Missing Cartilage
Note the large hole in the cartilage

Cartilage defects or holes in the cartilage on the end of your bones can herald the onset of osteoarthritis.  Cartilage is a firm,  smooth white substance found on the ends of our bones.  When we finish growing we have a rather thick layer of it on both sides of the knee joint.  Trauma, sports injuries, and degeneration can cause defects or holes in the cartilage surface of the knee.  If you are missing cartilage because of an injury, the remaining cartilage is subject to an increase in stress which can lead to osteoarthritis.

A natural tissue graft can spur regeneration of cartilage and improve symptoms in patients who have cartilage damage in their knee, according to a study by researchers

via Cartilage Repair Technique Shows Regeneration of Knee Cartilage

Cartilage InjuryRepairing holes in the cartilage, or cartilage defects can be challenging.  There is little consensus on which technique is best.  The latest technique available to treat cartilage defects is the DeNovo Cartilage Repair Technique, and the early results are promising.

Prior to DeNovo, the options available to us included procedures where we made small holes into the area where the bone marrow resides.  The goal of this procedure was to get the bone marrow cells to populate the hole in the cartilage and grow into a new cartilage surface.  Although somewhat successful, this “microfracture” procedure did not produce “normal” cartilage, and the results tend to degrade with time.

Prior to the approval of the DeNovo cartilage repair process, we were also able to take pieces of cartilage from a cadaver and transplant it into the defect in your knee.  Although this procedure works well for many cartilage defects, the issue is the availability of fresh cartilage grafts and the size of the cartilage defect that we are able to treat.

One last technique available to us is called the Carticel procedure.  This technique involves two operations.  One to harvest cartilage cells from your knee, and a second procedure to re-implant those cells a few months later after they had been grown – amplified in a laboratory at Genzyme.

What is the DeNovo Cartilage Repair Technique?

The DeNovo process uses cartilage tissue from organ donors under the age of 13.  The reason why the age of the donor is important is that children possess incredible healing and regenerative potential in comparison to adults.  In addition, the cartilage cells in children are far denser. This means there are many more cells per graft than if we used cartilage cells from a mature adult.  These young cartilage cells also lack certain proteins, so there is no risk of rejection.

DeNovo Cartilage RepariHow is the Denovo Cartilage Repair Performed?

During the cartilage repair process, an open incision is made in the front of the knee to expose or reveal the defect in the cartilage.  The defect is prepared, the cartilage cells are spread within the defect and the cells are kept in place with a special biological glue- called fibrin glue.  The incision is closed, and the body hopefully takes care of the rest. Over the next few months, the cartilage cells should divide, grow and produce a substance we the matrix… It is the matrix that produces the dense, smooth surface we see when looking at the cartilage.


Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

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About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

6 comments on “DeNovo Cartilage Repair

  • How long after surgery (knee matrix) do the DeNovo cells continue to grow? At what point would the cartilage be stable enough for high impact activities

    • no one really knows … I wait 6 months and then scope my De Novo patients to see whether or not the new cartilage is firm and well attached.

  • I had surgery about 18 weeks ago on my knee (a Denovo implant was put in on the medial side of my femoral condyle). I still feel significant soreness and pain in my knee (especially when walking up and down stairs and up and down slopes. I cannot put all of my weight on the operative knee and then bend it without a lot of pain. Is this normal? I had an MRI done at 12 weeks and the radiologist in his report stated that he believes the graft has partially come out. My surgeon says that the MRI isn’t conclusive on that. He says it is possible that the fibrin glue he put on top of the graft is what the radiologist is looking at. He is not sure how to proceed as it could be a number of things…over fill, hypertrophy of the repair tissue, the graft is peeling up etc. He says he might need to do a scope and clean things up a bit. I am the first person this surgeon has done this procedure on…so he is unfamiliar as to what is typical for recovery and pain. Is it possible that if there is overfill of the graft that it will just pack down over time? Or do I need this fixed? Right now the pain is worse than when I went in for surgery.

  • Thank you so much for pointing out that I had a cartilage defect in my comment on your post for Will Meniscus Tears heal.The first OS didn’t mention a thing about it and so I have seen other doctors.

    I live in the San Francisco Bay Area, and so far the Sports Medicine Doctors I’ve seen only offer ACI. I read online that ACI still creates some Fibrocartilage. Is it true that deNovo is more superior to ACI in this aspect? How can I find a provider near me?

  • Dear Dr. Luks,
    I am an active 49 yr old woman (I love sports and hiking) and have been diagnosed recently with Hallus Rigidus in my left foot. Would the DeNovo cartilage regeneration be an option for cartilage repair in my toe joint? Or is MACI used to stimulate cartilage growth/ repair? Or any other stem cell injections?
    I am very interested in cartilage regeneration given my age. I look forward to your advice.
    Kind regards

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