Cartilage injuries

Many patients present with cartilage injuries in their knee.  These usually take one of two forms.

Some patients have diffuse cartilage damage in their knee, whether it be in the medial or lateral compartments, or in the patellofellomoral joint. This is also known as osteoarthritis.  Please see the page on knee osteoarthritis Osteoarthritis.

Younger patients can injure their knee, and sustain focal or localized damage to the cartilage in one area of their knee.  This often leaves area of exposed bone, with can be up to 2 – 3 cm in diameter.  These lesions usually cause pain and swelling.

The accepted first line of treatment for localized cartilage defects is called a microfracture.  Using arthroscopy, the lesion is cleaned of scar tissue, and instruments used to create small holes in the bone at the base – this allows bleeding from the bone marrow which can remodel into fibrocartilage.  Patients should be on crutches for six weeks, and should not play sport for 6 months.  This type of surgery is very safe, and will help approximately 80% of patients.

For patients in whom microfracture does not work, or in whom the defect is large with missing bone and cartilage, other options must be considered.  One option is to use allograft or cadaveric bone and cartilage – this is very expensive, and difficult to obtain.  At Women’s College Hospital, Dr Dwyer and Dr Chahal are using a very promising new technique developed in Italy involving obtaining bone marrow and stem cells from the pelvis, and placing under collagen scaffold to regrow cartilage in the knee.