Progress in Orthobiologics: Stem Cells, Cartilage Repair & Replacement Surgery in the U.S.

Orthobiologics is the emerging science of harnessing the patient’s own healing powers as it applies to orthopedic conditions of the joints, cartilage and muscles and tendons. In many instances, that can be done in an office setting by injectable, non-surgical means. However, to harness the real power of regenerative medicine techniques as they emerge from research, surgery is often required.

For years, repairing cartilage injures of the knee, shoulder, hip, ankle and elbow has been difficult at best, owing to the biologic fact that human articular cartilage tissue, “hard cartilage” as it is referred to, does not heal itself in any real functional or durable manner. Dr. Richard Steadman, with whom I studied in my sports medicine fellowship, pioneered the “microfracture” technique of arthroscopic cartilage repair, and with minor modifications, it remains the “go-to” surgery for this common sports medicine problem. Microfracture drilling, when performed properly,  stimulates formation of Type I fibrocartilage to cover the damaged joint surface and relieve pain/improve joint performance. For years, short of aggressive, open surgical grafting procedures that required multiple procedures and long recovery times, it was the best we could do.

Recently, an explosion of research in both the U.S. and Europe has led to the development of new techniques to improve the results of cartilage surgery. FDA limitations in this country have made it difficult at best to develop and test these products, but now they are available to the sports medicine surgeon such as myself for clinical use in a safe and effective manner.

Now, the window is opening for new, innovative techniques from Europe such as Stem Cell “MACI” (matrix-augmented cartilage implant), after a long hiatus of  progress on cartilage repair in this country.

The over-arching principle is to augment the “tried-and-true” microfracture technique with auto- or  allograft (human stem cell,  matrix tissue and growth factors), to facilitate the maturation of the pluripotent stem cells of the patient’s own making in a way that leads to more normal articular and less scar cartilage.  Type II articular cartilage, long the elusive “holy grail” of joint surgery, finally appears to be within reach. This tissue will hopefully be durable, pain-free and less subject to wear and arthritis in active and athletic patients.

Time and continued research/clinical application will tell the story. This is an exciting time in cartilage surgery!

Read about the Biocartilage and Cartiform surgical alternatives in the “Sports Medicine”  and the “Learn more/Links” areas , as well as some of the early research results elsewhere , discussed at And stay tuned for a new pioneering study offered by our practice soon!