Services Offered

• Arthroscopic debridement and microfracture (marrow stimulation) Remove
  Arthroscopic debridement and microfracture (marrow stimulation)

  Using the familiar arthroscopic approach (typically under local anesthetic), surgeons locate the damaged chondral tissue and trim away or stabilize the area. This prevents the damaged tissue from flaking off, which is often responsible for swelling, joint lining irritation, and pain. This "clean up" is called a chondroplasty. When the injury is less than 1cm (3/8 inch) in diameter, in certain circumstances, it has a lower probability of progressing. For lesions that chondroplasty alone will have a poor probability of helping, the body can be stimulated to produce repair tissue. This repair tissue develops from cells which migrate to the area through small holes made in the bone by abrasion, drilling, or more recently, by using a small pick to create microfractures. This can be thought of as repairing "potholes" in a road. It may not last as long as a normal road, but it is often successful in eliminating symptoms in many patients. Studies suggest this repaired cartilage is fibrocartilage-like (scar cartilage), which is less resistant to wear than normal joint articular (hyaline) cartilage. In the future, a variety of means (for example, local growth factors, pulsed electrical current, or gene regulation) may be used to enhance the marrow stimulation cartilage to a more hyaline-like quality.
• Osteochondral Autograft Remove
  Osteochondral Autograft

  This technique is analogous to a hair-plug transfer. The surgeon removes a small plug of the patient's own cartilage along with an attached underlying bone plug. This is obtained from an area of the knee, which does not participate in high loading. The typical site of harvest is at the margin of the knee. If the area of harvest is involved with damage, then this technique may not be possible or an alternative site in the notch may be utilized. This bone and cartilage (hence the term: osteo (bone)--chondral (cartilage)) local graft is then transferred to the defect where a receiving hole (socket) has been prepared. Obviously, there is a limit to the amount of tissue available for "harvesting" and thus the size of the lesions treated with this technique are usually between 1-2 cm in diameter.
• Replacing the Meniscus Remove
  Replacing the Meniscus

  For patients who have had their meniscus removed, The CRC of Indiana offers an innovative option called a meniscal transplant. It is important to remember that, while only what seems is a part of the meniscus was removed, often the effect to the knee (from a functional standpoint) is the same as a total meniscectomy. With meniscal transplantation, a sized-matched cadaver donor meniscus is transplanted into the site of the original meniscus. Unlike other forms of transplantation, this procedure does not require patients to be on medications to prevent rejection. To make you aware of any potential bias, Dr. Farr discloses that he shares a patent for one of the instrumentation systems that assists surgeons in performing the procedure of meniscal allograft transplantation.
• Bracing Remove
  Bracing

  Bracing may be utilized for various reasons. The "unloader brace" could be utilized for tibiofemoral problems occurring only on one side of the joint. The "unloader brace" unloads the affected side of the joint putting increased force on the opposite side of the knee. A patellofemoral tracking brace may offer improved comfort for patients with subluxation or dislocation of the patella. A compression sleeve may be recommended for patients with chronic swelling. Bracing is often utilized to improve patient's comfort; however it typically does not fix the problem.
• Meniscal Cartilage Treatment Remove
  Meniscal Cartilage Treatment

  Knee meniscal cartilage tears represent the most common knee problem leading to surgery in America. Meniscus damage can happen through daily living activities that do not involve specific trauma or in other cases, meniscal cartilage tears can be a direct result of trauma that occurs in sport or in the workplace. Once there is injury to the meniscal cartilage, the body's response often is pain and swelling. At times, the knee may "lock," "give way," or "go out completely." Unfortunately, it is rare for a meniscus to heal without surgical intervention. The goal of meniscal surgery is to maintain meniscal cartilage function. Knee surgeons recognize the protective value of the meniscal cartilage and they will recommend corrective surgery to restore normal function. In the days of open cartilage surgery, the entire meniscus was typically removed. However, today, in an effort to preserve meniscal function after a tear, surgeons can, at times, repair the meniscus using a variety of techniques. These techniques include using special sutures, absorbable implants or staples to secure the tear. Nevertheless, even with the newest repair techniques available, the vast majority of meniscal tears are not repairable and are consequently treated by removing the torn portion. This is known as a partial meniscectomy. Unfortunately patients who undergo a partial meniscectomy often show a development of arthritis in long-term follow-up studies. This outcome is very similar to patients who underwent a total meniscectomy surgery in years past.
• Articular Cartilage Treatment Remove
  Articular Cartilage Treatment

  Articular cartilage, the glistening white tissue that covers the ends of the bones, is both tough and resilient. It is not only important for the smooth gliding of the joint, but also to "soften" the impact during loading much the same as a shock absorber. Articular cartilage may not appear to be alive, but it is. The number of cells (chondrocytes), which reside in the tissue, is indeed small (approx. 5%), but they have the job of keeping the matrix around them healthy. Think of the cells as the few marshmallows suspended in a Jell-O® mold. As with most body tissues, there is a constant wear-out and replacement activity of this matrix (The marshmallows repair and replenish the Jell-O® matrix). Unfortunately, the chondrocytes typically do not replicate and cannot repair themselves. They also decrease in number as we age. Once the chondrocytes are damaged or lost (die), the surrounding matrix then gradually degenerates. Without help, the body is not able to repair these articular cartilage defects. That is when cartilage restoration surgeons can intervene to help the body start a healing response or replaces the worn tissue. Dr. Jack Farr offers several options for treatment of damaged articular cartilage, starting with methods for repairing early, localized damage called focal chondral defects. These options include: -Regeneration, Repair, or Replacement of Damaged Articular Cartilage -Treatment of Established Arthritis -Other Surgical Techniques

Procedures Performed

Conditions Treated