Knee Cartilage Injury and Treatment Options

With cartilage damage there isn’t always a singular, dramatic injury that pinpoints the cause, unlike when you break a bone or experience a major ligament tear. However, damage to cartilage can still cause ongoing pain, swelling, stiffness or catching that makes sport, gym training, work and everyday movements harder.

The first step is working out the type of cartilage damage. A localised cartilage injury in an otherwise healthy knee is very different to widespread cartilage loss seen with osteoarthritis. And the treatment options are different too.

Dr David Kitchen, Orthopaedic Specialist in Adelaide, treats cartilage injuries and sports knee conditions. If ongoing knee pain, swelling or catching is affecting you, speak with your GP about a referral today.

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What is articular cartilage and why does it matter?

Articular cartilage is the smooth tissue covering the ends of the bones inside the knee joint.

In a healthy knee, it helps the joint surfaces glide over each other with very little friction and helps distribute load through the knee when you walk, run, squat or play sport.

The challenge is that articular cartilage has limited ability to repair itself because it does not have a direct blood supply.

Minor surface damage may remain stable. A deeper defect that extends down towards or into the bone beneath the cartilage can cause more persistent symptoms and may need closer assessment.

How does knee cartilage damage happen?

Cartilage injuries generally fall into two broad groups: traumatic focal injuries and degenerative cartilage loss.

A traumatic cartilage injury can happen after a twisting injury, direct blow to the knee, sporting collision or kneecap dislocation.

This may leave a focal defect, meaning one localised area of cartilage has been damaged even though the rest of the joint remains relatively healthy.

Degenerative cartilage loss is different. It develops gradually as part of osteoarthritis and tends to involve a broader area of the joint rather than one isolated defect.

That distinction matters because a cartilage repair procedure designed for one focal defect is not usually the same treatment used for widespread arthritic wear.

What does a cartilage injury in the knee feel like?

Though symptoms vary with the location and extent of the damage, you may notice:

Pain during or after activity
Swelling that becomes more noticeable after loading the knee
Stiffness
Clicking or catching
Difficulty returning to sport or exercise

If a loose fragment of cartilage or bone is moving inside the joint, the knee may occasionally lock or become stuck. Persistent locking or a knee that will not move normally should be reviewed by an orthopaedic specialist.

How is a cartilage injury diagnosed?

Imaging and scans may help with diagnosis but they are only one part of the assessment.

MRI is commonly used to assess articular cartilage because it can show cartilage defects and other structures within the knee.

X-rays do not show the cartilage itself as clearly, but they still provide useful information about the overall condition of the joint and can show features of osteoarthritis or, in selected cases, loose bodies.

Dr Kitchen will assess the imaging alongside your symptoms, how the knee moves, any previous injuries and what activities you are trying to return to.

Can a knee cartilage injury be treated without surgery?

Not every cartilage injury requires an operation and non-surgical treatments may include:

Physiotherapy to improve strength and support around the knee
Changing activities that repeatedly aggravate symptoms
Anti-inflammatory medication where suitable
Intra-articular injections in selected cases

These are used to reduce symptoms, improve function and see how the knee responds before considering surgery, if it is possible.

The type of cartilage injury matters here too. A small focal defect, widespread osteoarthritis and a loose fragment causing mechanical symptoms are different problems and are not managed in exactly the same way.

When is surgery considered for knee cartilage damage?

Surgery may be considered when symptoms continue despite non-surgical treatment or when the cartilage injury has features that make surgical treatment necessary.

The decision is based on the size and depth of the damage, its location, your age and activity level, the condition of the rest of the knee and what the injury is stopping you from doing.

In a younger active patient with a focal cartilage injury and an otherwise healthy joint, the goal may be to treat or repair the damaged area and preserve the rest of the knee. Whereas for someone with widespread degenerative cartilage loss and established arthritis, a focal cartilage repair procedure is less likely to address the underlying problem.

What surgery is used for a focal cartilage defect?

Different cartilage procedures are used for different types of defects.

Microfracture
This may be considered for selected smaller defects. The technique stimulates the bone beneath the damaged cartilage so repair tissue can form within the defect.

Osteochondral Transplantation
Involves moving a plug of healthy cartilage and underlying bone from a less load-bearing area of the knee to the damaged area.

Cartilage Restoration Techniques
Larger or more complex focal defects may require more advanced cartilage restoration techniques.

Dr Kitchen will consider the size, depth and location of the cartilage damage, the health of the surrounding joint and your activity goals before discussing which options may be suitable for you.

What if the cartilage damage is caused by arthritis?

Cartilage repair and treatment for knee arthritis are not the same thing.

When cartilage loss is widespread across the joint rather than confined to one focal area, the problem may represent osteoarthritis rather than an isolated cartilage injury.

In patients with significant arthritis and widespread cartilage loss, joint replacement may be considered instead of trying to repair one section of cartilage.

This is why confirming the pattern of damage is important before deciding on treatment.

Knee cartilage injury assessment in Adelaide

Dr David Kitchen is an Australian-trained Orthopaedic Surgeon with subspecialty training in hip and knee surgery. He treats cartilage injuries alongside ACL injuries, meniscal injuries and other sports knee conditions.

During assessment, Dr Kitchen will review your symptoms and imaging, examine the knee and consider if the problem is a focal cartilage injury, another knee injury or part of more widespread joint degeneration.

Treatment can then be discussed around the actual condition of your knee and the activities you want to return to.

Dr Kitchen consults privately at sportsmed Stepney and Henley Beach, and The Specialist Clinic in Port Pirie.

Should you get a cartilage injury assessed?

If knee pain, swelling, catching or locking keeps returning, or you cannot get back to sport, exercise, work or normal activity despite rehabilitation, speak with your GP about referral to Dr David Kitchen for a specialist orthopaedic opinion.