Chondral Defects Treatment Options

For mild to moderate chondral defects, conservative treatments are often recommended as the first line of defense. These treatments aim to manage symptoms and improve joint function without the need for surgery:

• Anti-inflammatory medications: Help reduce pain and swelling in the affected joint.
• Physical therapy: Strengthening the muscles surrounding the knee and improving flexibility can help reduce stress on the cartilage.
• Activity modification: Limiting activities that exacerbate symptoms, such as high-impact sports, can help manage pain.
• Supplements: Glucosamine and chondroitin are often recommended to support joint health, though their efficacy can vary from patient to patient.
• Injections: Corticosteroid or hyaluronic acid injections can reduce inflammation and improve joint lubrication, providing temporary relief.

While non-surgical treatments do not regenerate damaged cartilage, they can effectively manage symptoms in many cases.

For more severe or persistent chondral defects, surgical intervention may be necessary. Advances in cartilage restoration techniques over the past decade have significantly improved outcomes for patients with cartilage injuries. Dr. Jorge Chahla, an expert in cartilage restoration, offers several surgical options depending on the severity of the injury.

1. Arthroscopic Debridement: This minimally invasive procedure involves removing loose cartilage fragments, smoothing the edges of the defect, and reducing irritation in the joint. It is a common first-line surgical treatment for cartilage injuries and offers rapid symptom relief with minimal downtime.
2. Arthroscopic Microfracture: In this procedure, small holes are made in the bone beneath the cartilage defect to stimulate the growth of fibrocartilage. While fibrocartilage is not as durable as natural articular cartilage, it can improve joint function and reduce pain in certain patients. Microfracture is typically used for smaller, localized defects in active patients. However, its popularity has declined in recent years due to the development of more advanced techniques.
3. Cartilage Transplantation (MACI): This two-stage procedure involves harvesting healthy cartilage cells (chondrocytes) from a non-weight-bearing area of the knee, culturing them in a lab, and then implanting them into the cartilage defect. The cells are placed on a collagen membrane (MACI) and used to repair the damaged area. Since the patient’s own cells are used, there is no risk of rejection. This method is particularly effective for younger, active patients with focal cartilage defects.
4. Osteochondral Autograft Transplantation: This one-stage procedure involves taking a small plug of healthy cartilage and bone from a non-weight-bearing part of the knee and transplanting it into the defect. Autografts are ideal for smaller lesions and offer long-term durability.
5. Osteochondral Allograft Transplantation: For larger cartilage defects, donor cartilage and bone can be used. Allografts are particularly effective for patients with large or difficult-to-treat lesions, and they offer excellent survival rates even 10 years after the procedure.

Recovery from a chondral defect depends on the severity of the injury and the treatment approach. Non-surgical treatments may require several weeks of physical therapy and activity modification to manage symptoms effectively. For patients undergoing surgery, recovery can take several months. Most patients will need to follow a structured rehabilitation program that includes physical therapy to restore strength and mobility to the joint.

In many cases, patients can return to their normal activities, including sports, after completing their rehabilitation. However, individuals with more severe injuries or those who delay treatment may be at a higher risk of developing osteoarthritis in the affected joint.