Knee Cartilage Defect Treatment Options

Nonoperative treatment is typically the first line of defense for smaller, stable OCD lesions, especially those discovered early in children and adolescents whose bones are still growing. The goal is to give the lesion an opportunity to heal on its own while taking steps to mitigate the risk of further damage.

Activity Modification

The first step in nonoperative treatment often involves limiting high-impact and weight-bearing activities to reduce the stress on the affected joint. This means taking a break from sports or other activities that may have contributed to the injury. In the meantime, patients may engage in low-impact exercises such as swimming or cycling, which do not put much strain on the knees.

Physical Therapy

Physical therapy can be very beneficial in maintaining joint mobility and muscle strength while the lesion heals. Therapy often includes a combination of strengthening exercises, flexibility exercises, balance training, and techniques to help manage pain.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage the pain and inflammation associated with OCD. It’s important to note that these medications should be used under the guidance of a healthcare professional, as long-term use can lead to potential side effects, such as stomach bleeding, kidney problems, and an increased risk of heart problems.

Bracing

In some cases, a brace or cast may be used to protect the knee joint, limit painful movements, and promote healing. This option can be especially helpful during the acute phase of injury or during the healing process following surgical treatment.

If nonoperative treatments fail to relieve symptoms or if the cartilage lesion is large, unstable, or located in a weight-bearing area of the knee, surgical intervention may be considered. The specific surgical procedure is determined based on factors like the size and location of the lesion, the patient’s age, and the overall health of the joint. The timing of surgery is typically guided by the individual’s symptoms, the lesion’s characteristics, and the surgeon’s judgment.

Drilling or Microfracture

This procedure is designed to stimulate the growth of new cartilage by promoting blood flow to the lesion. Your knee surgeon Dr. Mayo drills small holes or creates fractures in the bone beneath the cartilage defect. These holes or fractures stimulate the body’s natural healing response, leading to the formation of a blood clot that releases growth factors, which in turn stimulate the growth of new cartilage.

Osteochondral Autograft Transplantation (OATS)

In this procedure, Dr. Mayo removes a piece of healthy cartilage and bone (a graft) from a non-weight-bearing area of the patient’s knee and transplants it into the lesion. The graft is harvested from an area of the knee that doesn’t typically bear weight, minimizing the risk of developing a defect in that area.

Osteochondral Allograft Transplantation

This procedure is similar to the OATS procedure but involves using a larger graft obtained from a cadaveric donor to replace the damaged area. This option is often reserved for larger lesions where a graft from the patient’s own knee would not provide sufficient coverage.

Autologous Chondrocyte Implantation (ACI)

In this two-step procedure, knee cartilage surgeon Dr. Mayo first harvests a small amount of healthy cartilage from the patient’s knee. These cells are then cultivated in a laboratory setting to multiply into millions of cells. In a second surgery, these cells are implanted into the lesion, where they continue to multiply and eventually form new cartilage.

The recovery process after surgery can be quite lengthy and requires a considerable commitment from the patient. Immediately after surgery, weight-bearing is typically restricted for several weeks to months to protect the repair site and promote healing. Following this initial phase, a structured physical therapy program is crucial to restoring function to the knee. This typically includes exercises to improve strength, flexibility, and balance.

It’s important to note that a return to sports or other high-impact activities is not typically recommended until at least 6 to 9 months post-surgery, and often longer. This timeline can vary greatly depending on factors such as the type of surgery performed, the size and location of the lesion, and the patient’s overall health and commitment to rehabilitation.

The success rate of these treatment options can vary based on factors such as the specific procedure performed, the characteristics of the lesion, and the patient’s adherence to postoperative rehabilitation protocols. Ultimately, the goal of treatment is to relieve pain, restore function, and slow or prevent the development of osteoarthritis in the affected knee.