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Knee Cartilage Repair and PreservationArticular cartilage lacks blood vessels, so when damaged it forms fibrocartilage—a mechanically inferior scar tissue that typically deteriorates within two to three years. This biological constraint shapes every treatment option, from temporary symptom relief to procedures attempting true cartilage regeneration.Articular cartilage lacks blood vessels, so when damaged it forms fibrocartilage—a mechanically inferior scar tissue that typically deteriorates within two to three years. This biological constraint shapes every treatment option, from temporary symptom relief to procedures attempting true cartilage regeneration.
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When cartilage repair is the right choiceCartilage repair is suited to younger, active patients with isolated damage in otherwise healthy joints where conservative care has not worked. It is mechanistically impossible when underlying bone is worn smooth, degeneration spans multiple compartments, or malalignment and instability persist uncorrected.Cartilage repair is suited to younger, active patients with isolated damage in otherwise healthy joints where conservative care has not worked. It is mechanistically impossible when underlying bone is worn smooth, degeneration spans multiple compartments, or malalignment and instability persist uncorrected.
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When knee pain needs an orthopaedic assessmentMost knee pain settles with rest and physiotherapy; the threshold for orthopaedic assessment is persistent dysfunction despite weeks of conservative care, or acute structural changes—and assessment maps options rather than commits to surgery.Most knee pain settles with rest and physiotherapy; the threshold for orthopaedic assessment is persistent dysfunction despite weeks of conservative care, or acute structural changes—and assessment maps options rather than commits to surgery.
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High tibial osteotomy as a first step in knee preservationHigh tibial osteotomy repositions the tibia to shift weight-bearing from damaged inner knee cartilage to the healthier outer compartment. For younger, active patients, the procedure preserves the natural joint and potentially extends its working life by a decade or more.High tibial osteotomy repositions the tibia to shift weight-bearing from damaged inner knee cartilage to the healthier outer compartment. For younger, active patients, the procedure preserves the natural joint and potentially extends its working life by a decade or more.
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Knee cartilage repair versus stem cell therapyEstablished cartilage repair using autologous chondrocytes shows 10–17 year durability for focal knee defects; mesenchymal stem cell therapies have not been tested in large-scale trials against them.Established cartilage repair using autologous chondrocytes shows 10–17 year durability for focal knee defects; mesenchymal stem cell therapies have not been tested in large-scale trials against them.
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ChondroFiller™ durability compared with ArthrosamidChondroFiller™ recruits the patient's own progenitor cells to build new cartilage tissue within a collagen scaffold. Three-year published follow-up shows mean IKDC scores of 80 — a 32.4-point improvement from baseline — with durability reported to extend beyond five years.ChondroFiller™ recruits the patient's own progenitor cells to build new cartilage tissue within a collagen scaffold. Three-year published follow-up shows mean IKDC scores of 80 — a 32.4-point improvement from baseline — with durability reported to extend beyond five years.
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Medial knee pain that isn't a meniscus tearAround 850,000 meniscal surgeries are performed annually in the United States, yet five other structures in the medial knee generate pain so similar that clinicians commonly mistake them for meniscal tears.Around 850,000 meniscal surgeries are performed annually in the United States, yet five other structures in the medial knee generate pain so similar that clinicians commonly mistake them for meniscal tears.
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Who qualifies for MACI knee surgery?Patients aged 18–55 with deep focal cartilage damage (Grade III-IV, >2 cm²) qualify for MACI if their knees are structurally sound—stable ligaments, correct alignment, no generalised osteoarthritis—and conservative treatment has failed. The procedure is two-stage, with extended rehabilitation required.Patients aged 18–55 with deep focal cartilage damage (Grade III-IV, >2 cm²) qualify for MACI if their knees are structurally sound—stable ligaments, correct alignment, no generalised osteoarthritis—and conservative treatment has failed. The procedure is two-stage, with extended rehabilitation required.
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OATS versus osteochondral allograft for large knee defectsDefect size determines which procedure: OATS, harvesting cartilage plugs from the patient's own knee, suits lesions up to 4 cm²; osteochondral allograft, using donor tissue, handles larger defects without an equivalent size limit.Defect size determines which procedure: OATS, harvesting cartilage plugs from the patient's own knee, suits lesions up to 4 cm²; osteochondral allograft, using donor tissue, handles larger defects without an equivalent size limit.
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Osteochondral Allograft for Post-Traumatic Knee DefectsOsteochondral allograft restores both the cartilage surface and the bone beneath in a single operation for post-traumatic knee injuries — a combination other procedures cannot deliver.Osteochondral allograft restores both the cartilage surface and the bone beneath in a single operation for post-traumatic knee injuries — a combination other procedures cannot deliver.
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The cost of leaving a knee cartilage defect untreatedKnee cartilage defects do not heal because cartilage lacks blood supply; defects widen under load with each step, spreading damage to surrounding tissue and progressing towards osteoarthritis if untreated.Knee cartilage defects do not heal because cartilage lacks blood supply; defects widen under load with each step, spreading damage to surrounding tissue and progressing towards osteoarthritis if untreated.
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AMIC vs MACI for knee cartilage repairStandalone microfracture for knee cartilage defects has less than 60% survivorship at three years; AMIC adds a collagen membrane to stabilize repair, whilst MACI uses cultured chondrocytes and shows superiority in the SUMMIT trial for lesions over 3 cm².Standalone microfracture for knee cartilage defects has less than 60% survivorship at three years; AMIC adds a collagen membrane to stabilize repair, whilst MACI uses cultured chondrocytes and shows superiority in the SUMMIT trial for lesions over 3 cm².
