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When cartilage repair is the right choiceCartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.Cartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.
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Allograft vs autograft for large knee cartilage defectsAutograft for knee cartilage defects larger than roughly 2–4 cm² risks replacing one area of cartilage loss with another at the harvest site. Osteochondral allografts from cadaveric donors eliminate this trade-off and achieve 5-year survival of 79–87.8%.Autograft for knee cartilage defects larger than roughly 2–4 cm² risks replacing one area of cartilage loss with another at the harvest site. Osteochondral allografts from cadaveric donors eliminate this trade-off and achieve 5-year survival of 79–87.8%.
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Injectable scaffold vs surgical knee cartilage repairFor focal knee cartilage defects, injectable collagen scaffolds provide a non-surgical treatment by acting as an acellular matrix that guides the patient's own progenitor cells in regenerating cartilage-like tissue, overcoming cartilage's inability to repair itself due to lacking blood supply.For focal knee cartilage defects, injectable collagen scaffolds provide a non-surgical treatment by acting as an acellular matrix that guides the patient's own progenitor cells in regenerating cartilage-like tissue, overcoming cartilage's inability to repair itself due to lacking blood supply.
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When is it too late for cartilage repair?Once cartilage loss becomes generalised and surfaces contact bone, no restoration procedure works; repair is viable only for focal defects.Once cartilage loss becomes generalised and surfaces contact bone, no restoration procedure works; repair is viable only for focal defects.
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OATS for focal knee cartilage repair in active patientsSingle-stage transplantation of cartilage plugs from the patient's own knee achieves 8.4-year mean functional survival in younger active patients — nearly double microfracture repair — with 75–93% returning to pre-injury sport within six to nine months.Single-stage transplantation of cartilage plugs from the patient's own knee achieves 8.4-year mean functional survival in younger active patients — nearly double microfracture repair — with 75–93% returning to pre-injury sport within six to nine months.
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Who benefits from an unloader knee braceUnloader braces use three-point pressure to shift load away from damaged cartilage. They work only for single-compartment osteoarthritis, and success depends more on professional fitting and follow-up than the device itself.Unloader braces use three-point pressure to shift load away from damaged cartilage. They work only for single-compartment osteoarthritis, and success depends more on professional fitting and follow-up than the device itself.
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Choosing ACI, MACI or single‑stage cell surgeryACI and MACI are two-stage repairs for localised full-thickness cartilage defects, while single-stage techniques place cells or cell-rich material into the defect in one operation. MACI has the strongest long-term follow-up, but single-stage methods still rest mainly on smaller, less comparable series.ACI and MACI are two-stage repairs for localised full-thickness cartilage defects, while single-stage techniques place cells or cell-rich material into the defect in one operation. MACI has the strongest long-term follow-up, but single-stage methods still rest mainly on smaller, less comparable series.
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Do you need a knee or ankle cartilage specialistPersistent knee or ankle pain, swelling or loss of function despite simple self-care usually warrants orthopaedic assessment; a cartilage or joint-preservation specialist is most useful when MRI shows a focal defect in a relatively healthy joint, while diffuse wear-and-tear or advanced arthritis usually suits a general orthopaedic or sports surgeon.Persistent knee or ankle pain, swelling or loss of function despite simple self-care usually warrants orthopaedic assessment; a cartilage or joint-preservation specialist is most useful when MRI shows a focal defect in a relatively healthy joint, while diffuse wear-and-tear or advanced arthritis usually suits a general orthopaedic or sports surgeon.
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Choosing joint preserving surgery before knee replacementOne-compartment knee wear does not automatically mean replacement is next: bracing, osteotomy and focal cartilage repair can reduce pain and delay arthroplasty when alignment and damage remain localised. Microfracture is now usually limited to very small defects, while AMIC, MACI, OATS and OCA are chosen by lesion size, depth and…One-compartment knee wear does not automatically mean replacement is next: bracing, osteotomy and focal cartilage repair can reduce pain and delay arthroplasty when alignment and damage remain localised. Microfracture is now usually limited to very small defects, while AMIC, MACI, OATS and OCA are chosen by lesion size, depth and joint health.
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Choosing cartilage repair pathways for knee and ankleSmall focal cartilage defects in the knee and ankle are treated differently from diffuse arthritis: first with physiotherapy and symptom control, then with repair procedures such as microfracture for lesions under about 1.0 cm², scaffold augmentation for larger defects, and OATS or osteochondral allograft for bigger or cystic lesions.Small focal cartilage defects in the knee and ankle are treated differently from diffuse arthritis: first with physiotherapy and symptom control, then with repair procedures such as microfracture for lesions under about 1.0 cm², scaffold augmentation for larger defects, and OATS or osteochondral allograft for bigger or cystic lesions.
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High tibial osteotomy recovery and joint preservationHigh tibial osteotomy shifts load away from a damaged knee compartment and is best suited to younger, active patients with correctable medial osteoarthritis. Recovery takes months, full weight bearing depends on fixation and healing, and long-term success is strongest when arthritis remains localised.High tibial osteotomy shifts load away from a damaged knee compartment and is best suited to younger, active patients with correctable medial osteoarthritis. Recovery takes months, full weight bearing depends on fixation and healing, and long-term success is strongest when arthritis remains localised.
