Rajesh Bhalla

Chondral Defect of the Knee

Cartilage is a semi-rigid, flexible connecting tissue surrounding joints. They envelop the ends of the bones and providing cushion-like support to joint bones. When there is loss of this construct this is called a Chondral Deffect. This is a painful condition and is the debility representing with different name in different condition. These can be a spectrum from single focal defect to advanced multifocal loss. It gets its nourishment from the synovial fluid supported by knee motion. It has poor blood supply. It is supported by underlying bone for this, thus the osteochondral unit makes it functional entity. Losing contact from underlying bone turn it non viable tissue. Cartilage has poor self healing power so it requires special care and technique for the injury management

Different conditions represent different area of the knee.

1. Osteochondritis desecan is more localized over posteriolateral aspect of the medial femoral condyle
2. Chronic ACL deficient knee show degeneration over anterior aspect of lateral femoral condyle and posteriolateral aspect of the lateral tibial condyle.
This can be due to an acute or chronic repetitive impact injury. This lead to fissuring, flap, sloughing out of the cartilage

What are the complaints?

History of contact injury/ trauma. Presents with effusion, painful knee movement.
These complaints are sufficient to consult orthopedic doctor. He will further examine the knee and get imaging to evaluate radio logically i.e X ray,MRI, CT scan.

How is this managed?

  1. Non operative /conservative
    • a. asymptomatic to mild  symptoms-

Rest, anti inflammatory drugs, physiotherapy, weight loss , viscosupplementatoin, corticosteroid injections, unloader splints, life style modification. Certain food supplements i.e. collagen peptide,Vitamin C ,Vitamin D,Calcium and natural anti inflammatory supplements

  1. Operative
    • Severe to acute injury with full thickness chondral / osteochondral defect or failed conservative treatment – debridement/chondroplasty/reconstruction techniques 
        • decision-making algorithm is based on several factors
          • patient factors
            • age
            • skeletal maturity
            • low vs. high demand activities
            • ability to tolerate extended rehabilitation
          • defect factors
            • size of defect
            • location
            • contained vs. uncontained

Presence or absence of subchondral bone

All above said treatment is individualized, there is no one best technique for all defects so are custom tailored on individual case study.

        • femoral condyle defect
          • correct malaligment, ligament instability, meniscal deficiency


        • patellofemoral defect
          • address patellofemoral maltracking and malalignment

MF=Microfracture (Marrow Stimulation)
OATS=Osteochondral aoutograft transfer(Mosaicoplasty)
ACI=Autlogous chondrocytes Implantation

This is a subject of judicious thorough understanding of the patient individual case scenario. Joint preserving orthopaedic surgeon Do this job diligently. Ignorance and casual attitude may worsen the condition. Such conditions if not addressed in right time may end in irreversible disability even under trained hands of best doctor for knee replacement in Delhi or best orthopaedic doctor in India

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