Cartilage Injuries Non-Surgical Treatment

Nonoperative treatment is often the first step for patients who:

• Have partial-thickness damage: Softening or fraying of the cartilage that does not extend to the bone.
• Have mild or intermittent symptoms: Pain that allows daily activities and responds to rest.
• Have an incidental finding: Cartilage changes seen on MRI that may not be the source of the patient’s pain.
• Have widespread cartilage wear: Diffuse arthritis-type changes are generally not treated with cartilage restoration procedures and are better served with some form of a replacement.
• Have a stable osteochondritis dissecans (OCD) lesion: In children and adolescents who are still growing, stable OCD lesions often heal with a period of activity restriction.

Nonoperative treatment is generally not the right first step for certain injuries. A loose fragment causing catching or locking, an unstable OCD lesion, and a large, full-thickness defect in a young, active patient are usually best evaluated for surgery, because a displaced fragment may be repairable only for a limited time after injury.

Nonoperative treatment does not regrow cartilage. Its goal is to reduce pain and swelling, improve how the leg absorbs load, and allow patients to remain active. Many patients experience meaningful symptom relief this way, particularly those with smaller or lower-grade damage. For patients who remain symptomatic, a well-rehabilitated knee is also better prepared for surgery if it becomes necessary.

Nonoperative treatment is an active process that combines several approaches:

• Physical therapy: Strengthening the quadriceps, hamstrings, hips, and core improves shock absorption and reduces stress on the injured cartilage. Therapy also addresses motion, balance, and movement patterns.
• Activity modification: Temporarily reducing high-impact activities such as running, jumping, and deep squatting allows an irritated joint to calm down. Low-impact options such as cycling, swimming, and elliptical training help patients stay active.
• Weight management: The knee absorbs a multiple of body weight with every step, so even modest weight loss meaningfully reduces load on the cartilage.
• Bracing: An unloader brace can shift weight away from a damaged side of the knee, and a patellar brace may help with symptoms behind the kneecap.
• Anti-inflammatory medications: Topical or oral anti-inflammatory medications can help control pain and swelling during flares.
• Injections: In select cases, an injection can reduce pain and inflammation and allow patients to progress with therapy. Options may include corticosteroid, hyaluronic acid, or platelet-rich plasma (PRP). Dr. Rynecki Baker will discuss whether an injection makes sense for you and the evidence behind each option. 

For young patients with a stable OCD lesion, treatment typically includes a period of activity restriction, sometimes with protected weightbearing or bracing, followed by repeat imaging to confirm healing.

Choosing nonoperative treatment is not a permanent decision. Dr. Rynecki Baker follows patients closely during rehabilitation and afterward. Surgery may be recommended if a patient:

• Develops catching, locking, or a block to motion
• Continues to have pain or swelling that limits daily activities, work, or sport despite a dedicated course of treatment
• Has an OCD lesion that does not heal or becomes unstable
• Has a defect on MRI that is likely to benefit from repair or restoration
• A knee that suddenly locks or develops new, significant swelling should be evaluated promptly. The goal is always to protect the cartilage and the long-term health of the knee.