Knee Cartilage Defects

A cartilage defect refers to damage or injury to the articular cartilage in the knee. The defect may be a single local lesion caused by acute trauma or a sports injury, chronic repetitive stress on the knee joint, overuse, aging or degenerative conditions like osteoarthritis. Cartilage lesions are not uncommon as patients, particularly over the age of 40 years. Furthermore, not all cartilage defects cause symptoms.

Symptoms include pain, swelling, stiffness, and a decreased range of motion in the affected knee. In some cases, the damaged cartilage may result in the formation of loose fragments within the joint, causing further discomfort and mechanical issues such as locking or catching. Left untreated, a knee cartilage defect can potentially lead to the development of osteoarthritis, a degenerative condition characterized by the gradual breakdown of cartilage in the joint.

Chicago Orthopedic Surgeon Dr. Ronak Patel will review your medical history, ask about your symptoms and when they began, inquire about any previous knee injuries and your activity level. He will conduct an orthopedic examination of the knee joint looking for signs of swelling and tenderness, and assess range of motion, ligament stability and gait.  He will also perform specific tests to assess stability and evaluate the integrity of the knee structures.

Dr. Patel will order x-rays to help identify bone damage and defects, assess joint alignment and evaluate the knee for fractures and rule out arthritis. Cartilage is not visible on an x-ray, so he will order a MRI scan to obtain detailed images of the soft tissues including the cartilage. It can reveal the size, location, and severity of the cartilage defect, as well as detect any associated injuries. That being said, the gold standard for assessment of cartilage defects is arthroscopy which may be indicated. 

The treatment options depend on the size, location, and severity of the defect, as well as the individual’s age, activity level, and overall health.

Non-surgical treatments

Non-surgical treatments are often the first line treatment offered. This involves pain management with over-the-counter anti-inflammatory drugs like NSAIDs, pain relievers, and injections can reduce inflammation and treat pain. PRP has been effective in the treatment of cartilage disorders and may be an option for some patients.  Rest, activity modification, and physical therapy. When conservative management fails to relieve symptoms, surgery may be recommended.

Surgical treatments

The aim of any cartilage repair procedure is to generate the highest tissue quality to improve clinical outcomes, return-to-sport, and long-term durability.

• Arthroscopic Debridement – This minimally invasive procedure removes loose and damaged cartilage fragments from the knee joint to treat pain, stiffness and decreased range of motion.
• Microfracture – This procedure involves making tiny holes in the bone underlying the defect to stimulate marrow to produce new fibrocartilage to fill the defect. This is not true cartilage and thus does not always prove durable over time.
• Osteochondral Autograft Transplantation (OATS): Healthy cartilage and bone plugs are taken from a non-weight-bearing area of the patient’s knee and transplanted into the defect.
• Osteochondral Allograft Transplantation – In this procedure, donor cartilage and bone are used to replace the damaged area of the knee joint.
• Scaffold-Based Techniques – These involve implanting a scaffold material into the defect, which provides a framework for new cartilage growth.