Over the past thirty years, however, a new era has begun in orthopaedics. Today, the goal is not only to reduce pain, but also to preserve the patient’s natural joint for as long as possible.
“Joint replacements revolutionised orthopaedics and have delivered excellent results. However, over the past decades, their limitations have also become apparent. Loosening, infection and fractures around the implant have encouraged us to consider biological solutions whenever possible,” says Professor Dr. László Hangody, Professional Director at Dr. Rose Private Hospital.
This shift in approach has driven the worldwide development of cartilage restoration techniques. Hungary has also played an important role in this field: several procedures developed or further advanced with Hungarian involvement have now become part of international orthopaedic practice.
Another technological breakthrough also contributed to this progress.
“Arthroscopy truly opened our eyes. Once we were able to identify cartilage defects at an early stage, it naturally became important not only to see them, but also to be able to treat them,” Professor Hangody explains.
Research soon focused on finding ways to create a cartilage surface that resembles the original tissue as closely as possible rather than simply producing scar tissue.
Mosaicplasty: A Hungarian Innovation Used Worldwide
Mosaicplasty is one of the most important methods for treating medium-sized cartilage defects. During the procedure, small cylindrical osteochondral grafts containing both cartilage and bone are harvested from a less weight-bearing area of the joint and transplanted into the damaged surface in a mosaic-like pattern. Because these grafts contain intact hyaline cartilage, the procedure can restore a cartilage surface of excellent biological quality.
“The greatest advantage of mosaicplasty is that we can restore genuine hyaline cartilage for the patient. This was the first technique to demonstrate that a durable cartilage surface could also be restored biologically,” explains Professor Hangody.
The procedure requires a suitable donor site and is therefore primarily used for medium-sized cartilage defects.
Mosaicplasty was developed by Professor Dr. László Hangody and his colleagues more than three decades ago. It has since become part of routine practice in orthopaedic centres around the world and has also provided the foundation for the development of numerous subsequent cartilage restoration techniques.
Biodegradable Scaffolds: Helping the Body Rebuild Cartilage
One of the most dynamically developing areas of modern cartilage restoration is the use of biodegradable, absorbable scaffolds. The emergence of this approach is also partly linked to mosaicplasty.
“Mosaicplasty worked extremely well, but in a small percentage of cases patients experienced discomfort at the donor site from which the osteochondral grafts had been harvested. We wanted to reduce this risk.”
One solution was the development of a specialised biodegradable scaffold that the surgeon places into the prepared cartilage defect. The implant gradually degrades while providing an environment that supports the formation of new tissue.
“Biodegradable materials already existed thirty years ago, but they had not been developed for cartilage restoration. Our aim was to create a material specifically designed to support cartilage regeneration,” Professor Hangody explains.
These technologies have continued to advance in recent years. Today, scaffolds are often supplemented with biologically active substances, growth factors or mesenchymal stem cells obtained from the patient’s own bone marrow.
During surgery, the surgeon prepares the cartilage defect, inserts the scaffold and then impregnates it with bone marrow aspirate obtained from the iliac crest or the ends of long bones. The regenerative cells introduced in this way help stimulate the formation of new tissue.
“This technique does not produce true hyaline cartilage, but rather very high-quality fibrocartilage. Nevertheless, it provides substantially better results than can be achieved with traditional regenerative procedures.”
Biodegradable scaffolds are particularly suitable for smaller cartilage defects.
Cartilage Cell Transplantation: The Patient’s Own Cells Rebuild the Cartilage
For larger but relatively superficial areas of cartilage loss, autologous chondrocyte implantation is one of the most advanced biological reconstruction techniques currently available.
The procedure consists of two stages. During the first operation, the surgeon takes a small cartilage sample from a non-weight-bearing area of the patient’s joint and sends it to a specialised laboratory. There, the cartilage cells are isolated from the extracellular matrix and multiplied over several weeks until several million cells have been produced.
“Within three to four weeks, a cell culture can be created containing up to ten million cartilage cells per millilitre. During the second operation, these cells are implanted back into the cartilage defect, generally with the help of a biodegradable scaffold,” Professor Hangody explains.
One of the main advantages of the technique is that, under appropriate conditions, it can enable the formation of a cartilage surface that closely resembles the quality of the original hyaline cartilage.
Its disadvantage is that it requires two operations and cell culture is extremely costly, meaning that the procedure is currently available only to a relatively small number of patients.
Fresh Osteochondral Allografts: Replacing Both Cartilage and Bone
In the most severe cases, not only the cartilage but also the underlying bone may be significantly damaged. In these situations, the previously described techniques are no longer sufficient.
“When not only the cartilage surface but also the bone beneath the cartilage is missing, the best solution currently available is the transplantation of a fresh osteochondral graft obtained from a tissue bank.”
The orthopaedic team at Dr. Rose Private Hospital aims to make this procedure available to patients as soon as possible.
There Is No Universal Solution
Modern cartilage restoration now offers several different biological techniques, including mosaicplasty, biodegradable scaffolds, autologous chondrocyte implantation and fresh osteochondral allografts. However, no single method is suitable for every patient.
“The key to successful cartilage restoration is not one miracle technique. Our task is to select the appropriate method according to the size, depth and nature of the damage. Together, these four techniques cover almost the entire spectrum,” Professor Hangody emphasises.
For this reason, successful treatment always depends on an accurate diagnosis, carefully established indications, precise surgical execution and personalised rehabilitation.
Modern Procedures with Different Levels of Access
Cartilage restoration techniques have developed significantly over recent decades, but the funding and availability of the individual procedures differ.
“Mosaicplasty is also funded by Hungary’s National Health Insurance Fund (NEAK), while the other procedures are currently available only in private healthcare,” says Professor Dr. László Hangody.
Accordingly, when selecting the most appropriate treatment, the availability of the procedure may need to be considered alongside medical factors.
Early Diagnosis Is Key
Persistent pain in the knee, ankle or other joints should not simply be regarded as a natural consequence of ageing. The earlier cartilage damage is identified, the greater the chance that it can still be treated using biological methods.
At Dr. Rose Private Hospital, Professor Dr. László Hangody and his orthopaedic team use state-of-the-art diagnostics and modern cartilage restoration procedures to help identify the treatment option best suited to each individual injury.
