Knee Cartilage Defects Treatment Options

Knee cartilage is the smooth, rubbery tissue that covers the ends of the bones inside the joint. It allows the knee to bend, twist, and absorb shock with very little friction. Cartilage is what keeps the knee moving smoothly during activities like walking, climbing stairs, running, or playing sports. When this tissue is damaged, doctors call it a cartilage defect. Because cartilage has no blood supply it cannot repair itself. Without treatment, a cartilage defect can get larger and lead to long-term problems such as arthritis.

What are the treatments for knee cartilage defects?

There are many different ways to treat a cartilage defect. The best approach depends on the size of the injury, where it is located in the knee, the age and activity level of the patient, and the overall condition of the joint. Treatment options are usually grouped into non-surgical care, procedures that stimulate the body to form new tissue, and surgeries that restore or replace the damaged surface.

Non-surgical treatment

Non-surgical treatment is often the first step. These options do not regrow cartilage, but they can manage symptoms and protect the knee from further damage. Physical therapy is one of the most effective tools. Strengthening the muscles around the knee improves support and takes pressure off the injured area. Stretching helps maintain flexibility so the joint moves more smoothly. Weight management is also important because losing even a small amount of weight reduces the force that travels through the knee with each step.

Medications such as anti-inflammatories may be recommended for pain and swelling. Some patients also benefit from injections. Cortisone injections calm inflammation for weeks or months. Hyaluronic acid injections act like a lubricant, helping the joint move more easily. Platelet-rich plasma (PRP) uses growth factors taken from the patient’s own blood to promote healing in surrounding tissues and reduce irritation in the joint. These options can make daily activities more comfortable, though they do not repair the cartilage defect itself.

Surgery treatment

Surgery may be recommended when non-surgical care is not enough.

One common procedure is called microfracture. In this minimally invasive surgery, the surgeon makes tiny holes in the bone beneath the damaged cartilage. This allows marrow cells to enter the area and form a clot. Over time, the clot turns into a type of scar tissue that covers the defect. This new tissue is called fibrocartilage. It can improve pain and function, but it is not as strong or long-lasting as natural cartilage. For small, contained defects in younger patients, microfracture may provide good results.

For larger defects or more active patients, other procedures may be better. One option is moving healthy cartilage from another part of the knee into the damaged area. This is known as an osteochondral autograft. It works well for small defects and replaces the injured surface with real cartilage. When the damaged area is too large to be covered this way, donor cartilage and bone can be used instead. This is called an osteochondral allograft. It allows surgeons to repair much bigger areas and restore the natural shape of the joint surface.

Another advanced treatment uses a patient’s own cartilage cells. In this approach, called autologous chondrocyte implantation (ACI) or matrix-assisted chondrocyte implantation (MACI), a small sample of cartilage is taken from the knee. These cells are grown in a lab until there are enough to fill the defect. The cells are then placed back into the knee on a special patch that holds them in place. Over time, the cells can produce new cartilage-like tissue. This technique is more complex and requires more than one surgery, but it may provide longer-lasting results for the right patients.

Rehabilitation after surgery

Rehabilitation after surgery is a critical part of success. Right after the procedure, movement is carefully controlled to protect the healing tissue. Weight-bearing is increased gradually over weeks to months, depending on the type of repair performed. Physical therapy helps restore strength, flexibility, and balance. Recovery can take several months, and in some cases up to a year, before a patient is cleared to return to running or sports. Following the rehabilitation program closely is one of the most important factors for long-term results.

Sometimes cartilage repair is combined with other procedures to protect the new tissue. If the knee is out of alignment, meaning the leg is bow-legged or knock-kneed, a corrective surgery may be needed to shift weight away from the damaged side of the joint. If the meniscus, which acts as a cushion and shock absorber, is torn or missing, it may be repaired or replaced. Ligament reconstruction may also be recommended if the knee is unstable, since ongoing instability can damage cartilage and undo the benefits of surgery.

Every patient’s situation is different, and treatment must be customized. A young athlete with a small defect may do well with a microfracture or cartilage transfer. An older patient or someone with a larger injury may need a graft from a donor or a cell-based procedure. Others may find relief with physical therapy and injections without surgery. The goal of every option is the same: to reduce pain, restore function, and protect the joint from further damage.

Dr. Brian Waterman is a board-certified and fellowship-trained orthopedic surgeon in Winston-Salem, North Carolina, who specializes in sports medicine and knee injuries. He has extensive experience treating cartilage defects with both non-surgical methods and advanced surgical techniques. By carefully evaluating the injury, the mechanics of the knee, and the goals of each patient, he develops personalized treatment plans. His focus is on helping patients return to the activities they love while maintaining the long-term health of the knee. Contact him to schedule consultation to get an expert option on your condition and all your treatment options