Cartilage Repair

Arthroscopic surgical approach to treating articular cartilage injury

What is cartilage repair?

Cartilage injury, also known as chondral injury and chondral lesions or ulcers, refers to damage to the cartilage that covers the ends of bones in a joint. Knee cartilage or lesion could lead to further degeneration and joint damage if left untreated. Additionally, cartilage injury/chondral lesions do not occur in isolation and are often accompanied by ACL injuries.
cartilage lesion
Cartilage lesions occur on the articular cartilage.

A cartilage repair in this context, refers to the arthroscopic surgical approach to treating articular cartilage injury.

A cartilage repair is also referred to as a chondroplasty and comprises two particular treatments, these are:

  • Microfracture (MFx): used to treat small cartilage injuries.
  • Scaffold/advanced microfracture: used to treat larger cartilage injuries.

Fundamentally, the goal of these treatments is to catalyse the healing process of cartilage superficially as chondral bones do not get any blood supply and are incapable of healing on their own. Cartilage repair is considered when a grade 3 or 4 lesion is present regardless of age. The exception for these treatments is patients with bone-to-bone osteoarthritis (advanced or severe arthritis), in which case, a total knee replacement would be suggested instead.

How does the cartilage repair work?

Patients may opt for one of the two treatment offerings, both similar treatment approaches. During the surgery, two or three small incisions are made at the knee and an arthroscope is inserted, allowing your surgeon to visually assess the condition of your knee through the camera. This phase of the procedure is also known as arthroscopic diagnosis.

Next, is the treatment phase of the surgery. Below are the details of what each treatment is like, the objectives, and the rationale behind the performance of these treatments for cartilage repair.

Microfracture is an arthroscopic approach to treating cartilage injuries


Microfracture is the gold standard of treatment for cartilage injuries. First, debriding is conducted using a resector followed by a detachment of calcified cartilage with a shaver. Next, an arthroscopic awl is used to drill small holes underneath the damaged area to encourage the formation of blood clots. This surgical method is commonly known as marrow stimulation.

Scaffold/advanced microfracture

The next treatment involves the steps of microfracture surgery with the addition of scaffolding via injection. Patients would require 2 surgical sessions for scaffold/advanced microfracture. In the first during diagnostic arthroscopy, adipose-derived stem cells are harvested. Then in the second surgery, a microfracture procedure is applied followed by an additional step of scaffolding via injection. Many studies have indicated that this mode of treatment is superior to microfracture regardless of age, gender, and health condition. The difference in the treatment is it provides extra structural support for the development and regeneration of tissue and cell. Scaffold materials vary and are usually made up of post-adipose-derived stem cells.

On top of treating cartilage injuries by themselves, it is also common for ACL injuries to be addressed and treated. Upon completion of treatment administration, the surgical site is then irrigated to prevent infections before it is closed either by sutures or staples.  

Benefits of cartilage repair

  • Relieve pain
  • Restores knee functionality such as mobility
  • Minimally invasive
  • Quicker discharge
  • Minimal scarring

What conditions can cartilage repair treat?

Cartilage repair can be used to treat the following conditions:

  • Onset of osteoarthritis
  • Cartilage deficiency
  • Congenital abnormal knee structure
  • Osteochondritis dessicans
  • Structural knee damage from obesity
Cartilage repair can be used to treat osteoarthritis.

What results can I expect?

Microfractures are an efficient treatment for regaining knee function and mobility among young patients and athletes. Studies indicate the return-to-sports rate for athletes is 100%,  in which 69% returned without significant difference in performance. Particularly for microfracture surgeries, there are concerns that fibrocartilaginous repair may subside in the long run.

However, this treatment is favoured as it is technically efficient, low-cost, and backed with a success rate of 80% (results vary by age group, gender, and accompanying conditions such as osteoarthritis).

Recovery can be slower than most anticipate as it could take up to a year to fully regain strength levels of the pre-injury phase. The recovery period depends on the complexity of the surgery and the damage incurred. Additionally, discipline and dedication towards physiotherapy are key in recovery. Diets, habits, and rehabilitation frequency will play a role comprehensively.

You can expect relief of symptoms, unperturbed knee functionality and improved quality of life. With positive post-surgical care and collaborative work with your orthopaedist, you can expect a satisfactory outcome.

Results will vary from person to person, depending on the severity of the issue and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.

How many treatment sessions are needed?

One cartilage treatment is sufficient, the surgical session varies according to the treatment options patients opt for. Thus, the surgical duration also varies accordingly. Variation of time is also dependent on the severity of the injury and if treatment is required for accompanying injuries such as ACL.

Treatment for cartilage injury does not stop at surgery. To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers.

The frequency of physiotherapy sessions will vary according to your personal goals such as the need to return to athletic endeavours.

Your orthopaedic surgeon will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

Frequently asked questions
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