How Do I Treat My Cartilage Injury?

Knee cartilage injuries can be challenging to treat due to the limited regenerative capacity of cartilage. The appropriate treatment depends on the severity of the injury, the patient's age, activity level, and overall health. Here are the main treatment options for knee cartilage injuries:

Non-Surgical Treatments

1. Rest and Activity Modification

   • Avoid activities that exacerbate the symptoms, especially high-impact activities.
   • Use assistive devices like crutches to reduce weight-bearing on the affected knee.

2. Physical Therapy

   • Strengthening the muscles around the knee can help stabilize the joint and reduce pain.
   • Specific exercises to improve range of motion and strengthen the quadriceps, hamstrings, and calf muscles.

3. Medications

   • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce pain and inflammation.
   • Acetaminophen for pain relief if NSAIDs are contraindicated.

4. Injections

   • Corticosteroid Injections: Provide temporary relief of inflammation and pain.
   • Hyaluronic Acid Injections: Supplement the natural joint fluid, potentially providing pain relief and improving joint function.
   • Platelet-Rich Plasma (PRP) Injections: Use the patient's own blood components to promote healing and reduce inflammation.

Surgical Treatments

1. Arthroscopic Debridement

   • Minimally invasive surgery to remove loose cartilage fragments and smooth the damaged cartilage surfaces.
   • Typically used for smaller, partial-thickness cartilage defects.

2. Microfracture Surgery

   • Creates small holes in the bone beneath the cartilage defect to stimulate the growth of new cartilage.
   • The new cartilage is usually fibrocartilage, which is not as durable as the original hyaline cartilage.

3. Autologous Chondrocyte Implantation (ACI)

   • Two-step procedure: First, cartilage cells (chondrocytes) are harvested from the patient's knee. Then, these cells are cultured and later implanted into the defect.
   • Promotes the growth of new hyaline-like cartilage.

4. Osteochondral Autograft Transplantation (OATS)

   • Transfers healthy cartilage and underlying bone from a non-weight-bearing area of the knee to the damaged area.
   • Suitable for small to medium-sized defects.

5. Osteochondral Allograft Transplantation

   • Uses cartilage and bone from a donor to fill the defect.
   • Can be used for larger defects and offers the advantage of providing mature hyaline cartilage.

6. Matrix-Induced Autologous Chondrocyte Implantation (MACI)

   • An advanced form of ACI where chondrocytes are cultured on a scaffold and then implanted into the defect.
   • Provides a more structured environment for new cartilage growth.

7. Meniscal Transplantation

   • For patients with extensive meniscus damage, a donor meniscus can be transplanted to restore knee function and protect the cartilage.

8. Osteotomy

   • Realigns the knee joint by cutting and reshaping the bones to shift the weight away from the damaged cartilage area.
   • Often used in younger patients with early-stage osteoarthritis to delay the need for joint replacement.

9. Partial or Total Knee Replacement

   • Considered for severe cartilage damage or advanced osteoarthritis.
   • Involves replacing the damaged joint surfaces with artificial components.

Emerging Treatments

1. Stem Cell Therapy

   • Uses stem cells to promote the repair and regeneration of damaged cartilage.
   • Still largely experimental but showing promise in clinical trials.

2. Tissue Engineering and Regenerative Medicine

   • Research is ongoing into new materials and techniques to improve cartilage repair and regeneration.

Rehabilitation and Recovery

1. Post-Surgery Physical Therapy

   • Essential for regaining strength, range of motion, and function after surgical interventions.
   • A tailored rehabilitation program is crucial for successful recovery.

2. Gradual Return to Activity

   • Patients should follow a structured rehabilitation plan and gradually return to normal activities as guided by their healthcare provider.

Prevention of Future Injuries

1. Strengthening and Conditioning

   • Regular exercises to strengthen the muscles around the knee, improve flexibility, and maintain joint health.

2. Proper Technique and Equipment

   • Ensuring proper technique in sports and exercises to minimize the risk of knee injuries.
   • Using appropriate footwear and protective gear.

3. Weight Management

   • Maintaining a healthy weight to reduce stress on the knee joints.

Summary

Treatment for knee cartilage injuries ranges from non-surgical options like physical therapy and injections to various surgical techniques depending on the extent of the damage. Emerging therapies such as stem cell treatments and tissue engineering hold promise for the future. Consulting with an orthopedic specialist can help determine the best course of action based on individual circumstances and the specific characteristics of the knee injury.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.