Spherox a breakthrough in cartilage treatment

Spherox is an innovative therapy for cartilage repair, developed specifically for damage in the knee. In this treatment, your own cartilage cells used to fill the damaged area in the cartilage. The process involves two steps. First, the orthopaedic surgeon removes a small piece of healthy cartilage from your knee (usually from a less stressed part of the joint) via keyhole surgery. This piece of cartilage goes to the laboratory, where the cartilage cells - also called chondrocytes called - are multiplied and grown. In this process, the cells grow into thousands of tiny pinhead-sized spheres. These spheres, also called spheroids called cartilage cells, contain millions of cartilage cells and a matrix formed by the cells themselves (a kind of glue-like intermediate of collagen and other building materials).

After about 6 to 8 weeks of culture time, the second step follows: implantation. In a second keyhole surgery, the surgeon inserts the cultured balls into the cartilage defect. First, the damaged, loose cartilage tissue is neatly removed until there is a clean bed of healthy tissue around the defect. Then the cells are inserted: the doctor carefully spreads the spheres over the damaged area. The special feature is that no glue or plaster is needed To secure them - the spheroids attach themselves within about 20 minutes firmly to the lower layer and edges of the surrounding cartilage. The knee is then simply closed. This lays the foundation for your body to build new cartilage tissue where there was a hole or damage before.

After Spherox implantation, a months-long process of healing and rehabilitation begins. Cartilage, unfortunately, does not grow back into fully strong tissue overnight. It goes through roughly four stages of recovery - each phase with its own characteristics in time course and feeling. Below, we discuss these phases step by step, also looking at what is happening in your knee at the cellular level.

1. Suture (immediately after implantation): In the first days and weeks after surgery, the cartilage spheres placed are mainly about adhesion. Initially, the cells sit in their small spherical cluster and need to bond firmly to the underlying bone and the edges of the surrounding cartilage. At the cellular level, the chondrocytes attach themselves to the fibrous matrix in the defect; they sense their new "home", so to speak, and begin to bond to it. For you as a patient, this phase means that your knee needs rest. Often, you will not be allowed to load (walk with crutches) or only partially load (walk with crutches) for the first few weeks to prevent the implants from loosening. You will also do light movement exercises without loading, for example gently bending and stretching your knee under the supervision of the physiotherapist. This restores the function of the muscles around the knee and provides movement and nourishment to the joint.
2. Outgrowth (a few weeks after surgery): In the following weeks, the attached cartilage cells begin to spread and multiply. This is the phase of outgrowth. The globules "fuse" with their environment, so to speak: cells migrate out of the spheroids and colonise the cartilage defect over its entire surface. In the process, they also produce important building materials. These include collagen (especially type II collagen, the main component of healthy cartilage) and proteoglycans (a type of gel-like protein that attracts water and gives cartilage resilience). Together, these substances form the matrix - a network around the cells that provides structure and strength. In the beginning, the new tissue is still soft and fragile, a bit like young scar tissue. You will find that you are slowly allowed to do a little more during this phase: perhaps from not supporting at all to gently allowing some weight on the leg. However, it is still crucial not to overload. Loading too quickly or too heavily can damage this newly formed layer of cartilage before it is strong enough. Patience at this stage lays the foundation for better results later on.
3. Maturation (maturation of the tissue, several months): After a few months, the newly formed cartilage tissue starts to become stronger and more organised - this is the maturation phase, or maturation. The cartilage cells are now well embedded in the matrix they have created. At the cellular level, all sorts of things are happening: the collagen fibres arrange themselves more and more neatly in line with the forces that come to bear on the cartilage, and the amount of collagen and other properties increase. The cartilage layer starts to look more and more like normal, healthy cartilage. You may notice this because your knee feels more stable and less painful during daily activities. You may now be able to do most light everyday things again, although sports jumping or running often remains limited. An MRI scan halfway through the rehabilitation year (around 6 months after surgery) usually shows that the defect has largely been filled with new tissue. However, that tissue often still has a slightly different structure than the surrounding cartilage - it has a higher water content and slightly different signals on the scan, for example - indicating that it is still maturing. During this period, you continue to expand your exercise programme under the guidance of your physiotherapist. There will be more emphasis on strength building of the thigh muscles and training balance and coordination, to prepare your knee for full functional use again.
4. Integration (towards a year and beyond): In the final phase, the repaired cartilage tissue fully grows together with the rest of the joint. This integration phase takes place from about 9 to 12 months after implantation to a year (and actually continues in fine-tuning thereafter). The edges of the new cartilage increasingly blend into the surrounding cartilage, as if a seamless carpet has been laid into the damaged area. The underlying bone also adapts: often, due to the old injury or surgery, there was bone oedema - which is a fluid accumulation in the bone under the cartilage, visible on an MRI as a white haze in the bone. In the integration phase, this bone oedema slowly decreases. The bone recovers and becomes firmer again, which is important to support the new cartilage. Ultimately, the goal is for the new cartilage to become as load-bearing as the original tissue. After about a year, many patients can return to doing almost everything they did before, including sports activities, provided rehabilitation has been carefully completed. A check-up MRI after a year often shows that the cartilage defect has filled in nicely; the repaired area can then look almost normal, although small differences sometimes remain. More importantly, as a patient, you feel that your knee is functional again - pain-free or at least much less painful - and that you can move with confidence.

It is notable that cartilage repair with Spherox is a lengthy process. This has everything to do with the nature of cartilage and the complexity of healing. Cartilage naturally has no blood supply. Unlike skin or muscle, for example, cartilage cells do not receive a direct supply of nutrients through the blood. Everything has to diffuse (sink in) from the synovial fluid and underlying bone. As a result, repair processes in cartilage are much slower. The cells do not divide as quickly and creating a full-fledged cartilage matrix simply takes time.

In addition, in your cartilage injury, the bone underneath the cartilage may also have played a role. When cartilage is damaged, the underlying bone is often also irritated or bruised - hence bone oedema what we were talking about. This is similar to a bruise inside the bone, which should slowly go away. As long as there is fluid and irritation in the bone, you may continue to have symptoms such as deep pain or nagging discomfort when loaded. It usually takes months for the bone oedema to completely disappear. Only then is the foundation under the cartilage stable again.

Finally, the new cartilage tissue has to become really strong and flexible, and that only happens through gradual loading and training. Compare it to a young plant: you have to water it regularly and put it in the sun (exercise and nutrients for the cartilage), but you can't step on it right away. Step by step, it grows into a full-fledged structure that can handle the normal forces in the knee. Wanting to go too fast can damage fragile new tissue, while patient build-up pays off with more lasting results. This is why the rehabilitation schedule after Spherox is so strict and gradual - it is tailored to the biological reality of cartilage growth.

A successful Spherox treatment hinges on the rehabilitation afterwards. The medical part - growing the cells and implanting them - is only the beginning. What comes next is partly in your own hands with support from professionals. In practice, we see that patients who follow the advice carefully end up having the best outcomes. Rehabilitation after cartilage repair requires discipline and patience. Your physiotherapist will work through a constructive schedule with you, which may include: first mobilising exercises (preventing your knee from getting stiff), then muscle strengthening without major knee strain (e.g. closed-chain exercise, such as gentle cycling on an exercise bike with little resistance), and later gradual return to impact (such as carefully learning to walk without crutches, gradually regaining full load, and eventually perhaps running or jumping again). This build-up is necessary to give the new cartilage the right stimulus at the right times: exercise stimulates the cartilage cells to organise themselves properly, and strength training ensures that the muscles relieve pressure on the knee and stabilise it.

Another aspect of rehabilitation is monitoring your knee. Regular check-ups with the orthopaedic surgeon and evaluations (e.g. an MRI after about a year) help assess whether recovery is going according to plan. Together with your physiotherapist, you can also measure your progress: how is your range of motion of the knee, how is your muscle strength progressing and how is confidence in the knee in daily movement? Based on these evaluations, the rehabilitation programme can be adjusted if necessary.

During this course, it is normal to experience ups and downs. Some weeks you feel a lot of progress - for example, an increase in flexibility or decrease in pain - and at other times things seem to stand still or you suffer a little more, for example after a heavier exercise. This is part of the process. The important thing is to always keep the long-term goal in mind: a healthy knee weight. You are not alone; a good rehabilitation team will guide you, answer your questions and help you through the difficult moments.

Cartilage repair with Spherox can offer a chance of a second life for a worn or damaged knee. It is a new development that involves using your own cells to grow new cartilage where the body would not normally do so. This advancement comes with the important prerequisite of time and commitment: recovery occurs in stages and can take up to a year. With a clear explanation and understanding of those four stages of recovery - attachment, outgrowth, maturation and integration - you will know what to expect and why patience is so essential. It's not an easy road, but one with a rewarding end result. By rehabilitating, you give the cartilage cells the best chance to grow into full, strong cartilage. In this way, you work step by step towards the ultimate goal: a hopefully pain-free, functional knee that will allow you to resume your daily activities and perhaps even sporting ambitions. Proper preparation, realistic expectations and the right guidance make Spherox treatment a promising route to sustainable knee recovery. Wishing you much strength and success on the road to recovery!