Articular Cartilage Damage

An Overview of Articular Cartilage Damage

Chondral knee injuries are the result of articular cartilage damage within the knee. Articular cartilage is a specific connective tissue covering joint surfaces that is important for smooth movement of the joint and allows the bones to move past each other without friction. Viewed by the naked eye, it has a glistening, white appearance. Microscopically, it is composed of water, collagen and a variety of matrix proteins and lipids.

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Articular cartilage has no nerve supply and therefore does not cause immediate pain when it is injured. Once it is damaged, articular cartilage is unable to repair itself. Although symptoms related to articular cartilage damage may take years to develop, articular cartilage injury is very common.

Many factors play a role in chondral knee injuries, including the patient’s age when the degeneration starts, the patient’s activity level and weight, and the overall presence of ligament damage. Cartilage damage may be in place for years, but sometimes an individual is unaware because they remain asymptomatic. Years of wear-and-tear and bone-on-bone rubbing can cause symptoms to develop slowly over time as this cartilage damage progresses to osteoarthritis.

Chondral Knee Injuries Grading Scale

Chondral damage is graded from mild to severe, and all grades can have characteristics of osteoarthritis.

Grade 0: Normal cartilage
Grade I: In this early stage, cartilage starts to become soft and swells
Grade II: This stage will present a partial-thickness defect with fibrillation (shredded appearance) or fissures (depressions) on the surface that do not reach the bone or exceed 1.5 cm in diameter.
Grade III: This stage presents an increased amount of damage to the level of subchondral bone (bone right below the cartilage) in an area with a diameter more than 1.5 cm. Patients will often complain about noise as the knee bends and soreness or trouble standing from a squatted position.
Grade IV: This phase will present an exposed subchondral bone—meaning, the cartilage may wear away completely. When the involved areas are large, pain usually becomes more severe, causing a limitation in activity.

Symptoms of Articular Cartilage Damage

The symptoms of a chondral injury resulting from articular cartilage damage will not present themselves as prominently as a torn ACL or meniscus tear. Similar to other arthritic conditions, the symptoms start mild and continue to progress as time goes on.

Symptoms with damaged articular knee cartilage, include:

Intermittent swelling (often the only symptom)
Pain associated with prolonged walking or stair climbing
Buckling or giving way when full weight is placed on the knee
Locking or catching
The knee may make noise during motion

Diagnosing a chondral injury can be difficult. Many times, a swollen knee will show a normal exam. Imaging using an X-ray, MRI or via an arthroscopic examination can help determine if cartilage loss is occurring, thus leaving a decrease in space between the bone surfaces.

Treatment for Chondral Knee Injuries

Non-Surgical

Articular cartilage degeneration is often treated without surgery. Dr. Millett will recommend exercises to strengthen the muscles around the joint, supplements and possibly injections of regenerative medicine, such as PRP (platelet rich plasma) or hyaluronic acid, to improve joint lubrication and reduce friction. There are medications that can be prescribed to help treat symptoms associated with chondral injuries. However, since new growth of cartilage is challenging, most medications presently will not cure the condition. Medications and other treatments however can allow patients to live pain-free and remain active.

Surgical

Over the past decade, there have been big strides and exciting advancements in the surgical treatment of articular cartilage defects. The most commonly performed procedures for treating chondral defects include chondroplasty (cartilage removal), microfracture (holes made in bones that release stem cells from the marrow), and OATS, or OsteoArticular Transfer – this can be done by taking a piece of bone and cartilage from elsewhere in one’s knee or from a cadaver knee and then transplanting it into the defective area.

Chondroplasty – Shaving or Debridement

This arthroscopic surgery technique uses special arthroscopic instruments to smooth the shredded or frayed articular cartilage. Ideally, this treatment will decrease friction and irritation, reducing the symptoms of swelling, noise, and pain.

Microfracture

This arthroscopic technique encourages the growth of new cartilage into the defect. This is a well-accepted technique that is a common procedure for patients with damage through the full thickness of articular cartilage (all the way to the bone).

OATS

OATS, osteochondral autograft transfer system, is a technique that involves replacing damaged joint cartilage (in high weight bearing areas) with healthy cartilage and bone (from lower weight bearing areas). This is an arthroscopic or open procedure done using either one’s own healthy tissue or tissue transplanted from a cadaver. Small holes are drilled into the damaged cartilage area. Then, bone and cartilage grafts are inserted into the defective area to re-surface the damaged cartilage. It is highly effective.

Have you experienced articular cartilage damage?

There are two ways to initiate a consultation with Dr. Millett:

You can provide current X-rays and/or MRIs for a clinical case review ($250).

You can schedule an office consultation with Dr. Millett.

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Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!