Knee Chondral Injuries Treatment Options

What are knee chondral injuries?

Knee chondral injuries, also known as chondral lesions or cartilage injuries, involve damage to the articular cartilage that covers the ends of the bones within the knee joint. These injuries can result from trauma, repetitive stress, degenerative changes, or concomitant pathologies such as meniscal tears. Common symptoms of knee chondral injuries include pain, swelling, stiffness, and a sensation of instability in the knee joint. Diagnosis typically involves a combination of medical history review, physical examination, and imaging studies such as MRI. Treatment options range from conservative measures such as activity modification and physical therapy to surgical intervention. Early diagnosis and appropriate management are crucial for alleviating symptoms, preserving joint function, and preventing further deterioration of the knee joint

What non-operative options are available?

Conservative management strategies may be considered for individuals with small, asymptomatic chondral lesions or mild symptoms. Conservative treatment approaches aim to reduce pain, inflammation, and functional impairment while promoting joint health and mobility. Key components of conservative management for knee chondral injuries include:

1. Activity Modification: Avoiding high-impact activities and modifying activity levels to reduce stress on the knee joint can help alleviate symptoms and prevent further cartilage damage. Individuals may benefit from transitioning to low-impact exercises such as swimming, cycling, or elliptical training to maintain joint mobility without exacerbating symptoms.
2. Physical Therapy: A structured physical therapy program focusing on strengthening exercises, range of motion exercises, and proprioceptive training can improve joint stability, muscle strength, and functional mobility. Physical therapists may utilize modalities such as ultrasound, electrical stimulation, or manual therapy techniques to reduce pain and inflammation and promote tissue healing.
3. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or analgesic medications may be prescribed to manage pain and discomfort associated with chondral injuries. Corticosteroid injections and hyaluronic acid injections may provide temporary relief by reducing inflammation and lubricating the joint surfaces.
4. Bracing or Orthotics: The use of knee braces or orthotic devices may help stabilize the knee joint, provide support, and offload areas of cartilage damage. Customized orthotics can redistribute pressure within the joint, reducing mechanical stress on the affected cartilage and alleviating symptoms during weight-bearing activities.

Conservative management approaches are generally recommended as initial treatment options for individuals with mild to moderate symptoms of knee chondral injuries. However, it’s essential to monitor the patient’s response to conservative treatment closely and consider alternative interventions if symptoms persist or worsen over time.

What minimally invasive procedures are available?

Surgical interventions offer targeted treatment options for individuals with symptomatic knee chondral injuries who have not responded adequately to conservative measures. These procedures aim to address cartilage damage, promote tissue healing, and improve joint function while preserving native joint structures. Common surgical procedures for knee chondral injuries include:

1. Arthroscopic Debridement: Arthroscopic debridement involves the removal of loose or damaged cartilage fragments, fibrillated tissue, and synovial debris from the knee joint using specialized instruments inserted through small incisions. This minimally invasive procedure can alleviate symptoms such as pain, swelling, and mechanical symptoms (e.g., catching or locking) and improve joint function by restoring the smooth articulating surface of the cartilage.
2. Microfracture: Microfracture is a surgical technique used to stimulate cartilage repair and regeneration by creating small perforations (microfractures) in the subchondral bone beneath the damaged cartilage surface. This procedure promotes the influx of blood and bone marrow-derived stem cells into the cartilage defect, initiating the formation of fibrocartilage tissue to fill the lesion. While microfracture can produce favorable outcomes in select cases, it may result in the formation of mechanically inferior fibrocartilage rather than hyaline cartilage, limiting long-term durability.
3. Autologous Chondrocyte Implantation (ACI): ACI is a two-stage surgical procedure designed to repair focal chondral defects by transplanting autologous cartilage cells (chondrocytes) into the lesion site. In the first stage, a small biopsy of healthy cartilage is harvested from a non-weight-bearing area of the knee joint. The chondrocytes are then cultured and expanded in vitro before being implanted into the defect site during a second surgical procedure. ACI offers the potential for durable cartilage repair and restoration of joint function, particularly in younger patients with isolated focal lesions.
4. Osteochondral Autograft Transplantation (OATS): OATS, also known as mosaicplasty, involves harvesting cylindrical plugs of healthy cartilage and bone from a non-weight-bearing area of the knee joint and transplanting them into the chondral defect site. OATS aims to replace the damaged cartilage with healthy hyaline cartilage, restore joint congruity, and improve joint function.
5. Osteochondral Allograft Transplantation: Osteochondral allograft transplantation involves transplanting cadaveric donor tissue containing both cartilage and bone into the chondral defect site. This procedure provides an alternative option for patients with extensive or complex chondral lesions who may not be suitable candidates for autologous cartilage transplantation.
6. Autologous Matrix-Induced Chondrogenesis (AMIC): AMIC is a one-stage surgical procedure that combines microfracture with the application of a biocompatible scaffold or matrix to the chondral defect site. The scaffold provides a supportive environment for cell attachment, proliferation, and differentiation, facilitating the formation of hyaline-like cartilage tissue within the lesion site.
7. Total Knee Arthroplasty (TKA): TKA, also known as total knee replacement, may be indicated for individuals with advanced osteoarthritis or extensive cartilage loss affecting multiple compartments of the knee joint. During TKA, the damaged articular surfaces of the knee joint are replaced with prosthetic components made of metal, plastic, or ceramic materials. TKA can provide significant pain relief, improve joint function, and restore mobility in patients with end-stage knee osteoarthritis.

Surgical interventions for knee chondral injuries are typically reserved for cases where conservative treatments have failed to provide adequate symptom relief or when there is significant joint damage requiring surgical correction. The choice of surgical procedure depends on various factors, including the extent and location of the chondral lesion, the patient’s age and activity level, and severity of pain and functional limitation.

Dr. Shane J. Nho is a board-certified fellowship trained sports medicine orthopaedic surgeon who specializes in the treatment of knee chondral injuries. If you believe you are affected by a knee chondral injury, schedule a consultation today with our experienced orthopaedic care team.