Advanced Cartilage Resurfacing

The Department of Orthopaedic Surgery at the National University Hospital is one of the premier institutions in Singapore and South East Asia performing advanced operations for the treatment of cartilage injury. Cartilage injury in large weightbearing joints such as the knee, ankle, shoulder and elbow may occur in younger patients as a result of injury during athletic or work-related activities. These injuries may result in chronic joint pains, swelling, pain, and an inability to perform normal activities and sports at a reasonable intensity.

Joint surface cartilage (articular cartilage) is very sensitive tissue, with an inherently poor ability to regenerate itself. There are many surgical techniques used in the treatment of cartilage injury. Certain smaller cartilage defects may require only a simple arthroscopic procedure ("scope" or minimally invasive surgery using fibreoptic cameras) which may be done as a day surgery procedure without the need for overnight stay. Some other cartilage problems may require limb realignment surgery. In severe cases and older patients where the cartilage loss is widespread or severe, sometimes the only option is Total Joint Replacement with an artificial joint, an operation that our surgeons are also highly proficient. However, in the majority of cases involving younger (less than 60 years old) patients, avoiding total joint replacement is preferable.

More severe cartilage defects may require advanced surgical techniques like Autologous Chondrocyte Implantation (ACI). The ACI procedure is an advanced technique performed in only a few centers in South East Asia, and in only selected specialist centers worldwide. It involves an initial minimally invasive day surgical operation using the arthroscope to harvest the patient's own cartilage and cartilage cells. These cells are then cultured (grown) in a cell culture laboratory for 3-4 weeks. This duration of time allows for multiplication of the cells, resulting in a large concentrated quantity of the patient's own cartilage cells. The patient is then admitted into hospital for 2-3 days for the main operation. This involves "implanting" the patient's own cultured cells into his or her cartilage defect, resulting in a "regeneration" of cartilage and a filling of the cartilage defect with new cartilage.

The pictures below depict the state of the knee in a patient with cartilage injury. The picture on the left demonstrates a cartilage defect in the knee joint. The picture on the right was taken in the same patient 6 months after autologous chondrocyte implantation procedure, the defect had filled in with new cartilage.



NUH Orthopaedic Surgery has Singapore's largest series of patients treated with the ACI technique. To date, over 100 patients have successfully undergone the procedure. Often, in other centers, the cells are harvested and then they need to be couriered to companies in Australia or Europe for cell culture. The National University Hospital at the National University of Singapore is the only center in Singapore with its own cell culture laboratory. This laboratory is a joint project funded by the hospital, the university, as well as the National Bio-Medical Research Council of Singapore.

An alternative to using chondrocytes would be using the patient's own mesenchymal stem cells which are harvested from their bone marrow to repair the worn-out cartilage and we have completed the procedure using both open and minimally-invasive techniques.

Our surgeons who have a special interest in this field include Professor Lee Eng Hin, A/Prof James Hui, Dr Kevin Lee and Dr Andrew Dutton. Make an appointment with them to discuss the topic in greater detail. For appointments, click here.

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