When knee cartilage damage (known as chondromalacia) occurs suddenly from an injury or from deterioration over a period of years. It limits the knee’s normal movement and can cause significant pain. If cartilage damage is not treated, it can worsen and eventually become knee arthritis.
Knee Cartilage & Meniscus
There are two types of cartilage in the knee:
- meniscus cartilage– the “rubbery” shock absorber between the bones.
- articular cartilage- the hard, smooth covering over the ends of the bones.
With injury or normal aging, the articular cartilage can wear away. This often begins as a crack or fissure known as chondromalacia and can progress down to bone.
What is Knee Cartilage Damage or Chondromalacia?
Chondromalacia is graded from I through IV.
What Are Knee Cartilage Damage Symptoms?
Common symptoms of chondromalacia include:
- Catching, locking, giving-way
- Inability to fully straighten or bend knee
A patient may have one symptom or all of them. Also, it’s quite common for meniscus or cartilage injury symptoms to vary from day to day.
How Is Knee Cartilage Damage Diagnosed?
Knee chondromalacia is diagnosed through a careful medical history, a thorough physical examination and X-rays. Although cartilage damage and meniscus tears are not visible on x-rays, the x-ray can provide important information regarding arthritis, fractures and osteochondral defects (a more severe cartilage injury that also damages the underlying bone). If the x-rays are normal, a MRI can be ordered to show chondromalacia or a meniscus tear.
Severe cartilage damage can progress to arthritis which is diagnosed with x-rays.
Knee Cartilage Damage Treatment
- Anti-inflammatory medications, glucosamine supplements, physical therapy and activity modification can alleviate minor symptoms.
Alternative Treatments to Potentially Avoid Surgery
- PRP, Stem Cell and Lipogems® injections obtained from patients’ blood, bone marrow or fat include growth factors and regenerative cells that can be injected into the knee to stimulate natural healing.
Surgery to Treat Chondromalacia without Cartilage Transplant
- Chondroplasty – 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 smoothed. It is impossible to make the damaged cartilage completely smooth like normal cartilage but the goal of this procedure is to reduce pain and slow down the progression of cartilage damage.
- Microfracture – a treatment used to stimulate the body to grow fibrocartilage in an area of damage. It requires only one surgery and can be completed entirely arthroscopically. It does not grow normal cartilage but can provide good short term results.
- BioCartilage (Arthrex Inc., Naples, FL) – Small particles donor cartilage are mixed with the patients’ blood to create a paste-like material that is placed over the defect. BioCartilage is a tissue scaffold that your body’s cells can attach to and produce new reparative cartilage tissue in the defect.
- Cartiform (Arthrex Inc., Naples, FL) – Another technology in which a small “patch” of donor cartilage is inserted into the patients’ cartilage defect to replace the missing cartilage.
- Osteochondral Grafting – With this technique, the damaged cartilage 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).
Autologous Chondrocyte Implantation (ACI)
- This is the most complex technology currently in use. In this two-step procedure, cartilage cells are harvested in the first surgery and re-implanted in the second.
- The second surgery is a traditional open surgery and not arthroscopic so it is more invasive. After surgery there is an extensive period of recovery and rehabilitation.
Why G2 Orthopedics and Sports Medicine?
We are a small, specialized orthopedic practice in Richmond, VA that provides Advanced Orthopedic Treatment Options, Excellent Results, Personalized Care and Convenient Appointments.
Dr. Vic Goradia is fellowship trained in sports medicine, minimally invasive surgery and knee & shoulder reconstructive surgery. He began practicing in Richmond in 2001 and has extensive experience.
Dr. Jake Budny is fellowship training in joint replacement surgery with a special interest in minimally invasive direct anterior hip replacement, knee replacement and complex, revision joint replacement.