2 Indications and current treatments
2.1 Chondral damage (or localised damage to the articular cartilage) in the knee can be caused by injury or arthritis, or it can occur spontaneously (a condition called osteochondritis dissecans). It may also happen because of knee instability, muscle weakness, or abnormal unbalanced pressures, for example, after an injury to a ligament or meniscal cartilage. In young people, the most common cause of cartilage damage is sporting injuries. Symptoms associated with cartilage loss include pain, swelling, instability, joint catching and locking, and may lead to degenerative changes in the joint (osteoarthritis).
2.2 There is no uniform approach to managing cartilage defects in the knee. Treatment options depend on the size of the defect and its location. There are 2 main categories of procedure: those intended primarily for symptom relief and those that also try to re-establish the articular surface. Interventions that aim to re-establish the articular surface include marrow stimulation techniques (such as abrasion arthroplasty, Pridie drilling and microfracture), mosaicplasty (also known as osteochondral transplantation), and autologous chondrocyte implantation (in which chondrocytes harvested from the knee are cultured and implanted into the damaged cartilage). Interventions that aim to relieve symptoms include knee washout (lavage) with or without debridement, osteotomy, and knee replacement.