Cartilage Transplants Help Repair Shoulder Joints

Doctors are finally beginning to use cartilage transplants to fix damaged shoulder joints instead of relying on arthroscopic surgery or impermanent implants to do the job. But only a few hospitals nationwide have taken up the practice.

"For a long time, surgeons have been looking for an alternative to joint replacement that is more effective than simply cleaning out the joint arthroscopically," said Brian Cole, an orthopedic surgeon at Rush University Medical Center, in Illinois, who specializes in cartilage restoration of the joints. "In cartilage restoration, we regrow fresh tissue or use donated tissue. It's an exciting and promising new treatment for damaged joints, now including the shoulder."

Physicians usually treat shoulder cartilage problems, as with any joint, in a multistage process, starting with physical therapy, proceeding to anti-inflammatory drugs and steroid injections. If these don't work, arthroscopic surgery is in order, in which a small incision is made in the shoulder and a small camera and instrumentation are inserted to clean out the damaged cartilage and scar tissue.

This surgery often produces only short-term benefits, because it doesn't address the root damage to the cartilage. But with cartilage transplants, orthopedists now have two additional options. They can take some cartilage tissue from a patient's own body and grow a larger mass of it in a specialized tissue repair laboratory to create tens of millions of new cells. The patient's shoulder is then operated on to remove the defective cartilage, and the resulting gap is covered with a patch - a piece of periosteum, the thin connective tissue that sheaths bone.

The cultured cartilage mass is then introduced under the patch, where it continues to grow and becomes integrated with the nearby tissue. In the doctors' second option, a cylinder of cartilage is removed from a suitable cadaver and inserted into the gap in the shoulder cartilage, where it too grows and merges with adjacent tissue. The two procedures are generally targeted at young and active patients.

Inserting metal and plastic implants isn't a good idea in such patients, because they eventually wear out, and the patient must then undergo a much more complicated operation to re-correct his condition. "For younger patients in severe pain, with limited movement because of cartilage injury or wear, transplants are a new and emerging option that can help them return to an active lifestyle," Cole said.