Articular cartilage damage – either in a localized area or diffusely as osteoarthritis – is one of the most common injuries of the knee. In this week’s Ask Dr. Geier column, I address one of the common concerns of patients with articular cartilage damage, namely if and how it limits motion of the knee.

Beth asks:

Hypothetically, will a pothole in articular cartilage stop a person from extending their knee?

I use the analogy of a pothole to describe articular cartilage injury to my patients in clinic all the time. Basically, articular cartilage should be smooth, like a cue ball in pool. Instead, if it looks like crab meat, where the cartilage is frayed or beaten up, that represents articular cartilage damage. A localized defect can look like a pothole in a road. There is an area of partial-thickness or full-thickness articular cartilage damage with exposed underlying bone.

Normal articular cartilage without cartilage damage
Normal articular cartilage

Signs and symptoms of cartilage damage

Pain often results from this damage. Now there is a rough surface gliding over a smooth one. Often the pain alone can limit a person’s knee motion, as it hurts to bring the knee into full flexion, like when doing a squat.

On the other hand, there can occasionally be a mechanical block to knee motion. Essentially some structure can catch between the bones and prevent full knee extension or flexion. Some meniscus tears and loose pieces of bone can block motion. Loose pieces of articular cartilage can potentially do it as well.

Surgery for cartilage damage

Arthroscopically smoothing out the damaged articular cartilage, a procedure called a chondroplasty, is not thought to be very helpful long term when articular cartilage damage is spread throughout the knee. Some surgeries, though, might be reasonable if a patient has an isolated cartilage defect. Smoothing out or removing loose pieces of cartilage might improve symptoms like a block in motion, at least short-term. Other options to repair or replace the area of damaged articular cartilage, like osteochondral autograft transplantation, osteochondral allograft transfer or autologous chondrocyte implantation (ACI) can be options in some patients.

Also read:
Ask Dr. Geier: Return to sports after ACL surgery
Ask Dr. Geier – Recovery from meniscus repair

This is a simplified overview of articular cartilage injuries. If you have cartilage damage in your knee, it can be reasonable to discuss the problem with your doctor.

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