Cartilage repair

Restoration of cartilage begins with stress view X-Rays to determine whether there is cartilage damage, followed by an MRI done with special cartilage protocols that determine the exact location and extent of the damage. Surgical treatment follows which involves removal of the damaged area, and replacement with cartilage taken from a healthy, non-weightbearing part of the joint. This surgery is called an osteochondral allograft, or OATS procedure.

On occasion Dr. Vermillion may do a two-stage surgical procedure to replace damaged cartilage, called a Carticel Implant. In the first surgery he takes a biopsy of healthy cartilage which is then sent to a lab to be grown into a piece large enough to graft into the damaged area during a second surgery.  As of October, 2008, Dr. Vermillion has done 57 of these Carticel Implant surgeries.  Dr. Vermillion participated in the Study of the Treatment of Articular Repair (STAR) in 2001 at Madigan Army Medical Center.  The STAR study was a prospective, 4-year, open label, multi-center assessment of 154 patients treated with Carticel.  At 48 months 78% of evaluable patients reported a follow up score of good to excellent.  For more information on the STAR study please click here.

Dr. Vermillion is currently working to refine new techniques that utilize biotechnology to repair and replace normal cartilage. He has a keen interest in basic science and research and applies it in his clinic. Some of Dr. Vermillion's clinical research cases on healing ankle cartilage defects were presented at the Kerlan Jobe Orthopaedic Clinic Research Meeting in Calgary, Canada, in July, 2007. 

Often a key factor in cartilage repair is correcting the malalignment that caused the cartilage damage in the first place. Moving the patella over through a lateral release, medial reefing, or tibial tubercle transfer, or correcting knock-knees or bowlegs through an osteotomy, can save the newly healed cartilage from the same type of damage that occurred to the original cartilage. Dr. Vermillion is developing new techniques for limb alignment procedures that are essential in cartilage and joint restoration.  He currently is involved with an Institutional Review Board approved research project entitled "Correction Accuracy of High Tibial Osteotomies Performed Using Stryker Opening Wedge Instrumentation System and Surgical Technique."  This project utilized an innovative jig and instruments that Dr. Vermillion helped to design.  This tool may assist surgeons in performing alignment procedures safely and accurately.  These procedures are essential in providing optimal results in cartilage restoration procedures.

These pictures show an osteotomy which was done along with a cartilage retoration surgery. The picture on the left is one week after surgery, the one on the right at six weeks post surgery.  An osteotomy is done to correct alignment problems, such as bowlegs or knock-knees, so that the patient does not wear out newly repair cartilage.  Alignment problems wear out cartilage just as a car's tires wear unevenly if they are out of alignment. This patient was able to run again 14 months after surgery.

Dr. Vermillion is shown with Dr. Lars Peterson at Fort Hood Texas in 2006 when he developed and implemented a cartilage restoration program for the Army.  Lars Peterson is from Sweden and is thought worldwide to be the father of Autologous Cell Implantation.  This cartilage restoration program resulted in 18 of 25 combat soldiers returning to full combat duty within 18 months of Autologous Cell Implantation.  These results were presented at the Texas Orthopaedic Association Meeting in the spring of 2007.   Dr. Peterson has been a great mentor for Dr. Vermillion in his constant goal to help patients maintain an active lifestyle.

Recovery from cartilage repair can be painful and inconvenient. Patients are usually asked to be completely non-weightbearing for 4 to 6 weeks, which means the use of crutches for an extended period. Depending on the amount of damage and the amount of repair necessary, there can be considerable bone healing required, which is usually a slow and painful process. This healing is greatly accelerated by the selective use of newly-developed biologics in an off-lable fashion. Many of Dr. Vermillion's patients have returned to full activity within 9 to 12 months. This has included soldiers returning to active duty on the front lines.

More about Dr. Vermillion's cartilage techniques may be found in the attached literature on this page.