Cartilage repair: how to best preserve damaged cartilage

Written by: Mr Amer Khan
Published:
Edited by: Cameron Gibson-Watt

It is difficult to prevent cartilage deterioration as many activities put patients at increased risk of either developing a chondral lesion (cartilage defect) or worsening an existing chondral lesion. Some examples of these activities include running long distances regularly on hard surfaces, contact sports, deep squats and burpees.


We spoke to Mr Amer Khan, a renowned consultant orthopaedic surgeon based in London, who explained to us some of the most effective preventative treatments available and which surgical treatments can be used to help prevent cartilage deterioration.

 

 

Which techniques do you use in diagnosing cartilage problems?

To diagnose cartilage problems, we use a 3-T MRI scan, often with cartilage mapping techniques that allow us to determine and quantify chondral (cartilage) defects more precisely. The 3-T MRI scanner produces high-resolution quality images that enable the surgeon to see what is going on inside the knee more accurately and plan treatment effectively.

 

Can cartilage ever repair itself?

There are different types of cartilage and to repair and heal naturally, it requires a blood supply. Articular cartilage, however, does not have a blood supply, therefore it is avascular. It forms the shiny surfaces in the knee joint that coats the end of the thigh bone (femur), top of the shin bone (tibia) and back of the knee cap (patella). It does not heal naturally when injured, however, if the underlying bone is also injured then the body produces substitute cartilage, known as fibrocartilage, which does not have the same characteristics as the original cartilage.

 

Similarly, the meniscus (load distributer within the knee) does not heal when torn because, with the exception of the peripheral (outside) margin of the meniscus, it is also avascular. The difference with the meniscus is the body does not produce any type of substitute if it is injured.

 

What are some effective non-surgical cartilage preservation treatments?

Firstly, it is important to avoid injury to the cartilage as once injured, a chondral lesion will either remain or become larger. The latter may occur with excessive and repetitive load and torsion, and it may be exacerbated by the presence of underlying joint instability.

 

What surgical procedures can be used and how do they work?

Bone marrow stimulation is a well known and accepted surgical treatment for cartilage defects. A technique I use is known as microfracture chondroplasty, which relies on creating bone channels that allow blood and marrow to enter the lesion, collect, form a clot with natural healing factors and ultimately a fibrocartilage cap over the lesion.

 

There are also more sophisticated techniques that involve a wide spectrum of scaffolds and membranes, which may be synthetic (animal/human-derived) in combination with biological stimulating factors and cells to replace the cartilage defect.

 

Are all cartilage problems the same?

No, all cartilage defects vary according to their width, length and depth. There are multiple detailed grading systems used for radiological (MRI) and arthroscopic (keyhole surgery) assessment of these defects and the treatment is dictated by the patient’s symptoms, signs, grading of the defect and their lifestyle, which includes their expectations.

 

Mr Amer Khan practices in several private centres across London. To make an appointment with him, visit his Top Doctors profile and check his availability.

By Mr Amer Khan
Orthopaedic surgery

Mr Amer Khan is a renowned consultant orthopaedic surgeon whose areas of expertise include soft tissue sports injuries, knee and shoulder conditions, arthroscopy, ACL reconstruction, meniscus repair and both cartilage preservation and replacement. He is a highly trained surgeon and sports arthroscopist who works alongside a multidisciplinary team of experts.

He was educated at King's College London where he studied physiology and exercise medicine. He completed further subspecialist fellowship training in complex shoulder surgery at the Royal Devon and Exeter Hospital and complex knee surgery at Guy's and St Thomas’ Hospital. Mr Khan was awarded the highly respected British Orthopaedic Association European Travelling Fellowship which gained him further subspecialist training working with leaders in arthroscopic surgery. This took place in several cities in Belgium and France before starting additional fellowships in the USA and other European Centres of Excellence.

Mr Khan was appointed to work on the knee team for the London 2012 Olympic and Paralympic Games. There, he treated various athletes and performed their surgery at the Homerton University Hospital. He still treats professional athletes from all disciplines and also sports and fitness enthusiasts.

While practising as a consultant, he also dedicates his time to research and medical education, teaching courses on shoulder and knee surgery and has recently been involved in teaching and examining orthopaedic and sports and exercise medicine trainees to practice at a consultant level.

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