Articular Cartilage Repair in Mumbai by Arthroscopic Surgeon Dr. Aditya Pawaskar

What Is Articular Cartilage?

Articular cartilage is the smooth, protective tissue covering the ends of bones inside a joint. It reduces friction, distributes pressure and allows the knee to move smoothly.

Unlike many other tissues, articular cartilage has a limited ability to heal naturally because it does not have its own direct blood supply. Damage may occur following a sports injury, accident or progressive joint degeneration. When cartilage becomes damaged, patients may experience knee pain, swelling, stiffness or difficulty performing everyday activities.

What Causes Articular Cartilage Damage in the Knee?

Knee cartilage injuries may develop due to sudden trauma, repetitive stress or degenerative changes.

Common causes include:

• Sports injuries: Twisting, pivoting, sudden stops or awkward landings during sports.
• Direct knee trauma: Falls, accidents or impact injuries affecting the joint surface.
• Associated ligament injuries: ACL tears and other knee injuries may occur alongside cartilage damage.
• Repetitive joint loading: Repeated high-impact activities may contribute to cartilage problems.
• Osteoarthritis: Progressive degeneration can cause widespread thinning and loss of joint cartilage.
• Osteochondral injuries: Damage involving both the articular cartilage and underlying bone.

Not every cartilage abnormality causes symptoms or requires surgery.

Signs and Symptoms of Knee Cartilage Damage

Symptoms vary depending on the location, size and severity of the injury.

• Persistent knee pain, especially during weight-bearing activities
• Swelling after exercise or prolonged activity
• Stiffness or reduced range of motion
• Clicking, catching or occasional locking sensations
• Difficulty squatting, climbing stairs or running
• Discomfort during sports or everyday movement

These symptoms may also occur with meniscus tears, ligament injuries and osteoarthritis. A clinical assessment is needed to identify the underlying cause.

How Is Articular Cartilage Damage Diagnosed?

Diagnosis begins with a detailed medical history and physical examination. Dr. Aditya Pawaskar may recommend imaging based on the patient's symptoms and examination findings.

• Physical Examination: The evaluation may include assessing knee movement, swelling, tenderness, alignment, stability and functional limitations.
• X-rays: X-rays help assess joint alignment, bone abnormalities, fractures and signs of osteoarthritis. Cartilage is not directly visible on standard X-rays.
• MRI Scan: MRI provides detailed images of cartilage, ligaments, menisci and surrounding structures. It can help determine the size, depth and location of cartilage damage.
• Knee Arthroscopy: Arthroscopy allows direct visualization of the joint through a small camera. It may be used when clinically indicated, often as part of a planned surgical procedure rather than solely for diagnosis.

Non-Surgical Treatment for Knee Cartilage Damage

Not every cartilage injury requires surgery. Conservative treatment may help manage symptoms and improve function, particularly when symptoms are mild or surgery is not appropriate.

Treatment may include:

• Physiotherapy: Strengthening muscles around the knee and improving movement.
• Activity modification: Temporarily reducing activities that aggravate symptoms.
• Pain management: Appropriate medications under medical supervision.
• Weight management: Reducing excess joint loading when relevant.
• Knee braces or walking aids: Providing support in selected situations.
• Injections: Considered in selected cases for symptom management, with benefits and limitations explained.

Types of Articular Cartilage Repair Procedures

• Microfracture: To encourage the growth of new cartilage, this procedure involves making tiny holes in the damaged cartilage.
• Autologous Chondrocyte Implantation (ACI): In ACI, healthy cartilage cells are removed from the patient's body, grown in a lab, and inserted into the damaged area.
• Osteochondral Autograft Transplantation (OAT): Oste OAT entails moving healthy bone and cartilage from a joint area that doesn't bear weight to the damaged area.
• Osteochondral Allograft Transplantation: In this procedure, the damaged tissue is replaced with donor bone, and cartilage taken from a deceased donor.

Who May Be a Candidate for Knee Cartilage Repair Surgery?

Cartilage repair or restoration surgery may be considered when:

• A localized cartilage defect is causing persistent symptoms.
• Symptoms continue despite appropriate conservative treatment.
• Imaging identifies a potentially treatable cartilage lesion.
• Knee alignment and stability are suitable or can be addressed.
• The patient can follow the required postoperative rehabilitation program.

Patients with advanced, widespread osteoarthritis may require a different treatment approach. The final decision depends on a comprehensive orthopaedic evaluation.

How Is Articular Cartilage Repair Surgery Performed?

The surgical process varies according to the selected technique.

• 1. Preoperative assessment: Review of symptoms, imaging, medical history and treatment goals.
• 2. Anaesthesia: General or regional anaesthesia, depending on the procedure and clinical requirements.
• 3. Surgical access: Arthroscopic, mini-open or open surgery, depending on the technique.
• 4. Cartilage treatment: Repair, stimulation or transplantation of tissue to address the defect.
• 5. Postoperative care: Protection of the treated area followed by a structured rehabilitation program.

Associated problems, such as ligament instability, meniscus deficiency or abnormal knee alignment, may also need treatment to support the cartilage procedure.

Recovery After Articular Cartilage Repair Surgery

Recovery depends on the surgical technique, size and location of the defect, associated procedures and the patient's progress.

• Early Recovery: The knee may need protection with crutches, a brace or restricted weight-bearing. Gentle movement and prescribed exercises may begin under supervision.
• Rehabilitation and Strengthening: Physiotherapy focuses on restoring movement, muscle strength, balance and controlled weight-bearing as healing progresses.
• Returning to Sports: Returning to running, jumping and competitive sports requires adequate healing, strength and functional recovery.

Recovery may take several months, and more complex restoration procedures may require a substantially longer rehabilitation period. Clearance should be based on the surgeon's assessment rather than a fixed timeline.

Potential Benefits and Risks of Articular Cartilage Repair

In appropriately selected patients, cartilage repair or restoration may help reduce pain, improve knee function and support participation in daily activities.

However, results vary, and surgery does not guarantee complete cartilage restoration or prevent future arthritis. Discussing these benefits and risks with an orthopaedic specialist in Mumbai helps establish realistic treatment expectations.

Can articular cartilage repair surgery prevent arthritis?

Repairing the articular cartilage can lessen discomfort and enhance joint performance. Still, it may not completely stop the onset of arthritis. But prompt and effective treatment can halt the progression of arthritis and lengthen the life of the joint.

Understanding the causes, available treatments, and post-operative care associated with articular cartilage repair enables people to make well-informed decisions about their healthcare.

Sports Prone to Articular Cartilage Repair and Injury Risks:

Frequently Asked Questions About Articular Cartilage Repair