Nonsurgical Management of Cartilage Defects of the Knee: Who, When, Why, and How?

Abstract

The nonoperative practitioner managing individuals with cartilage defects should use a patient-centered, multifaceted approach that aims to individualize treatment to provide optimal benefit. These include addressing modifiable risk factors for disease progression and instituting interventions such as weight loss, nutrition, physical activity, and potentially regenerative medicine strategies. This review will focus on these nonoperative treatment strategies with a focus on when treatments are necessary, who will benefit from these approaches, why they are specifically appropriate, and, finally, how these treatments directly modify the structure of a patient's cartilage and resulting symptoms.

Comparative Study of the Pain, Function and Biomarkers of Joint Disease in the Transition to Adulthood in Individuals With and Without Cerebral Palsy

“…Crouch gait has been demonstrated to potentiate increased tibiofemoral and patellofemoral contact pressures compared with normal gait and shift the center of force posteriorly along the tibial cartilage, 22 which can precipitate mechanical sheer forces in the pathogenesis of OA. It has also been associated with widespread hip and quadriceps weakness, a well-established risk factor for the onset and worsening progression of cartilage defects and a frequent target for intervention 23,24 . Hamstring spasticity in crouch gait can also induce overstretching of the quadriceps muscle fibers and the infrapatellar tendon, leading to the development of patella alta, patellar fragmentation, or chondromalacia 25 that can precipitate the development of patellofemoral OA in individuals with CP 26 .…”

“…It has also been associated with widespread hip and quadriceps weakness, a well-established risk factor for the onset and worsening progression of cartilage defects and a frequent target for intervention. 23,24 Hamstring spasticity in crouch gait can also induce overstretching of the quadriceps muscle fibers and the infrapatellar tendon, leading to the development of patella alta, patellar fragmentation, or chondromalacia 25 that can precipitate the development of patellofemoral OA in individuals with CP. 26 Thus, in our cohort of individuals with primarily spastic-type CP, crouch gait could be a major contributing factor to the synergistic effects of both quadriceps weakness and joint deformities that culminate in the accelerated breakdown of cartilage and the observed trends of higher serum MMP-1 and potentially urinary CTX-II levels in individuals with CP compared with controls.…”

Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 3: Rehabilitation and Exercise

“…Hip OA is a consequence of abnormal joint biology in the context of abnormal biomechanics [50]. Nonoperative interventions including weight loss and the prescription of physical activity (modifying physical activity or integrating it into a patient’s lifestyle) [19,29] affect both joint biology (via anti-inflammatory effects) and joint biomechanics (such as optimized joint loading). The American College of Sports Medicine (ACSM) recommends for people with knee OA a minimum of 30 minutes per day of moderate-intensity activity, 5 days per week [21].…”

Patellar Cartilage Bossing Causing Patellofemoral Pain After Cartilage Repair With Hyalofast® Scaffold and Bone Marrow Aspirate Concentrate (BMAC)

“…Conservative management would involve physical therapy and pharmacological treatment, whereas surgical management would be an arthroscopic removal of loose body and mini-open cartilage repair with Hyalofast ® and BMAC. Known effective conservative management includes weight loss, nutrition, and physical activity, and tends to be more successful in younger patients with mild to moderate cartilage defects [7]. Dekker et al recommended surgical management, either via osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-assisted ACI (MACI), or newer biologic scaffolds of allograft cartilage in younger or athletic patients [4].…”