diagnosis is made exclusively through a specialist medical visit, based on clinical symptoms and imaging studies such as X-rays and MRI.
What to Do If Knee Cartilage Wears Down
When knee cartilage wears down, it is crucial to consult a doctor to assess the extent of the damage and discuss treatment options. Strategies may range from lifestyle changes and physiotherapy to more invasive treatments like injections or surgery.
Cartilage deterioration is a common condition that may result from injury, age-related wear, or diseases such as arthritis. It can cause pain, stiffness, and reduced joint mobility.
Treatments may be used alone or in combination, tailored to the lesion’s location and extent. The chosen technique will depend on the lesion type and patient characteristics.
Knee Injections
Knee injections can provide temporary pain relief for those with cartilage deterioration. These may include corticosteroids to reduce inflammation or substances like hyaluronic acid to lubricate and protect the joint, improving knee function.
This treatment can be used alongside medication and has shown good results in managing moderate cartilage damage.
How Is Cartilage Rebuilt?
Cartilage reconstruction can be achieved through various methods, including surgical microfracture, autologous chondrocyte implantation, and stem cell use. The best method depends on the patient’s specific condition and the specialist’s judgment.
In mild to moderate cases, less invasive treatments may be considered, such as:
- Stem cell therapy, where fat-derived cells from the abdomen are purified and injected into the knee;
- PRP (Platelet-Rich Plasma), taken from the patient’s blood, which stimulates the joint environment and reduces inflammation.
If these treatments fail to resolve the issue, surgery may be necessary to restore walking ability and halt cartilage degeneration.
What to Take to Rebuild Cartilage?
To support cartilage reconstruction, nutritional supplements such as glucosamine, chondroitin, and hyaluronic acid may be recommended, along with a diet rich in anti-inflammatory foods. These supplements can help maintain joint health but are not substitutes for advanced medical treatments. Additional support can come through diet.
To increase collagen production—a protein essential for the function of cartilage-producing cells—it’s recommended to consume foods rich in:
- Vitamin C;
- Vitamin D.
To strengthen cartilage, one can also eat foods high in lysine, an essential amino acid not produced by the body. Dietary supplements can further assist tissue regeneration.
Knee Cartilage Reconstruction: Prof. Marcheggiani Muccioli’s Credentials
Prof. Giulio Maria Marcheggiani Muccioli has distinguished himself in orthopedics, graduating with honors in Medicine and Surgery at the University of Bologna in 2006, specializing with honors in Orthopedics and Traumatology at the Rizzoli Orthopedic Institute, and earning a PhD in Surgical Sciences.
He is an Associate Professor of Orthopedics at the University of Bologna’s Faculty of Medicine and Surgery, with a focus on biomechanics and lower/upper limb pathology.
He expanded his expertise through international fellowships in the UK, Japan, and the USA, establishing himself as an orthopedic surgeon with extensive experience, performing over 250 surgeries annually.
He plays a key role in training new generations of doctors through academic teaching in various medical and surgical disciplines.
He is one of only ten Italian surgeons selected in the last 20 years by the American Knee Society for the prestigious John Insall Knee Surgery Fellowship. His contributions include over 250 scientific publications and constant academic and conference involvement, demonstrating his commitment to advancing minimally invasive techniques, sports medicine, and innovations in knee and shoulder treatment.
Bibliography
- Conservative treatment of spontaneous osteonecrosis of the knee in the early stage: pulsed electromagnetic fields therapy. Marcheggiani Muccioli GM, Grassi A, Setti S, et al. Eur J Radiol. Eur J Radiol. 2013 Mar;82(3):530-7.
- Characteristics and Properties of Mesenchymal Stem Cells Derived From Microfragmented Adipose Tissue. Carelli S, Messaggio F, Canazza A, et al. Cell Transplant. 2015;24(7):1233-52.
- Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, et. al. Knee Surg Sports Traumatol Arthrosc. 2013 Nov;21(11):2509-17.
- Arthroscopic second generation autologous chondrocytes implantation associated with bone grafting for the treatment of knee osteochondritis dissecans: Results at 6 years. Filardo G, Kon E, Berruto M, Di Martino A, Patella S, Marcheggiani Muccioli GM, Zaffagnini S, Marcacci M. Knee. 2012 Oct;19(5):658-63.
- Arthroscopic cartilage transplantation. Zaffagnini S, Giordano G, Kon E, Lo Presti M, Bruni D, Marcheggiani Muccioli GM, Marcacci M. Rev Chir Orthop Reparatrice Appar Mot. 2006 Dec;92(8 Suppl):4S13-7.
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