Knee Joint Cartilage Defects: Treatment Options

Knee Joint Cartilage Defects: Treatment Options

Without treatment, cartilage defects of the knee can worsen over time. Early management typically includes nonoperative options such as physical therapy, activity modification, nonsteroidal anti-inflammatory medications, and various types of knee injections. While these treatments may help reduce pain and swelling, they do not address the underlying cartilage damage.

If nonoperative treatment fails to provide lasting relief, surgery may be considered in select cases. Surgical treatment is more appropriate for cartilage defects that are localized to one area of the knee and associated with persistent pain, recurrent swelling, loose bodies, or mechanical symptoms such as clicking and locking.

Not all patients are candidates for cartilage defect surgery. Conditions such as meniscus tears, knee instability caused by ligament damage, or widespread cartilage loss seen with osteoarthritis often require alternative surgical approaches. Surgery may also be inappropriate in patients with inflammatory arthritis or morbid obesity, as these conditions can limit the ability of cartilage to heal.

Because articular cartilage has a limited blood supply, it has a poor natural healing capacity. Several surgical techniques aim to preserve or restore cartilage, including chondroplasty to smooth damaged cartilage, marrow stimulation procedures that create small holes in the underlying bone to promote healing, osteochondral autograft or allograft transfer (OATS), and cartilage transplantation using the patient’s own tissue or donor cartilage.

When a cartilage graft is required, the size and shape of the defect help determine whether patient-derived cartilage or donor tissue is most appropriate. Smaller, well-contained defects are often treated with grafts taken from the patient, while larger or irregular defects may benefit from donor cartilage.

During surgery, the patient is positioned on their back. Many cartilage procedures can be performed arthroscopically using small incisions, though larger defects or those located behind the kneecap may require an open incision.

The decision to proceed with surgery should be made through a detailed discussion between the patient and health care provider, reviewing the potential risks and benefits. Important considerations include postoperative weight-bearing restrictions, the need for prolonged rehabilitation, and the possibility of requiring additional surgery if the outcome is unsuccessful.

Rehabilitation following surgery depends on the specific procedure performed and surgeon preference. Most patients begin with a period of non-weight-bearing using crutches or another assistive device, followed by a gradual progression of weight-bearing and physical activity over several weeks.