What is a cartilage injury?
Articular cartilage is the smooth, glassy tissue that covers the ends of the bones in a joint. It has no blood supply, so it has very little ability to heal. A focal cartilage injury is a localized defect, often the size of a coin or smaller, in an otherwise healthy joint. This is different from arthritis, in which cartilage wears thin across large parts of the joint.
Causes include a twisting injury, a direct blow, kneecap dislocation, an ACL tear, or a small piece of bone and cartilage dying from poor blood flow (osteochondritis dissecans).
What does it feel like?
Typical symptoms are deep aching, swelling after activity, catching, and a sense of the knee “locking” or giving way. Pain is often worse with impact, stairs, squatting and pivoting. Because a lot of these symptoms overlap with meniscus and ligament injuries, an MRI is usually needed to sort out what is going on.
Do I need surgery?
Many cartilage lesions do not need surgery, especially small ones that cause few symptoms. Non-surgical care includes activity changes, strengthening, correcting alignment problems with bracing or footwear, anti-inflammatory medicine and injections. These treatments help you function but do not rebuild cartilage.
When is surgery considered?
Surgery is considered when you have persistent pain and swelling that limit sport or work despite a course of non-operative care, the lesion is well defined on MRI, and the rest of the knee is in good shape. Surgeons also look at associated problems such as meniscus loss, ligament instability and leg alignment, because fixing the cartilage without fixing those problems often fails.
What are the surgical options?
The choice depends on the size and location of the defect, your age and your goals:
- Debridement. Smoothing loose cartilage flaps arthroscopically to relieve catching.
- Marrow stimulation (microfracture). Tiny holes in the bone let marrow cells fill the defect with repair tissue called fibrocartilage. It works best for small lesions.
- Cell-based or graft repair. Cartilage cells taken from your knee are grown and implanted into the defect, or healthy cartilage and bone plugs are transferred from a low-stress area or from a donor.
- Fixation. A loose fragment that still has healthy bone attached can sometimes be reattached.
No technique restores cartilage to exactly what it was, and some are not suited to patients with widespread arthritis, for whom partial or total knee replacement is more appropriate.
Should I get a second opinion?
It makes sense if you were told you have “bone on bone” but are young and active, or if you have had a cartilage procedure that did not help. Request a visit and bring your MRI.
Where can I see Dr. Stepanyan?
Dr. Stepanyan sees knee patients in Glendale, East LA and Santa Fe Springs.
What does recovery look like?
Recovery after cartilage surgery depends on the technique. These are typical stages after a restoration procedure. Your own plan may differ.
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Weeks 0–6
Protect the repair
You use crutches and avoid putting weight on the leg. A continuous-motion machine or a gentle motion program may be used to nourish the new tissue.
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Weeks 6–12
Progress weight
Weight bearing increases in stages, and the brace comes off. Therapy focuses on walking and low-load strengthening.
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Months 3–6
Build strength
Stationary cycling and swimming are added. Impact is still avoided while the repair tissue matures.
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Months 6–12
Return to activity
Jogging and sport are introduced gradually. Cartilage repair tissue takes a year or more to mature fully.
After simple debridement, recovery is much quicker. Dr. Stepanyan will give you a plan that matches the exact procedure.