Knee Cartilage Defects Treatment Options

Cartilage surgery is indicated in people with symptomatic defects with the short-term goal of improving pain and function, and a longer-term goal of delaying or avoiding the need for knee replacement, especially in young patients. Minimally invasive procedures have been developed to treat cartilage defects to help younger patients avoid knee replacement surgery.

What are the treatment options?

The type of treatment recommended will depend on the location and size of the defect, as well as the patient’s age, activity level and overall health. Defects limited to a specific area may only require nonsurgical management. However, these small defects can be challenging to treat due to the limited healing potential of cartilage.

Large defects can lead to accelerated wear, worsening pain and potential post-traumatic arthritis. This is especially challenging for young patients who desire to maintain a physically active lifestyle.

What are non-surgical treatments?

Non-surgical treatments for knee cartilage defects include:

• RICE: rest, icing, compression, and elevation to reduce pain and swelling.
• Over the counter or prescription anti-inflammatory medication help reduce pain and inflammation.
• Occasionally steroid injections may be recommended to improve pain and inflammation. Physical therapy is designed to help strengthen the muscles around the knee and improve range of motion.

When nonsurgical management fails to provide relief and restore function or the damage is severe, surgery will be recommended.

What are the surgical options available to treat cartilage defects?

Many cartilage repair and restoration techniques are performed with minimally invasive arthroscopic surgery. Arthroscopic surgical treatments for knee cartilage defects include:

• Debridement: Arthroscopic debridement is a minimally invasive procedure that involves smoothing the damaged cartilage and removing loose fragments of cartilage from the joint to prevent catching and locking and rubbing on other knee structures.
• Microfracture: Articular cartilage has no blood supply. This limits regeneration and healing potential. Microfracture is a technique that involves making microscopic fractures in the bone around the defect. Bone marrow containing proteins and stem cells that can heal the damage are released into the defect to stimulate the growth of new cartilage. The new cartilage is not as strong as the original and can wear quickly leading to additional surgery. This procedure is only available for small, isolated cartilage defects.
• BioCartilage: BioCartilage is a product that is made of micronized cartilage. It is frequently used to augment microfracture. The procedure involves implanting the BioCartilage into smaller cartilage defects along with platelet rich plasma or bone marrow aspirate concentrate, to help heal the defect. The BioCartilage acts as a scaffold on which new cartilage cells can grow to fill in the defect.
• Platelet rich plasma and bone marrow aspirate concentrate are regenerative procedures used to augment microfracture or cartilage derived matrix implantation. Platelet rich plasma is created from the patient’s blood during a simple blood draw. The plasma is spun to concentrate platelets which contain multiple growth factors that aid in healing. Studies show that concentrated platelets and growth factors support all phases of healing and repair, and treat inflammation.

Bone marrow aspirate is created from bone marrow removed from the patient’s hip bone. It contains stem cells and growth factors that are anti-inflammatory and regenerate tissues including cartilage. Studies are clear that bone marrow aspirate provides pain relief and improved healing in the treatment of localized cartilage defects and osteoarthritis of the knee.

• Osteochondral autograft (OAT) is a technique that involves transplanting healthy cartilage and bone from another area of the joint to the defect site. Osteochondral allograft (OCA) is a technique that involves transplanting healthy cartilage and bone from a donor to the defect site. These procedures are only recommended for small to medium cartilage defects in patients under age 50.
• Autologous chondrocyte implantation (ACI) is a two-step procedure that involves the removal of a small sample of healthy cartilage cells from the joint and the cultivation of new cartilage cells in a laboratory which takes one to three months. The new cartilage cells are then implanted into the defect site.
• Knee replacement surgery is a last resort treatment for patients with advanced knee osteoarthritis. Knee replacement surgery involves the removal of the damaged joint surfaces and the placement of artificial joint components.

Dr. Jonathan Godin offers an array of surgical options both established and emerging techniques and technologies. He is a world-class surgeon and a leader in sports medicine.  He received fellowship training in advanced arthroscopic and reconstructive surgical techniques for the treatment of complex orthopedic and sports related injuries at the renowned Steadman Clinic in Vail, Colorado. Contact him at Vail Orthopedic Surgery with offices in Vail, Frisco, and Edwards Colorado to schedule a consultation to receive the correct diagnosis and all your classic and state of the art treatment options.