Restoring articular cartilage in the knee

Following damage or injury, as well as normal wear and tear, articular cartilage in adults has limited healing potential. Repair of cartilage is dependent on the extent and depth of the injury, its location, and the surviving chondrocytes and extracellular matrix. The ultimate goal of cartilage repair is to restore the normal composition and matrix of the cartilage, but for most patients this is not feasible. In these cases, filling the defect using interventions that provide adequate, albeit not optimal, functionality and pain relief is desirable. Therefore, a more realistic goal in these patients may be restoration of their respective activity levels and the delay or avoidance of prosthetic replacement. Depending on the age, activity level, and degree of cartilage damage, several methods to decrease pain and attempt cartilage repair are available; these include lavage and debridement, abrasion arthroplasty, and tissue and cell transplantation. Future strategies for cartilage repair may involve tissue engineering techniques, possibly coupled with specific growth factors. Randomized clinical trials must be established.