A cartilage (chondral) defect is a localized area of damage to the articular cartilage that covers the ends of the bones in the knee joint. The development of chondral defects can increase the risk and rate of progression of knee osteoarthritis.
Management of chondral defects is challenging and requires an assessment of the size and location of the defect, limb alignment, ligamentous stability of the knee, and the health of the patient. All treatment options are individualized for each patient’s specific needs and demands.
Initial treatment for a chondral defect is conservative measures including over-the-counter and prescription anti-inflammatory medications, analgesics, weight loss, physical therapy and exercise. When conservative management is insufficient to relieve symptoms nonsurgical steroid, hyaluronic acid, regenerative medicine options such as Stem-Cell or PRP injections may be offered before proceeding to surgery.
The goal of surgery is to improve function and eliminate pain, and to prevent osteoarthritis, and the need for a knee replacement.
Arthroscopic debridement is a procedure to remove cartilage fragments and smooth out the cartilage to reduce friction, and for symptom relief. This can be a good first approach to cartilage injuries because some people will improve with this minimally invasive procedure. Furthermore, it will allow the surgeon to characterize the cartilage injury if an advanced cartilage restoration procedure is required in the future.
Microfracture is the most common surgical option to treat small chondral lesions to treat pain and restore cartilage. This minimally invasive procedure entails perforation of bone near the lesion to induce bleeding and stimulating the release of bone marrow cells that promote cartilage restoration. The goal is to prevent further damage and knee arthritis.
ACI is an advanced treatment for cartilage restoration. This procedure is utilized for medium-sized cartilage lesions of the femur and patella. ACI is a two-step process where cartilage-producing cells called chondrocytes are harvested from the patient in a small biopsy from the knee or another area. The cells are grown in a lab and implanted into the cartilage defect during a subsequent surgery. ACI is a predictable and durable option in young and active patients.
An osteochondral autograft is tissue – bone and cartilage – harvested from a less-weightbearing area of the knee and transplanted into the defect to fill it. This is a single stage procedure. With time the transferred cartilage fills the defect. Studies report that OATS is an excellent option that provides clinically significant improvement in function. OATS is usually reserved for small-to-moderate sized lesions and has been shown to be superior to microfracture and requires superior technical skill to achieve appropriate sizing and contouring of the graft to fill the defect.
Osteochondral allografts are obtained from a donor and the fresh graft is implanted into the patient. They are often used successfully to treat larger cartilage defects.
Biologic therapies such as bone marrow stem cell transplants are on the horizon. Bone – derived stem cells can differentiate into cartilage cells for implantation. Our team at LALL Orthopedics + will discuss these options during your consultation.
Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon who specializes in hip arthroscopy, robotic hip replacement and cutting-edge regenerative medicine such as platelet-rich plasma (PRP) and Stem-Cell therapy. He treats non-athletes and athletes at all levels of play from collegiate to professional to the Olympic level. Dr. Lall is a world-renowned orthopedic surgeon who cares for all patients like family. Contact LALL Orthopedics + to schedule a consultation, receive the correct diagnosis, and undergo state-of-the-art treatment options.
At a Glance
Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
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