Chondral Injury

synonyms: articular cartilage injury, Chondral Injury, chondromalacia

Injuries to cartilage are known as chondral injuries or chondromalacia. Unfortunately articular cartilage does not regenerate. Lesions generally fill with biomechanically inferior fibrocartilage and ofter progress to arthritis.

In the knee, chondral injuries may cause knee pain. The location of the pain is dependent on location of defect in the cartilage. Acute injuries often present with knee swelling or hemarthrosis which means blood in the knee joint.

Treatment options for chondral injuries are dependent on the depth, size and location of the lesion as well as the patients age and activity level. Non-surgical treatment options include: acetaminophen, NSAIDs, glucosamine/chondroitin supplements, steroid/hyaluronic acid injections, activity modificatations and unloader braces.

Surgical treatment options include: knee arthroscopy with lavage and debridement, microfracture, osteochondral allograft, autologous chondrocyte implantation, osteochondral autograft and knee arthroplasty.

Risks of surgery include but are not limited to: Infection, Neurovascular Injury, Hardware failure, Pain unchanged or worse than before surgery, Stiffness, Incisional scar (cosmesis), CRPS, Numbness surrounding the incision, Incomplete relief of pain, Incomplete return of function, Need for further surgery, blood clots (DVT), pulmonary embolus (PE), and the Risks of anesthesia including heart attack, stroke and death. Although complications can occur they are uncommon and most patients are satisfied with their surgical outcomes. You should always discuss any concerns that you have about surgery with your surgeon and ensure that you have a surgeon that you trust and are confident in.

In general, the post-operative course for chondral injuries of the knee procedes as follows:

• Immediately Post-op: patients begin knee range of motion exercises and are non-weight bearing for 6 weeeks. Patients must use crutches or a walker to ambulate.
• At 7-10 Days: Wound check, continue range of motion exercises and non-weight bearing status.
• At 6 Weeks: Advance to full weight bearing
• At 3 Months: Resume all normal activities of daily living.
• At 6 Months: Gradually begin running / sport specific rehab.
• At 1Yr: Return to sport / full duty. Return to high-impact activites after treatment of large defects is not recommened.

Further information about chondral injuries can be found at the following sites:

• eOrthopod

Every person and their particular circumstances are different so the treatment for your knee may be different than those discussed above. Please read this information carefully. Write down any questions that you have about your injury and its treatment and discuss them with your surgeon. Working together you and your surgeon will determine the best treatment for you.

Appointments to discuss chondral injuries with Dr. Grutter can be made here. If you have continued questions or concerns after seeing your orthopaedic surgeon a second opinion from Dr. Grutter is often beneficial.