Initial treatment includes physical therapy, anti-inflammatory medications, and steroid injections. Surgery to restore articular cartilage may be considered for patients with large articular lesion or if conservative treatment fails. Articular cartilage repair is performed to provide relief from pain, improve range of motion, slow the progression of the damage, and delay the option of joint replacement surgery.
INDICATIONS FOR SURGERY
Surgery is usually not necessary when the cartilage defect is small and asymptomatic. Defects which are smaller than 2 cm can be treated arthroscopically and larger defects may require transplantation of cartilage from other areas of the joint. Most of the cartilage restoration procedures are done using an arthroscope.
The surgical procedures for cartilage restoration include:
- Microfracture: Microfracture involves creating numerous tiny holes in injured joint surface using a special tool, called ‘awl’. The holes are made in the bone under the cartilage, called as subchondral bone. This creates a new blood supply to the cartilage which stimulates the growth of new cartilage.
- Drilling: This procedure is similar to microfracture where multiple holes are created in the injured joint area using a surgical drill or wires.
- Abrasion arthroplasty: This procedure is similar to drilling but involves use of high speed burs to remove the damaged cartilage.
- Autologous chondrocyte implantation (ACI)