Some patients with an articular cartilage injury improve with conservative treatment. The treatment includes exercises, use of anti-inflammatory medications (NSAIDs), and possibly an injection of steroid. The exercise may include a program you can do at home or formal physical therapy. Depending on the extent of the damage, some patients get better with these treatments and do not require surgery. If patients do not get better with conservative therapy, or have a large articular cartilage lesion, surgery may be necessary.

How are articular cartilage injuries treated with surgery?
The surgery for articular cartilage injuries depends on the extent of the problem. There are several surgical options, and which procedure is best depends on several factors. These factors include the patient’s age and activity level, the size of the lesion, and the chronicity (age) of the lesion.

What are the treatment options for articular cartilage injuries?
Some patients with an articular cartilage injury improve with conservative treatment. The treatment includes exercises, use of anti-inflammatory medications (NSAIDs), and possibly an injection of steroid. The exercise may include a program you can do at home or formal physical therapy. Depending on the extent of the damage, some patients get better with these treatments and do not require surgery. If patients do not get better with conservative therapy, or have a large articular cartilage lesion, surgery may be necessary.

How are articular cartilage injuries treated with surgery?
The surgery for articular cartilage injuries depends on the extent of the problem. There are several surgical options, and which procedure is best depends on several factors. These factors include the patient’s age and activity level, the size of the lesion, and the chronicity (age) of the lesion.

The first step in evaluating the lesion is usually arthroscopy. The arthroscope is a fiber optic instrument (narrower than a pen) which is put into the knee joint through small incisions. A camera is attached to the arthroscope and the image is viewed on a TV monitor. The arthroscope allows me to fully evaluate the entire knee joint, including the knee cap (patella), the cartilage surfaces, the meniscus, the ligaments (ACL & PCL), and the joint lining. Small instruments ranging from 3-5 millimeters in size are inserted through additional incisions so that I can feel the joint structures for any damage, diagnose the injury, and then repair, reconstruct, or remove the damaged tissue.

Once the lesion is evaluated, there are several options for treatment. These include:

• Smoothing of the lesion and removing loose edges only (debridement)
• Techniques to stimulate scar cartilage to grow into the lesion (microfracture)
• Techniques to replace the lesion with new cartilage (osteochondral autografts, osteochondral allografts, or autologous chondrocyte implantation).

What is debridement of the articular cartilage?
Debridement is performed by using small arthroscopic instruments, such as a mechanical shaver, to smooth the cartilage edges. This is performed so that there are no loose edges to irritate the joint, and to prevent the area of damage from expanding. Debridement is primarily used for small lesions, or when severe arthritis is found that involves the entire knee joint. Many patients can do well with debridement.

• Patient Guide to Articular Cartilage Injury (1.1Mb)

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