What can you do about cartilage damage?

What usually helps before a procedure?

Change how much activity you do first. If a long walk brings swelling, walk less and rest longer. Strength work may help the muscles support the joint. Weight loss isn't for everyone, but it may ease knee strain when body weight adds to the ache.

Medicine sometimes helps. It also carries risk. Ask a pharmacist or your doctor to compare it with every pill you take and each health problem. Physical therapy may help with strength, balance and safe movement.

Home care isn't wasted effort. It gives you facts for the exam. If shorter walks bring less swelling, the amount of walking matters. If the joint still aches at rest, tell the staff member who checks it.

When is surgery a different decision?

Surgery may come up when one damaged spot catches, locks or leaves loose cartilage. Doctors call one bounded area of damage a defect. That's different from wear spread across most of the joint.

Repair surgery usually aims at that one damaged area, not broad wear. Recovery can limit walking and require months of rehab. Ask what the operation will do, how long you'll need help and what comes next if soreness remains.

Even when surgery fills the damaged area on a scan, the joint may still hurt or feel stiff, so ask how your doctor will judge movement at the next visit.

Surgery takes a clear reason and a workable recovery plan.

What if home care isn't enough?

You can't sort this out from soreness alone. An exam can show whether the joint is swollen, weak or blocked. Take your old X-rays and medicine list. Say which chores you've stopped doing and which activity you want back.

QC Kinetix uses the names natural pain treatments and regenerative treatments for non-surgical care, including a shot prepared from blood drawn from you. PRP means platelet-rich plasma. Staff separate the blood, concentrate a portion and ready it for the sore area.

Medical providers means the clinic staff who perform your exam and talk through care. Ask who will do the exam and whether that person is a doctor. The clinic may discuss this care as a knee or hip surgery alternative, but surgery may still be needed.

Choose care only after the exam explains your soreness.

Sources

1. A JBJS evidence-based review of chondral lesions of the knee sets management by lesion size, location, limb alignment and rotation, and patient demand rather than by product: osteochondral autograft transfer is described as durable and predictable for smaller lesions (under 2 cm2) in young active patients, while lesions of 2 cm2 or more are typically treated with osteochondral allograft transplantation, particulated juvenile articular cartilage, or matrix-associated chondrocyte implantation, with favourable mid- and long-term results reported for allograft or MACI in large lesions of 3 cm2 or more.

   Dekker TJ, et al. — Chondral Lesions of the Knee: An Evidence-Based Approach.. J Bone Joint Surg Am, 2021. DOI: 10.2106/JBJS.20.01161.

2. Sixty competitive athletes (mean age 24.3) with a symptomatic knee cartilage lesion were randomised to mosaic osteochondral autologous transplantation or microfracture. At a mean 37 months, 96% of the transplantation group had excellent or good results versus 52% after microfracture.

   Gudas R, et al. — A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes.. Arthroscopy, 2005. DOI: 10.1016/j.arthro.2005.06.018.

3. At 14 to 15 years, the Norwegian multicentre randomised trial of 80 patients with a single symptomatic femoral condyle cartilage defect found no significant difference between autologous chondrocyte implantation and microfracture on any clinical scoring system. There were 17 failures in the ACI group versus 13 after microfracture, and more total knee replacements had been needed after ACI (6 versus 3).

   Knutsen G, et al. — A Randomized Multicenter Trial Comparing Autologous Chondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years.. J Bone Joint Surg Am, 2016. DOI: 10.2106/JBJS.15.01208.

4. FDA biologics licence BL 125603 (Vericel) describes MACI verbatim as "an autologous cellularized scaffold product indicated for the repair of symptomatic, single or multiple full-thickness cartilage defects of the knee with or without bone involvement in adults." The licensed indication is a two-stage surgical implantation for full-thickness DEFECTS of the knee in adults. It is not an injection, it is not licensed for osteoarthritis, and it is not licensed for any joint other than the knee.

   U.S. Food and Drug Administration — MACI (autologous cultured chondrocytes on porcine collagen membrane). FDA, Center for Biologics Evaluation and Research, 2024.

5. Forty-five people who had had a partial medial meniscectomy 3-5 years earlier were randomised to four months of supervised exercise three times weekly or to no intervention. The exercise group improved cartilage glycosaminoglycan content measured by dGEMRIC relative to controls (+15 ms versus -15 ms; P = 0.036), with a strong dose-response to reported activity. Adult cartilage can adapt its composition to loading - which is not the same as filling a hole in it.

   Roos EM, et al. — Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis.. Arthritis Rheum, 2005. DOI: 10.1002/art.21415.

6. In a 19-year multicentre Norwegian follow-up of 322 patients (328 knees) with an arthroscopically verified focal cartilage lesion, mean age 36.8 at index surgery, those who had not needed arthroplasty or osteotomy reported significantly better pain, Lysholm and KOOS scores at final follow-up than before their index operation. By follow-up 17.7% had undergone later cartilage surgery, and nearly 50% met the study's treatment-failure definition, with BMI of 25 or more among the main risk factors.

   Birkenes T, et al. — Long-Term Outcomes of Arthroscopically Verified Focal Cartilage Lesions in the Knee: A 19-Year Multicenter Follow-up with Patient-Reported Outcomes.. J Bone Joint Surg Am, 2024. DOI: 10.2106/JBJS.23.00568.

7. In the 24-month GAIT ancillary study, 572 patients with knee osteoarthritis took glucosamine, chondroitin sulfate, their combination, celecoxib or placebo. No statistically significant difference in loss of joint space width was found for any treatment versus placebo, in which mean loss was 0.166 mm over two years. Oral supplements did not change the structure of the joint.

   Sawitzke AD, et al. — The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial.. Arthritis Rheum, 2008. DOI: 10.1002/art.23973.