In the late 1980's and early1990's, Dr. Richard Steadman, an orthopedic surgeon from Vail Colorodo, developed microfracture surgery as a means to facilitate the growth of a cartilage-like material (technically cartilage scar tissue) around the knee. By cutting small splices into the bones surrounding the knee, Dr. Steadman released stem cell rich red blood and bone marrow into gaps left by eroding cartilage. This seepage then clotted and developed into a cartilage scar tissue durable enough to enable the patients to engage in activities pain free. Many high profile athletes such as Jason Kidd, Chris Webber, Zach Randolph, Penny Hardaway, Amare Stoudamire, John Stockton and most recently Greg Oden have undergone the procedure.

The lure of gaining back cartilage is an elixir that many, especially top level athletes, can not turn down. Cartilage, the cushion that acts as a buffer between your bones, is crucial to experiencing pain free activity. Without cartilage, life is hell, literally. Besides pain, bone on bone wear leads to arthritis, limited range of motion, muscular imbalance and depression. For some, if the damage is minor, cartilage can be repaired or cleaned up, but for many, who have already suffered loss of cartilage, the diagnosis isn't so simple. Articulate cartilage, the majority of cartilage found in the knee, suffers from lack of blood flow. Therefore it can not heal itself or regenerate. When it goes, it's gone.

Microfracture surgery gives the patient a chance to regain something that was irrevocably lost. Even so, it is not without detractors. Some do not believe the scar-like tissue created during the procedure is durable enough or adequate. Even in the best case scenarios, erosion of the new cartilage happens within six years. In the worst case scenarios, erosion can happen within a year of the surgery. In addition to this concern, the surgery, though successful with younger patients, has not yielded the same results with older patients.

Microfracture, though somewhat imperfect in its results, is now, according to bio tissue engineers, ready for the next step. A company in California, Cartilix, has developed a bio material that they believe will change the face of cartilage regeneration. ChonDux, a hydro gel developed for the purpose of growing cartilage, is a bio material that surgeons can spread over the bone before it is spliced during microfracture surgery. Stem cells from other sources of cartilage are placed in the gel while fresh stem cells from the red blood and bone marrow coalesce in hydro gel. The surgeon than activates the liquid gel by shining ultra violet light on the substance changing it from a liquid to a gel. This process called scaffolding allows the stem cells to regenerate into a much more stable form of cartilage than was previously obtained through microfracture alone. After six weeks the hydro gel disintegrates leaving intact cartilage in its place. The process has already had good results when performed on animals and is now starting human trials in the States. FDA approval has not been obtained, but if all goes well Cartilix expects that in ten years, ChonDux will be available for use in microfracture surgeries.

The long term hope for hydro gels, developed by bio tissue engineers such as Jennifer Elisseff of Johns Hopkins University and Krsiti S. Anseth of the University of Colorodo, is that they will have a broad range of applications from bone growth to cosmetic surgery.  For now, it appears that the immediate future is in cartilage work.