Osteochondral Defect: Cartilage Injury in the Knee

The body is made up of different support structures, and one of the most important of these as it relates to movement is cartilage. Cartilage is a tissue that’s found all over the body, and helps connect bones while offering padding and support. Without cartilage to make movements smoother, many of the bones in our body would grind down and become damaged.

Cartilage is especially important in the weight-bearing bones and muscles of the lower body. When there are problems with cartilage and how it connects to and supports bone, this is called an osteochondral defect. Osteochondral defects are most commonly found in the thighs, shins and knees – areas that bear a lot of weight.

Many osteochondral defects are caused by too much pressure on the joints and cartilage, and there are some cases where certain lifestyle changes and emphasis on joint health can help prevent these problems. In other cases, specific treatments will be needed.

Causes and Basic Symptoms

Most osteochondral defects are caused by one of two events:

Wear and tear over time
Injury from sports or physical activity: Injuries usually occur with a combination of twisting force and direct impact that damages the cartilage. Many of the worst ligament and cartilage injuries in professional sports are considered severe osteochondral defects.

When osteochondral defects are present, they can range in their severity:

Slight pain caused by damaged cartilage
Moderate movement problems and pain caused by fragments of bone and cartilage
Total loss of cartilage, leaves bones grinding together and often severe pain
If pain and limited movement becomes severe enough that it’s presenting problems in daily life, speak to your doctor about a potential osteochondral defect diagnosis.

Diagnosis

Your doctor will use a variety of methods to diagnose osteochondral defect:

1. Medical history: If you’ve had any problems in the painful area before, share it with your doctor – in fact, if you’ve had cartilage or ligament problems anywhere else in the body at all, you should tell your doctor about it. You may also discuss your future exercise and movement goals with your doctor, which will allow him or her to figure out which treatment is best for you. Doctors typically ask about medications, allergies and previous conditions as well.
2. Physical exam: In most cases, it’s possible for your doctor to make a basic diagnosis of osteochondral defect without any specific lab tests. They’ll feel the area and ask about pain in certain spots, and they’ll test out how well you can move the area. In some cases, they’ll take a small amount of fluid from your knee to test it (blood and tissue may show up a certain way in tests if there’s damage to the cartilage).
3. Lab tests: Usually an X-ray, MRI or arthroscopy, which is a tiny camera inserted into the area (usually for the knee only).

Treatments

Osteochondral defects generally linger or get worse unless they’re treated. Treatment is split up into three grades, depending on how severe the injury is:

Grade 1: This treatment doesn’t require any invasive procedures. You may need to wear a cast or walking boot to restrict certain movements, but most of this treatment focuses on limiting sports and heavy activity.
Grade 2: Arthroscopic drilling of frayed or damaged cartilage in the affected area
Grade 3: Grade 3 treatments involves the removal of bone and cartilage. In some cases, transplants might be required.

Recoveries for these treatments vary depending on how severe they are. If you’re worried you have the symptoms of an osteochondral defect, speak to your healthcare provider.

Orthopedics is rewarding for me because it allows me to help patients with injuries and get them back into action quickly. I love meeting people of all ages in my practice—I see kids, athletes, adults and retirees. I enjoy being able to understand people’s unique situations and trying to help them recover. I tend to be conservative with my surgical treatment, and much of my training is in minimally-invasive procedures, such as arthroscopy.