There are several types of procedures for cartilage repair and regeneration that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.

The choice of procedure depends on the size and location of the defect. Larger defects are typically treated with autologous chondrocyte transplantation or osteochondral allograft transplantation, both of which require open incisions. Smaller defects in specific locations can be treated with marrow-stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer.

Intended audience

The aim of this article is to provide comprehensive information about chondral/osteochondral lesions and possible ways of cartilage repair. This section is recommended for anyone interested in cartilage problems, and for patients suffering from chondral/osteochondral lesions.

What is cartilage repair?

Osteochondral/chondral repair means a restoration of the cartilage (articular) surface of a joint that has been affected by an osteochondral/chondral defect. The affected joint usually swells up following injury, and it may take weeks or even months before the swelling goes down. This swelling can recur. Drugs such as aspirin, ibuprofen, and naproxen, known as non-steroidal anti-inflammatory drugs (NSAIDs), and other conservative treatments usually have the only limited effect on the pain and do not treat the underlying problem.

If there is a severe fluid build-up and a loose body in the joint, removal and treatment via arthroscopy may be necessary. Arthroscopy is also useful for assessing the cartilage lesion, as knowing the extent of the affected area is crucial for deciding the best treatment. The methods typically used for cartilage repair are, depending mostly on the size of the lesion: microfracture, mosaicplasty, cartilage cell implantation (autologous chondrocyte implantation) or large allograft implantation.

The decision over surgical management of cartilage defects depends on the size and location of the defect, and whether it is self-contained or spread out.

It also depends on

Whether or not the joint has been operated before

The patient’s age

The patient’s physical fitness and activity

Whether the patient wants to undergo surgery

The presence of other conditions and diseases

The presence of any associated injuries

Treatment of any other joint problems, such as the reconstruction of ligaments, corrective axial procedures (osteotomy), meniscus removal (meniscectomy), or suture/replacement of a torn meniscus, must be included in the operation and postoperative rehabilitation. Otherwise, early wear of the resurfaced area or even worse degeneration may develop.

Treatments that provide hyaline or hyaline-like cartilage coverage for cartilage defects are generally better than those that use a connective tissue or fibrocartilage surfaces.

What are the disadvantages of Cartilage Repair Techniques?

Osteochondral/chondral lesions have a very poor ability to regenerate. Without surgery, the condition gets worse, and sooner or later it will advance to a level where total joint replacement becomes necessary. Patients need to have a surgery to improve their quality of life and to be able to return to their daily activities.

What are the disadvantages of Cartilage Repair Techniques?

There are no disadvantages of osteochondral/chondral repair. Surgery slows down an otherwise inevitable process. However, as with all surgical procedures, there is a risk of complications such as deep vein thrombosis, bleeding into the joint and painful scar tissue restricting joint movement. These would be discussed with the doctor at the time of surgery.