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During a soccer game at the age of 12, Kayla dislocated her kneecap. It was her first knee injury. She would go on to dislocate it several times again over the next few years.

Despite chronic pain, Kayla continued doing the activities she loved. However, one day her doctor told her she’d need to have surgery if she wanted to keep playing sports.

Determined to live a healthy and active lifestyle, Kayla underwent her first surgery. Unfortunately, it ultimately failed.

Six years later, Kayla found herself at a crossroad. She could continue living with her knee pain and accept that she’d no longer be able to do the activities she loved. Or, she could take another chance and undergo surgery again.

Making the decision: treatment or not?

Like Kayla, many patients are faced with these kinds of critical healthcare decisions. There are so many unknowns:

  • What treatment option is best for my knee pain?
  • Will I be able to return to the activities I was doing pre-knee pain?
  • Will this even work?

These are all valid questions and ones that I hear from my patients every day.

The implications of not getting treatment for knee cartilage injuries

As an orthopedic surgeon, I’ve seen far too many patients with knee pain postpone treatment or not seek treatment at all. Some people are fearful of the recovery time. Others are afraid that the treatment won’t work. And, some don’t act because they think the pain will simply go away by itself.

It’s important, however, that patients with knee pain know that seeking treatment too late or not seeking treatment at all can have serious implications. It can, unfortunately, lead to even further complications down the road. For example, patients who don’t receive treatment for knee cartilage damage can be left with limited mobility and fewer treatment options.

That is why I encourage knee pain sufferers to talk with their doctor so that they can better understand their particular knee issue as well as the treatment options available to them. Luckily, today there are many repair options that have been proven to help patients get back to the activities they love.

I believe that doctors and physical therapists can do a better job of helping patients like Kayla who are at a crossroads with their knee issues by informing them of the serious impacts of not seeking treatment. We should also discuss the repair options with them earlier in their course. That way they will have the knowledge and confidence to choose a treatment option that will let them get back to the things that they love to do. 

Knee cartilage injuries can lead to chronic pain 

In the United States, chronic knee pain is a prevalent issue affecting many people’s health. Knee pain is the second most common cause of chronic pain among Americans. It sends more than 12 million to the doctor’s office each year. Half of these people have damage to their knee cartilage. 

Knee cartilage injuries aren’t just reserved for athletes. They can happen to anyone. And, they can occur in a number of different ways, including:

  • repetitive movements during light exercise and other physical activity
  • acute or traumatic events like a serious fall.

Unlike other tissue injuries, cartilage injuries do not repair themselves. This is because of a lack of blood supply to the damaged area.

Therefore, cartilage damage can often be chronic. And it can get worse over time if not treated properly. This may cause limited mobility that forces people to give up the activities they love the most.

A survey of knee pain sufferers

The Harris Poll recently conducted a survey of knee pain sufferers on behalf of Vericel, the manufacturer of a knee cartilage procedure called MACI. It found that over half of knee pain sufferers experienced a decrease in their mobility since they first experienced knee pain.

As time went on, those who did not seek treatment, found themselves with even less mobility. This impacted their ability to participate in the activities they once enjoyed.

Nearly three-quarters (73%) of the knee pain sufferers who used to play team sports said they no longer played. A similar proportion (73%) of prior runners said the same. Additionally, nearly 8 in 10 (77%) said they forgot what it was like to be pain-free.

Despite living in pain and missing out on the things they love, a majority of people admit they’d rather deal with their knee pain and manage it with medication than undergo surgery.

Moreover, many admit they aren’t even actively looking for a solution to their knee pain. According to the survey, nearly 3 in 4 knee pain sufferers (74%) hope their knee pain will just resolve itself. Others cited different reasons for not pursuing treatment, including:

  • fear the surgery will not work
  • fear they will not be able to return to their pre-knee pain activity level 

To help alleviate some of the reluctance and fear that knee pain sufferers have towards treatment, doctors must have conversations with their patients about the treatment options that are available to them. Even more important, they need to assure them that these treatments can work.

What are the treatment options for knees cartilage injuries? 

Today, there are many treatment options available for patients with knee cartilage injuries. Surgical options available include: 

  • Chondroplasty

Chondroplasty is a palliative procedure where doctors use an arthroscope to assess the defect, trim the damaged cartilage and clean the area with sterile water.

  • Marrow stimulation repair procedures

Marrow stimulation repair procedures like microfracture, abrasion arthroplasty and subchondral drilling that stimulate bone marrow and its associated chondroprogenitor cells. This can result in the formation of fibrocartilaginous tissue.

  • Osteochondral implants

Autologous or allograft osteochondral implant procedures plug healthy pieces of both cartilage and bone into damaged areas.

  • Autologous chondrocyte implantation (ACI)

ACI is a reparative procedure that involves expanding a patient’s own cartilage cells in a lab and then implanting them in the damaged area to restore the tissue.

How do you decide which treatment is right?

So, which treatment is right for patients with knee cartilage damage? It largely depends on the patient’s circumstance and personal preference, as well as the size of the defect.

In terms of repair assessment, ACI has demonstrated greater improvement in tissue durability, knee pain, and knee function over microfracture.

Clinical studies looked at the results of receiving either ACI or microfracture treatment of their cartilage injury at two and five years. They showed that patients treated with ACI had more durable repair tissue, as well as greater improvement in knee pain and knee function.

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Resources for Repair Options

Choosing the best course of treatment can be scary for patients, but there are things patients and doctors can both do to make the decision process easier. For example, doctors can provide useful resources and guidance to help patients make an informed decision, including:

The knee is a complex joint serving as the meeting point for three major bones, with ligaments and cartilage connecting and protecting the bones at the knee joint. There are several kinds of injuries that can occur to the knee, but knee cartilage injuries are often chronic. They are, moreover, one of the most critical to treat due to the fact that cartilage does not repair itself.

There are a lot of different treatments, but ACI has proven efficacy in long-lasting pain relief and improved knee function for more than 20 years.

Hearing about others who have had success with their treatment can instill a sense of trust and confidence in patients when choosing a treatment option. Many people who have chosen repair options like MACI have gone on to live very healthy and active lifestyles – much like they did before they started experiencing knee issues.

Being prepared for your doctor’s visit:

Patients should be prepared for their doctor’s visit by compiling a list of questions to ask. Here are some they may want to ask:

  • What is the source of my knee pain?
  • What treatments are available to help provide pain relief?
  • What treatments can help restore my active lifestyle over the long term?
  • What is the rehabilitation process like?
  • What will happen if I wait to pursue treatment?
  • What is the best choice for me?

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Conclusion

Chronic knee pain due to injury of the cartilage is common, however, many people are afraid of surgery. Or they may not really understand the various treatment options. Doctors need to take the time to educate patients about the consequences of not getting treated. And they should help them understand their options. That way, patients and their doctors can feel confident about their treatment choice and begin the process of recovery.


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Financial disclosure: Dr. Van Thiel is an orthopedic surgeon who is a consultant of Vericel, the manufacturer of  MACI, a third-generation ACI treatment used for the repair of symptomatic cartilage damage of the adult knee. He is one of few providers offering MACI in the Northern Illinois area. His business could, therefore, benefit from this article.

Editor note: TDWI did not receive any compensation for publishing this article. Rather, we published it because of the quality of its content.

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