Knee Cartilage Injuries

• Traumatic Injury: Sudden impact or twisting movements can damage the articular cartilage.
• Degenerative Changes: Age-related wear and tear can lead to cartilage degeneration, especially in individuals over 50.
• Improper Alignment: Structural abnormalities or misalignment in the knee can increase stress on certain areas, predisposing them to cartilage wear.
• Obesity: Excessive body weight increases the load through the knee joint, potentially accelerating cartilage wear.

Symptoms can vary depending on the severity and type of injury but commonly include:

• Pain: Especially when bearing weight on the affected leg or during activity.
• Swelling: Caused by inflammation and excess fluid within the joint.
• Stiffness: Limited range of motion of the knee joint.
• Locking or Catching: Sensation of the knee getting stuck or not moving smoothly.

Diagnosis involves a combination of clinical evaluation and imaging studies.

Your UCSF Women’s Sports Medicine Center expert will review your medical history, inquire about your knee injuries and prior treatments, and thoroughly examine the knee to assess for pain, swelling, and range of motion.

Imaging studies may include X-rays and an MRI. X-rays evaluate the shape and alignment of the bones and show the joint space between them. Narrowed joint space may indicate cartilage loss. MRI shows more detail of the soft tissue and bone of the knee and can better characterize the location and extent of cartilage injury. Both of these types of imaging play a crucial role in surgical planning should surgery be necessary.

Treatment depends on the severity of the injury and may range from conservative to surgical options:

Non-operative treatment:

• Rest, ice, compression, elevation (RICE)
• Physical therapy to improve motion, reduce swelling, and gain strength in the muscles that support the knee
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
• Injections: such as corticosteroid or hyaluronic acid injections can provide relief of symptoms and can also be diagnostic
• Cartilage protection: includes braces that off-load that area of the knee with cartilage injury, weight optimization, and activity modification

Surgery:

• Surgery is an option for those who have continued symptoms despite non-operative treatment
• Options include a range of arthroscopic and open knee surgeries depending on the cartilage injury. They range from arthroscopic surgery to evaluate the cartilage injury, clean up or remove damaged cartilage that is causing catching and locking, and articular cartilage restoration techniques such as microfracture, osteochondral autograft transplantation (where cartilage is transferred from one part of your knee to another area), osteochondral allograft transplant (where a larger cartilage plug is transplanted from a donor’s knee), autologous chondrocyte transplantation (called ACI, where cartilage cells from your knee are used to grow more cartilage cells in the lab that are later placed into your knee).
• If knee malalignment is present, realignment surgery called osteotomies corrects knee alignment and is often paired with one of the above cartilage restoration surgeries.

These treatments aim to relieve symptoms (pain and swelling), restore joint function and ability to do activities, and delay the progression of osteoarthritis.

Preventative measures focus on minimizing risk factors and include regular, balanced exercise to strengthen the muscles around the knee, proper mechanics during sports and physical activities, and participation in a diversity of types of activities from low to high impact.