How to treat articular cartilage damage?
The treatment of chondral defects of the knee can depend upon the location and size of the defect. In general, those that are on the end of the thigh bone, the femur, are the ones that are easiest to treat and have the best outcomes. Those on the tibia and kneecap (patella) are harder to treat and the results are not as reliable. For those patients who have a surface defect of the cartilage, with a flap or crack in it, a cleaning out or shaving of a defect, called a chondroplasty, can be performed. This may be useful to alleviate the catching and painful symptoms from a cartilage flap, but they do not cure the underlying chondral defect. In effect, it is resurfacing the defect and it is important the patient be careful about returning to the activities which caused the cartilage flap in the first place or it could happen all over again.
For those patients who have very deep cartilage defects, which extend all the way down to bone, the treatment of these can depend upon the location and overall diameter of the defect. For smaller lesions, a technique called a microfracture, which tried to rely on the patient’s own stem cells and healing to form a fibrocartilage cap over the “pothole”, can be useful. In other instances where the bone under the cartilage defect is also damaged, replacement with a plug of bone and cartilage from another portion of the knee can also be useful. This is called an autograft osteochondral transfer. For deeper or larger cartilage defects, one of the more reliable techniques in indicated patients is a fresh osteoarticular allograft. This is a cadaver graft, donated from a recently deceased young donor, which can be used to replace the whole bone and cartilage unit. These are the most predictable ways for us to treat cartilage defects of the knee, but obviously the donor supply is limited so it cannot be used in all patients.
Nonoperative Treatment of Chondral Defect of the Knee
In some instances, the chondral defects of the knee may be small enough to trial a period of rehabilitation. In these circumstances, there may not be any large cartilage flaps demonstrated on the MRI scan and there may just be softening of the cartilage surface. These patients may benefit from a program of rehabilitation, focusing on low-impact strengthening, primarily the quadriceps mechanism, to increase one’s absorption and overall strength. This has been found to be very beneficial in these patients. In addition, for patients who may have a lot of joint space irritation, called synovitis, a steroid injection or a platelet-rich plasma injection (PRP) may be indicated. For patients who choose not to want surgery and who have more extensive chondromalacia, the use of an unloader brace to take the stress off a malaligned joint which has the weightbearing fall through the cartilage defect, or the use of further injections, such as viscosupplementation with hyaluronic acid or PRP may be indicated.
Chondral defects of the knee are important to thoroughly evaluate to determine the best treatment regimen. Both operative and nonoperative treatments may be indicated. In addition, assessment of alignment may indicate if an unloader brace may help alleviate a patient’s symptoms and review of newer biologic or corticosteroid or viscosupplementation injections may be indicated.
Chondral Defect of the Knee Recovery
The recovery process and rehabilitation requirements vary significantly among the different operative procedures used to repair articular cartilage damage. The patient’s commitment level to the rehabilitation process is an important factor in determining which treatment may be the best choice.