CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Cartilage Defects
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Injuries and Conditions: Cartilage Defects : Cartilage Defects : Treatment Options
 

Overview
Damage to cartilage on the kneecap will not typically require surgery for a full recovery. Cartilage defects may range from minor tears to severe wearing away of the cartilage beneath the femur and above the tibia. These differences in the severity of degradation will affect the treatment decision, as will the degree of activity that the patient wishes to pursue after treatment.

Some patients, even with quite severe damage, may choose to not undergo surgery. However, damaged cartilage cannot rebuild itself, surgery will be required to produce additional cartilage-like material to supplement cushioning in the joint.

Treatment options:

Cartilage Defects - Microdrilling Overview
An arthroscope is inserted into the knee joint through a small incision in the skin. The area of the damage can be viewed through the arthroscope and may resemble a small flap of cartilage that has partly lifted from the surrounding larger mass of cartilage.

Fluid is introduced to the knee through another incision to clear away any blood and to expand the joint.

The doctor will make one or two further incisions to allow the working instruments (such as a burr, a probe or a small drill) to enter the joint. As the doctor views the interior of the knee from the monitor, they are able to work the surgical instruments with one hand while placing the arthroscope with the other hand.

Using the instruments, the area of the damaged cartilage is cleaned, removing stray fragments or bits of cartilage that may not be repairable.

A burr is used to rough the areas of bone surface that are exposed under the flap of cartilage or other areas where the cartilage has been damaged and needs to be repaired. A drill may also be used to make several small holes in the outer surface of the bone. Either instrument will remove surface material until the subchrondal area of the bone is exposed and has been well roughed and abraded by the doctor. After the operation and during recovery, the roughed and abraded subchrondal material will produce scar tissue on the outside of the bone as it heals. This new material will work to replace the damaged or missing cartilage and help the knee to function smoothly.

If the flap or other surrounding bits of cartilage are damaged and able to be repaired, these pieces will be sutured or tacked back into place. Any other areas of cartilage that remain jagged or that protrude into the joint will be smoothed and curved to ease motion of the knee.

Evaluation of Patient for Surgery

  • A complete physical examination that provides an assessment of the patient's overall health.
  • An examination of the range of movement in both the injured and uninjured knee.

    Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
  • The knee will remain tender and slightly painful after surgery. However, the pain will tend to decrease as painkillers are administered and the knee recovers from the operation.

    POST-OPERATIVE INSTRUCTIONS:
    Diet:

  • Begin with clear liquids and light foods (jellos, soups, etc.).
  • Progress to your normal diet if you are not nauseated.

    Activity:

  • Follow general post operative guidelines.
  • Be wary of any signs of infection.
  • Elevate the operative leg above chest level for 48 hours after surgery.
  • Do not place pillows under knees.
  • Use crutches to assist walking, do not place weight on the operative leg until instructed otherwise by the doctor.
  • Do not engage in activities which increase knee pain or swelling.
  • Return to sedentary work (school or desk work) only after 3-4 days if the pain is tolerable.
  • Avoid long periods of sitting and long distance traveling for two weeks.
  • Do not drive until permitted by the doctor.
  • Ice Therapy:

  • Begin ice therapy immediately after surgery.
  • Use a cryocuff continuously or as tolerated for the first week after your operation or until your follow-up appointment with your doctor. If you have not been instructed to use a cryocuff, icing should be performed every two hours for twenty minutes until swelling is controlled.

    Rehabilitation Program

    Initial care will focus on rest and avoidance of activities that aggravate the condition. Actions that involve any pounding force against the knee, such as running or jumping which cause pain, should be avoided. Physical therapy will work to increase strength and stamina within the quadriceps and hamstrings, which will help stabilize the knee and tracking of the knee joint.

  • If muscle imbalances are contributing to a poorly aligned knee joint, proper conditioning of the thigh muscles will work to re-establish a healthy biomechanical relationship.
  • Weight loss, if applicable, is recommended. This will help reduce stress on the joint, particularly while walking, climbing stairs or during other daily activities.
  • Non-steriodal anti-inflammatory medication (NSAIDs) may be administered which reduces irritation and swelling in the joint.
  • Therapists may recommend changes in activity and specialized bracing to support the knee during movement or while it is under load. This may include a knee support, knee brace or, in more severe cases, a knee immobilizer.
  • If over-pronation of the feet is a factor, orthodic shoe inserts may be used to correct the patient's stance, reducing strain on the kneecap.

    Long Term Expectations for Recovery

  • Surgically treated cartilage damage, if rehabilitated properly, will allow the patient to eventually regain complete strength, stability and motion of the knee.
  • Patients with more severe symptoms that require surgery can expect a longer recovery. The patient may return to activity after more than a month, in a limited capacity. Ongoing physical therapy combined with modifications to previous athletic activities will likely be required for more than three months.
  • To help maintain a healthy knee, continued gentle use of the knee will be required. Running or other pounding and impact producing activities should be considerably reduced or eliminated.
  • In all cases, physical therapy is required to restore the muscle strength, flexibility and stability lost after the initial damage to the cartilage, and the time required to rehabilitate the joint.

    Possible Complications and Risks

  • Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection and reactions to anesthesia.
  • Re-injury to the cartilage is possible if physical therapy or other activities during rehabilitation are overly strenuous, causing damage to the recently supplemented cartilage.
  • The repaired cartilage structure is not as durable or long lasting as the body's natural cartilage. However, the material will tend to remain robust if not subjected to abuse.

    Conservative Treatment of Cartilage Defects Overview
    Initial care will focus on rest and avoidance of activities that aggravate the condition. Actions that involve any pounding force against the knee, such as running or jumping should be avoided. Physical therapy will work to increase strength and stamina within the quadriceps and hamstrings, which will help stabilize the knee and the tracking of the kneecap.

    Rehabilitation Program

  • If muscle imbalances are contributing to a poorly aligned knee joint, proper conditioning of the thigh muscles will work to re-establish a functional and balanced biomechanical relationship.
  • Weight loss, if applicable, is recommended. This will help reduce stress on the joint, particularly while walking, climbing stairs or during other daily activities.
  • Non-steriodal anti-inflammatory medication (NSAIDs) may be administered which reduces irritation and swelling in the joint.
  • Therapists may recommend changes in activity and specialized bracing to support the knee during movement or while it is under load. This may include a knee support, knee brace or, in more severe cases, a knee immobilizer.
  • If over-pronation of the feet is a factor, orthotic shoe inserts may be used to correct the patient's stance, reducing strain on the kneecap.

    Medication and Medical Products
    Knee: Compression SleevesKnee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.


  • NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Long-Term Expectations for Recovery

  • Patients with minor damage can expect to fully recover after a month of physical therapy.
  • Patients suffering severe damage will require much longer to rehabilitate. In these cases, some degree of pain or discomfort may remain during movements that place pressure on the knee.
  • Patients that have not achieved full recovery will need to reduce their level of physical intensity to prevent further injury to the cartilage of the knee. In some cases this will mean completely refraining from activities that place particular stress on the knee.
  • Recovery is more dependent upon the condition of the joint and how the internal structures have repaired, and less on the number of days, weeks or months since the injury occurred.

    Possible Complications and Risks

  • Re-injury or aggravation to the cartilage is possible if physical therapy becomes overly strenuous for the condition of the knee.
  • For patients with severe cartilage defects, physical therapy may not sufficiently recondition the knee joint for vigorous athletic activities.

    Surgical Hardware Considerations

    The micro-drilling process does not require surgical hardware implants.

    Factors in Transplant Source
    The micro-drilling process does not require transplanting any tissue.