Knee Joint Cartilage Defects: Treatment Options

Knee Joint Cartilage Defects: Treatment Options

Without treatment, cartilage defects of the knee are at risk for getting worse. Early treatment includes nonoperative methods like physical therapy, activity modification, NSAID medication, and different types of knee injections.

While these treatments can help manage symptoms, they do not fix the underlying cause. If nonoperative treatment does not provide lasting symptom relief, surgery may be considered for certain cases. These include cartilage defects at one specific area, pain that is difficult to control, recurring swelling, loose bodies, and symptoms like clicking and locking.

Not all cases can benefit from cartilage defect surgery, however. These include meniscus injuries, knee instability due to damage to supporting ligaments, and widespread cartilage damage as seen in osteoarthritis. Other surgical procedures are usually needed to address these issues.

Surgery may also not be appropriate if there are other conditions, like inflammatory forms of arthritis or morbid obesity, that affect the ability of cartilage to heal. Surgical treatment will vary depending on the cartilage defect location, size, and physical demands of the patient.

Articular cartilage has a limited blood supply, so it has a limited ability to heal on its own. Different procedures are available to try to preserve or restore the cartilage. These include chondroplasty, where the damaged cartilage is smoothed out; marrow stimulation, where small holes are drilled into the underlying bone to stimulate healing; an OATS procedure, where a graft of cartilage and bone is transferred from a from a healthy non-weight-bearing area of the knee into the cartilage defect (OATS can also be performed with donor cartilage and bone, called an allograft, to fill the defect); and cartilage transplantation, where small pieces of cartilage are removed from the patient's own knee or taken from a donor and transferred into the cartilage defect.

If a cartilage graft is needed, the size of the cartilage defect will help determine if the graft can be taken from the patient or from a donor. Smaller, round cartilage defects may often be treated with cartilage grafts taken from the patient, while larger, irregularly shaped defects may benefit from a donor graft.

During surgery, a patient will be positioned on their back. Many procedures can be performed through arthroscopy with small incisions around the knee, but larger cartilage defects may require an open incision, especially if the cartilage defect is behind the kneecap.

The decision to undergo surgery should be made through a discussion between the patient and health care provider to go over potential risks and benefits of an operation. Things to take into consideration following surgery include weight-bearing restrictions, need for extended rehabilitation, and the risk of surgery having to be redone due to unsuccessful outcomes.

Rehabilitation after surgery will depend on the procedure performed and the surgeon's preference. Typically, there is an initial period of non-weight-bearing where a patient will need to use crutches or another assistive device to stay off of the operated knee, followed by a gradual increase in weight-bearing and physical activity over several weeks.