You specialize in cartilage transplantation in the knee joint. When does a patient with a meniscus problem need cartilage transplantation? When does ligament tear or patellofemoral knee joint injury needs cartilage transplantation? Okay? That’s an excellent question because I am a specialist and a referral doctor for freshers osteochondral cartilage transplantation. I perhaps use cartilage transplantation treatment in one out of thirty knee problem cases that I see. Cartilage transplantation itself must be done only in the most extreme cases of knee problems. Very rarely do I perform cartilage transplantation treatment as the first-line treatment of knee problems. Most patients I have transplanted have been treated previously 2 or 3 or 4 times. I remember one patient with a knee injury who was treated 11 times. He was 29 years old. He was operated on 11 times before. These patients are the best cases for cartilage transplantation when all other knee injury treatments have failed. We have a window for knee cartilage transplantation. We have the osteochondral allograft treatment available to restore a good quality of life. I know other cases when patients have what we call “trauma consequences.” For example, after a tibial plateau fracture, or patella fracture, the regularity of the joint line has been severely damaged. In those cases, you can also offer this kind of cartilage transplantation treatment. But in most cases, a patient had been treated surgically several times before the fresh osteochondral transplantation is offered. In other less severe cases, I perform the less aggressive or less radical treatment. It is a different method of cartilage transplantation. There are different tissue scaffolds in the cartilage layer. Also, joint alignment is an essential aspect to be considered in cartilage transplantation. As I said before, sometimes, we are looking at the MRI for only a cartilage injury. But we need to have a holistic view of the lower limb. We must see how good is the alignment of your knees because we can treat a specific area of the knee with a cartilage problem. But due to the malalignment, there is an overload in that specific knee joint compartment. We may treat a local problem with a cartilage transplant. Then we will try to perform a cartilage regeneration procedure. But it will most probably fail if we don’t address this overload and misalignment concomitantly. So that’s also very important in most of the cases when I perform osteochondral transplantation. In around 60 or 65% of the knee injury cases, I also perform some kind of knee realignment procedure.
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