LAST WEEK I gave an overview of the non-surgical management of knee cartilage lesions in the young active patient.
When those measures have been tried for the appropriate period of time without adequate improvement, surgical treatment should be considered.
Surgical management is far more effective for discrete (isolated) cartilage lesions. The role of surgery for widespread cartilage degeneration that is osteoarthritis is far less clear. The focus of this article will be young patients with isolated cartilage lesions of the knee.
Arthroscopy accompanied by general trimming and clean up (debridement) of cartilage is of questionable benefit for the patient with knee osteoarthritis. Patients with unstable meniscus tears or cartilage flaps show better improvement of symptoms and function.
There are techniques for restoration or regeneration of discrete lesions of cartilage. These techniques will be the focus of the next article in this series.
Realignment of the limb can redistribute the load across the joint and remove stress from areas of the joint with cartilage injury. This technique is commonly used to treat patients with “bow legs”. They often have wear of the cartilage on the inner aspect of the knee only.
The leg bone (tibia) is cut in these patients and the leg is realigned to shift the load to the outer (lateral) compartment of the knee. This technique is called a high tibial osteotomy and is very effective at improving symptoms and delaying the need for joint replacement.
Another option for the patient with cartilage degeneration in only one compartment of the knee is a joint replacement limited to only that compartment. This is called a unicompartmental knee arthroplasty.
The final solution for a knee with cartilage degeneration is a total knee arthroplasty. This means that the cartilage surfaces of the thigh bone (femur) and the tibia are replaced with synthetic surfaces. This technique gives the best results in terms of pain relief.
Unfortunately, the implants do not last as long in young active patients and are better suited for older less active patients.
Next: Cartilage regeneration techniques.
Paul Adams is an orthopaedic surgeon with a fellowship in orthopaedic sports medicine.