Knee cartilage repair surgery
An effective and reliable treatment
Knee articulate cartilage repair is a reliable solution for patients who want relief from the discomfort caused by the following symptoms: gnawing ache or pain in the knee joint, “crunching” sound, “locked” sensation and swelling. The surgery is also recommended for osteoarthrosis sufferers (also called arthrosis, osteoarthritis or degenerative joint disease), which manifests itself in damage to the articulate cartilage, the surrounding soft tissue and the bones.
We offer the following treatment options for conditions involving damaged cartilage: medicines, kinesiotherapy, physiotherapy, injections (corticosteroid, hyaluronic acid, PRGF, nStride, stem cell therapy). When none of the above work, or when the damage to the cartilage is extensive, surgical treatment is recommended.
The knee cartilage repair surgery performed at our Centre uses the most advanced techniques: spongialization + covering with coagulated plasma (we are the only centre in Lithuania performing this unique cartilage restoration surgery!), scaffold, membrane assisted surgery, which we perform most frequently, arthroscopic surgery, arthroscopic microfracture surgery, natural cartilage repair – Matrix-Induced Chondrocyte Implantation (MACI), autologous osteochondral transplantation/mosaicplasty, mesenchymal stem cell treatment.
A number of factors determine which cartilage repair method is the most suitable for each individual case. If the pain has been bothering you for several weeks or more, make sure you get an appointment to see your doctor. Any delay may limit the choice of the possible treatment options.
Knee cartilage repair surgery price
What factors affect the price?
The prices indicated below apply to citizens of the Republic of Lithuania and the European Union.
If you are coming from another country please check the price by telephoning or sending an email.
When are the examinations are carried out:
2 hours for the most common (routine) blood tests and urinalysis.
The reports of computed tomography (CT), magnetic resonance tomography (MRT) imaging and other
instrumental examinations are usually ready immediately, i.e within 2-3 hours after the examination.
What you need to know about surgery?
Spongialization technique for knee cartilage repair (covering with coagulated plasma) is the standard arthroscopic surgery. The optical devices are inserted through small incisions, the joints are examined from the inside and the damage to the cartilage, including the size of the affected area, are assessed.
The patient’s own blood is prepared and processed, it is separated out to create platelet and growth factor rich plasma which is then combined with the healthy cartilage fragments and coagulated using a special method. A solid plasma and cartilage mixture transplant is then attached to the defected area of the cartilage.
If the area of the damage is not extensive, i.e. only a few cm2, the surgery is minimally invasive and is performed through small incisions. If the damage to the cartilage is extensive, a 5-7 cm incision is made to allow for the defected area to be properly covered. No additional membranes or synthetic gels are used for this purpose.
The surgery takes about one hour and we are the only centre in Lithuania that performs it!
Scaffold, membrane assisted surgery is the most common surgery. Scaffolds and membranes are natural polymers, collagen, hyaluronic acid, chondroitin-6-sulfate, silk fibroin. These are biologically active substances, that encourage cell adhesion and growth. During the surgery, one of these membranes is transferred to the joint and attached to the healthy cartilage. New healthy cartilage cells start being produced and the damaged cartilage tissue is restored.
Arthroscopic surgery is suitable for patients who have been diagnosed with grade 1-2 chondromalacia with small cartilage defects, and grade 3-4 osteoarthrosis. The damaged cartilage, loose bodies etc. are removed during the operation.
Arthroscopic microfracture surgery can be performed on small – 1-2 cm2 cartilage defects.
During the surgery, multiple holes, or microfractures are made, the bone marrow cells and blood from the holes combine to form a clot, which is rich in protein and specific cells that are able to regenerate. It is used to cover the defective area. A healthy hyaline cartilage forms in approximately 4 months.
Matrix-Induced Chondrocyte Implantation (MACI) is a natural method that can regrow the cartilage. During the surgery a small sample is taken from the patient’s healthy cartilage, which is then transported to laboratories in Germany. The cultivated cartilage is implanted in the defective area. It is a two-step procedure which is not performed very frequently as we prefer not to perform more interventions than necessary.
Autologous osteochondral transplantation/mosaicplasty is performed when osteochondral damage is <4 cm2. It is suitable for young and active patients.
During the surgery, the damaged cartilage is replaced with osteochondral allograft or autologous transplant.
Mesenchymal stem cell treatment
The Lipogems technology is used to obtain stem cells from the patient’s bone marrow or fat tissue, and these are then injected into the damaged area of the articular cartilage. This aids the regeneration of the cartilage.
Following the surgery you will stay in hospital for 24 hours under the observation of our medical staff. You will leave the hospital on crutches and will continue using them for up to 6 weeks.
During the recovery period it is essential to protect the newly formed cartilage from any trauma, therefore you will have to use crutches for up to 6 weeks, gradually increasing the load on the operated limb. Patients are referred for rehabilitation treatment (exercises at home and/or in the gym and/or in the pool; massages, bicycle, treadmill). Following the surgery, the patients have to work on increasing their muscle strength, and aid the regeneration and formation of the cartilage. Patients can return to their full sports routine 13 weeks after surgery.
With a gradual and correct increase of physical load, the patient can again get involved in their favourite physical activities 7-12 months following the surgery.
Tests required before the surgery:
Complete blood count;
Activated partial thromboplastin time (APTT);
Blood glucose test;
Electrocardiogram (ECG) including interpretation.
Patients can bring their test records from other healthcare institutions, or they may have them done at the Medical Diagnostic and Treatment Centre. The tests take 2 hrs. Prices of the tests performed at the Centre. The tests must be performed no earlier than 14 days before the surgery.
for choosing us
We can perform the required tests and confirm the diagnosis in 1 day.
Surgery can be performed within 2-3 weeks after the consultation. You can travel by plane the day after the surgery.
Surgeries are performed by one of the most experienced surgeons in Lithuania.
Hospital acquired infection rate – 0 in 5 years.
Frequently asked questions
The knee cartilage can become damaged for a number of reasons, but in most cases it is caused by trauma. It can be any type of trauma, such as acute momentous trauma, sports trauma, falling over, twisting the joint in an awkward way, a car accident or another high impact trauma. The damage can be also caused by long-term impact, e.g. prolonged walking or running. If you have not been physically trained to deal with such a load, and your knee has not been subjected to it before, the cartilage may be too weak to endure it and can become damaged.
Cartilage damage is also associated with obesity, when the joints have to carry too much weight, hormonal imbalance and autoimmune diseases.
Injured muscles and tendons, as well as fractured bones have the ability to heal and grow back together. However, because cartilage tissue does not contain blood vessels or nerves, its chances to regenerate or heal are very limited.
MRT (magnetic resonance tomography) is the main test, as it presents images of soft tissue and cartilage. It is used to assess the condition of tendons and menisci, the location of the cartilage damage, the size and depth of the affected area, and the condition of the surrounding bone. This helps in the selection of the treatment options and surgery method.
The surgery technique and method depend on the extent, place, depth of the damaged area, its origin, as well as the age and profession of the patient (normally patients have to be under 50). Spongialization, which is a method of articulate joint restoration, when a coagulated plasma transplant is formed using the patient’s own blood, is more suitable for recent injuries and when there is substantial healthy cartilage that can be used for surgery. All the above factors play an important role when it comes to good surgery results.
The conservative treatment methods: physiotherapy, kinesiotherapy, anti-inflammatory and pain reducing treatments, hyaluronic acid, plasma, steroid injections are used when the cartilage defects aren’t deep, or are superficial. Certain life-style changes can also be recommended, such as weight monitoring, changing of sports or work activities.
Other cartilage regeneration methods are recommended for older patients. When the cartilage damage is extensive and the osteoarthrosis is in the advanced stages, we recommend joint replacement or endoprosthetic surgery.
If the damage consists of a full-depth cartilage defect, surgery to restore the damaged cartilage is performed. Different surgery techniques may be used: marrow stimulating techniques, microfracture surgery, osteochondral transplantation, mosaicplasty, use of cartilage bone transplant, autologous chondrocyte implantation, use of collagen membranes, and autologous cartilage tissue implants. Only an experienced doctor can determine which method is best for each individual.
As with any other disease, we risk causing even more damage to ourselves if we fail to seek help in good time when confronted with cartilage, tendon and menisci injuries. The untreated problem leads to osteoarthritis – a degenerative disease of the joint, which may end up in disability.
Statistics show that 5-10% of people over 40 have a deep cartilage defect. That means that the condition affects every 5th to 10th person. In older age, with the progression of the disease, approximately 80% of patients over 75 suffer from the degenerative joint disease – osteoarthritis.
The situation is even worse in the world of professional sports: in up to 38% of contact sports, such as basketball, football and rugby, players are diagnosed with cartilage defects. Following the surgery, only 45-78% of athletes return to their previous physical form.