Chondral defects are damage to the cartilage that covers the ends of the bones in the knee joint. This damage is common and can be caused by sudden injury or the routine wear and tear that comes with aging. Some people may not experience any symptoms related to these defects for many years. The first symptom may be intermittent swelling, which occurs due to loose pieces of cartilage floating around in the knee. Other symptoms include pain in the knee during walking and other activities, the knee buckling when there’s weight placed on it, and noises coming from the knee when it’s being moved.
Diagnosing chondral defects can be difficult. Swelling may be present during a physical exam but not in every case. X-rays can provide some indication of cartilage loss, and MRI scans may be used to detect later stages of chondral defects. Arthroscopic examinations, in which a doctor looks into the knee using a small camera, remain the best way to identify these defects.
When diagnosed, chondral defects are often treated using nonsurgical methods, which provide many patients with relief. These treatments include special types of exercise, shock-absorbing shoe inserts, changes in physical activity, hyaluronic acid injections and prescription pain medications.
The most common surgical techniques for treating chondral defects are:
- Shaving or debridement – This procedure has been used for decades and involves smoothing shredded or frayed cartilage in the knee.
- Microfracture or abrasion – A surgeon scrapes the damaged area within the knee, causing blood to accumulate there. Blood and bone marrow cells will come into contact with the defect, encouraging scar tissue to grow there and replace the damaged cartilage.
- Osteochondrol autograft resurfacing – Cartilage is taken from another part of the body and “planted” where there’s a defect.
- Autologous chondrocyte implantation – Cartilage cells are removed from a patient’s own injured knee and developed in a tissue culture outside the body for several weeks. It is then implanted in the defect to promote the growth of new cartilage there.
- Osteochondral allograft resurfacing – This procedure is used if there’s damage to bone, as well as cartilage. A transplant will be used from a recently deceased donor.
If you are showing signs of chondral defects and would like to discuss the available treatments options, schedule an appointment with Dr. Ira Guttentag at Florida Medical Orthopaedics, Sports Medicine & Spine. Dr. Guttentag treats athletes of all ages and skill levels, and he specializes in addressing chondral defects and other problems with the knee.