The knee joint is made up of three bones: the thigh bone (femur), the shin bone (tibia) and the kneecap (patella). The end of each of these bones is covered by a smooth, shiny, white, gristle-like layer of tissue called articular cartilage. This layer allows the bones to glide smoothly over each other during knee motion. Articular cartilage can be damaged during twisting or pivoting injuries, or by a direct impact to the knee during falls, sports injuries, or motor vehicle accidents, and can be damaged in the setting of ligament injuries, such as an ACL tear, or with meniscal tears (See ACL Tear and Meniscus Tear). Small pieces of the cartilage may occasionally break off and float around in the knee as loose bodies. Often, however, there is no clear history of a single injury. The patient’s condition may result from a series of minor events that have occurred over time.

Cartilage damage may not cause symptoms, but sometimes knee pain is present, and is often worse with weight-bearing activities. The location of the pain often correlates with the location of injury and the type of activity that stresses that part of the knee. If the patella or its groove on the femur are involved, symptoms may be worse with stairs and squatting. Swelling in the knee and mechanical symptoms, such as locking, catching, or painful popping may also occur. In patients with loose bodies, patients sometimes report a sensation of something moving around in the knee.
Cartilage injuries can be difficult to diagnose. Often, suspicion is based on clinical history and a comprehensive physical examination by an experienced knee surgeon. X-rays and an MRI are beneficial in providing additional diagnostic information, but often arthroscopy is required to provide a definitive diagnosis.
The treatment for cartilage injuries depends several factors, including the size and location of the lesion, the age and activity level of the patient, the presence of a loose body, the symptoms experienced by the patient, and the presence and degree of arthritis in the remainder of the knee.

For low demand patients with minimal symptoms, non-operative treatment modalities like weight loss, activity modification, anti-inflammatory medications, and steroid and/or visco-supplementation injections are usually effective. These modalities may decrease the symptoms, but none of them will actually heal the defect/injury.

For younger, active patients or those who have failed non-operative treatment, surgery is often recommended. The type of surgical treatment depends upon numerous factors including patient age and activity level and expectations, the size and location of the lesion, and prior surgical treatments. Surgical options range from arthroscopic chondroplasty and debridement, to more complex, and sometimes staged, procedures like osteochondral resurfacing and chondrocyte implantation.

At Oceana Sports Medicine and Orthopaedic Center, Dr. Aboka performs Arthroscopic Cartilage Restoration Surgery, customized to each patient and utilizing cutting edge approaches and instrumentation, facilitating a return to an active lifestyle.