Knee Cartilage Injury
What Is a Knee Cartilage Injury?
The ends of the femur and tibia are covered with a smooth, glossy layer of articular cartilage, which allows the bones to glide against each other nearly frictionlessly. A cartilage injury occurs when this surface is damaged — through a direct impact, a shearing/twisting force, or as a result of another knee injury like a kneecap dislocation. Unlike a bruise or muscle strain, articular cartilage has a very limited capacity to heal on its own, since it lacks a direct blood supply.
What Causes a Knee Cartilage Injury?
- A direct blow or fall onto the knee
- Twisting injuries, often occurring alongside a meniscus or ligament tear
- A kneecap dislocation, which can shear cartilage off the back of the patella or the femur
- Repetitive impact over time, gradually wearing down the cartilage surface
- A single traumatic event in an otherwise healthy knee, particularly in younger athletes
What Are the Symptoms of a Knee Cartilage Injury?
- Pain localized to a specific area of the knee, often deep within the joint
- Swelling, which may come and go with activity
- A catching, locking, or grinding sensation, especially if a loose piece of cartilage is present in the joint
- Pain that increases with impact activities like running or jumping
- In some cases, symptoms that seem out of proportion to what’s visible on a standard X-ray, since cartilage doesn’t show up on X-rays the way bone does
Why Don't Cartilage Injuries Heal Like Other Injuries?
Most tissues in the body heal because they have a blood supply that brings in the cells and nutrients needed for repair. Articular cartilage is different — it’s a specialized, low-friction tissue without its own direct blood vessels. When it’s damaged, the body has a limited ability to fill in the defect, and what does grow back (called fibrocartilage) is typically less durable than the original cartilage. This is why cartilage injuries, even relatively small ones, are taken seriously and why untreated defects can progress toward arthritis over time.
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Treatment Options for a Knee Cartilage Injury
Nonsurgical treatment may be appropriate for small, incidental cartilage lesions without significant symptoms, focusing on activity modification, physical therapy, and anti-inflammatory measures.
Surgical treatment is often considered for symptomatic cartilage injuries, particularly in younger, active patients, and may include:
- Microfracture, which stimulates the bone marrow to form a repair-tissue patch over the defect
- Removing unstable, loose cartilage fragments
- Cartilage restoration procedures, including cell-based treatments like MACI (Matrix-Induced Autologous Chondrocyte Implantation), which uses a patient’s own cartilage cells to grow a more durable repair
- In select cases involving malalignment, a knee osteotomy to shift weight away from the damaged area
Learn more about these options on our Articular Cartilage Surgery and MACI Knee Treatment pages.
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Dr. Palsis specializes in the treatment of knee, shoulder, and sports injuries.