Chondromalacia and Cartilage damage

This is the most common treatment for damaged articular cartilage. When loose areas repeatedly catch, small flaps become larger flaps over time. These loose pieces can be removed and the damaged cartilage under the kneecap smoothed. It is impossible to make the damaged cartilage completely smooth like normal cartilage but the goal is to reduce pain and slow down the progression of cartilage damage.

After surgery, patients are permitted to fully move the knee and walk. Most patients do not even use crutches. There is still some swelling and discomfort from surgery and most patients require physical therapy to regain strength and function. Although symptoms improve, or even subside completely, the remaining cartilage is still not normal so depending on the size of damage, swelling can take weeks, or sometimes months, to resolve.

This is a common, relatively simple initial treatment for areas where cartilage is worn down to bone (Grade IV). In this technique, loose cartilage is removed and the underlying bone is roughened with specialized instruments. Next, small (1-2 millimeter) diameter sharp picks are used to penetrate the bone multiple times at certain distances allowing blood flow into the damaged area. The blood flow brings nutrient cells that transform into cartilage, which helps to patch the damaged area.

Although this cartilage is not the same as the original articular cartilage, it helps to relieve pain in many patients. Depending on the size and location of damage, a brace and/or crutches may be required for a few weeks. The cartilage forms over many months and so returning to twisting, squatting, pivoting, running and jumping must be restricted during the healing period.

With this technique, the damaged cartilage in the knee is replaced with a plug (graft) of cartilage and bone known as an osteochondral graft. This graft can come from the patient’s own tissue (autograft) or from a cadaver (allograft). If an autograft is planned, the plug of bone and cartilage must come from a non-weight bearing area that has little contact with other bones. This fact limits its application to treating smaller lesions. An allograft is more appropriate for larger injuries.

This procedure works very well for focal defects down to the bone. If a large area of cartilage is damaged from arthritis, this technique is not possible. After surgery, patients use crutches for 2 weeks and a brace for walking for 6 weeks.

Autologous Chondrocyte Implantation, or ACI, is the most complex technology currently in use. In this two-step procedure, surgeons first use arthroscopic techniques to harvest chondrocytes (cartilage cells) from a healthy, non-weight bearing area of the knee joint. The chondrocytes are then sent to a laboratory where they are treated so they will multiply.

During the second surgery, the surgeon cleans the injury site and removes a piece of the soft tissue (periosteum) that covers the shin (tibia). The periosteal tissue is sutured and secured over the injury, and the cultured chondrocytes are then injected beneath the patch. There, the chondrocytes will eventually produce a form of cartilage that is very much like the original articular cartilage. Because the second surgery is a traditional, open surgery and not arthroscopic, there is an extensive period of post-op recovery and rehabilitation.

This surgery isn’t appropriate for everyone. Several factors must be considered in decision-making, including the size of the defect, the number and type of previous surgeries, the patient’s demands and expectations, the location of the injury, and the presence of coexisting lesions. The patient’s age and the reason for cartilage deterioration must also be considered. An older person with advanced osteoarthritis is not a candidate for ACI, but a younger person with a traumatic injury to the knee may be a good candidate.

If you have a large area of cartilage thinning and damage, this is known as osteoarthritis, or degenerative joint disease. A chondroplasty may be an option if you experience swelling, catching, and giving-way. The arthritis, however, cannot be “removed.”

If symptoms persist, other options for treatment include medications, injections, bracing, and ultimately joint replacement. As technology has improved, there are many less invasive options for partial joint replacement for appropriate candidates.