Table of ContentsView AllTable of ContentsCausesManagementInjectionsSurgeryComplicationsCoping
Table of ContentsView All
View All
Table of Contents
Causes
Management
Injections
Surgery
Complications
Coping
When you have no cartilage in your knee, simple movements can be painful.Cartilage—a type of connective tissue that lines the end of bones—provides cushioning for joints and prevents bones from rubbing together. Severe knee cartilage loss makes walking, sitting, standing, squatting, and going up and down stairs extremely painful.
People with a total loss of knee cartilage can benefit fromjoint injections. Because your body can’t naturally regenerate cartilage, surgery including a total knee replacement is often needed to treat this condition.
This article discusses treatments for cartilage loss in the knee. It also covers complications and how to prevent mild knee osteoarthritis from progressing into total cartilage loss.
Verywell / Laura Porter
Causes of No Knee Cartilage
Knee cartilage can also be damaged from injuries, such asanterior cruciate ligament(ACL) ruptures,meniscus tears, and patellar (kneecap) dislocations, which increase the risk of knee OA.
If found in the early stages, knee cartilage loss is treated with conservative measures such as weight loss, exercise, pain relieving medication, and physical therapy. However, once OA progresses to the point where there is no knee cartilage left, more advanced treatments are needed.
Can you rebuild cartilage in your knee?Your knee doesn’t have the ability to regenerate lost cartilage on its own. This is because there is naturally poor blood supply to the joint and the cells that form cartilage can’t migrate.
Can you rebuild cartilage in your knee?
Your knee doesn’t have the ability to regenerate lost cartilage on its own. This is because there is naturally poor blood supply to the joint and the cells that form cartilage can’t migrate.
Ways to Manage Pain
People in the early stages of knee osteoarthritis can often prevent further damage and total loss of knee cartilage through conservative treatment methods. These include weight loss, braces, exercise, over-the-counter medications, and other conservative treatments.
Weight Loss
Increased body weight places an increased amount of pressure on the knee joint with weight-bearing activities like standing, squatting, walking, and going up and down stairs.
Each extra pound of weight can put up to six additional pounds of pressure on the knees with physical activity. People who are overweight also tend to developosteoarthritisat an earlier age with greater severity of symptoms compared to those at a healthy weight.
Excessive fat cells within the body also stimulate an elevated insulin response and inflammatory processes throughout the body that increase the rate of cartilage cell degradation.
Diet and Exercise for Arthritis
Resistance Exercises
Research shows that strengthening the muscles around the knee joint can reduce pain and stiffness and improve physical function in people with knee osteoarthritis.Resistance exercises that target the knee joint include:
You should monitor your pain before, during, and after exercise. Do not do these exercises if you are experiencing a flare-up of pain. If you experience pain while doing exercise, stop. If your knee hurts after exercise, apply ice to reduce swelling and inflammation.
Cardio
Exercise can help slow the progression of osteoarthritis, but it is important to avoid high-impact exercise that can place more strain on the joints.
Research suggests that uphill walking on a treadmill can help improve the range of motion in a person with knee osteoarthritis.However, working outon an ellipticaltends to place less strain on the knees overall, since your foot does not strike the walking surface with each stride as it does on a treadmill.
Braces
If cartilage loss is localized to one side of the knee—most commonly the inside of the knee joint—specialized, custom-made braces can help reduce pressure on the knee joint and improve the alignment of the knee.
Anunloader knee bracestabilizes the knee to limit side-to-side movement while allowing the knee to bend and extend without limitation. The brace also contains three pressure points that push the knee away from the area of cartilage loss to decrease compression at the joint surface.
Knee braces are strongly recommended for the treatment of knee osteoarthritis to help decrease pain and improve function.
NSAIDs
Over-the-counter pain-relieving medications such as Tylenol (acetaminophen) or anti-inflammatory medications like Advil (ibuprofen) and Aleve (naproxen sodium) can help reduce pain, swelling, and inflammation in the knee joint.
If symptoms are severe enough, your healthcare provider may prescribe a higher dosage of anonsteroidal anti-inflammatory drug(NSAID) to help decrease your knee pain so you can sit, stand, and walk with less discomfort.
Physical Therapy
Physical therapyplays an important role in decreasing symptoms and preventing the progression of cartilage loss in the knees.
A physical therapist will evaluate your knee and hip alignment, muscle strength, range of motion, and movement patterns to develop an individualized plan of care to address your limitations.
The muscles surrounding the knee help support the knee joint. When they are weak, the bones of the knee joint are subject to increased pressure and a higher risk of cartilage breakdown.
Strengthening the muscles around the knees and hips helps offload the knee joint and support your body weight so that less pressure is applied to the joint surfaces and surrounding cartilage.
Nutritional Supplements
Certain dietary supplements can help support healthy cartilage cells to protect the knee joint from wear and tear.
Glucosamineandchondroitincan help repair damaged cartilage in the joint and prevent enzymes from further breaking down cartilage.
Vitamin D3is also important for maintaining good bone health and supporting immune system functioning to decrease inflammation throughout the body.
20 Supplements and Vitamins for Arthritis
Joint Injections
People with moderate to severe knee cartilage loss may benefit from injections directly into the joint. Options include corticosteroids,hyaluronicacid, and platelet-rich plasma (PRP). Combination intra-articular injections can also be effective for people who have lost knee cartilage.
Corticosteroid Injections
Corticosteroids, orcortisone injections, are anti-inflammatory medications that can be injected into the knee joint to reduce pain, swelling, and inflammation. They are the most commonly used type of knee injections for treating knee pain from osteoarthritis.
Corticosteroid injections are performed under local anesthesia, where you will be awake for the procedure but your knee will be numbed. A small amount of anesthesia will be injected into your knee before the corticosteroid, which usually begins to work two to three days later.
Corticosteroid injections can help relieve pain and reduce symptoms for between six weeks and six months, although the injections are not effective for everyone. You are typically not allowed to receive more than two or three injections per year.
Corticosteroid injections may not be recommended for patients who havediabetesor other problems with blood sugar since corticosteroid use can raise blood sugar levels.
Hyaluronic Acid
Viscosupplementation, sometimes called gel injections, refers to injecting hyaluronic acid into the knee to decrease pain and improve joint movement. Hyaluronic acid is manufactured in one of two different ways: from the combs of chickens and through biological fermentation.
Hyaluronic acid (HLA) is a gel-like substance that occurs naturally in the synovial fluid within each joint capsule that surrounds all joints. It serves as a lubricant that allows bones to move smoothly within a joint and provides shock absorption to decrease pressure and friction within joints.
Over time, hyaluronic acid levels in the joints decrease, especially as the joints wear down with osteoarthritis.
With viscosupplementation, you may receive between one and five injections during a treatment course. If there is excess swelling and fluid buildup in the knee joint, your healthcare provider will use a needle to aspirate (remove) the fluid before injecting the hyaluronic acid.
There is some evidence that different types of HA may work differently in the body. For example, high molecular weight HA is thicker than low molecular weight HA. Studies have found that high molecular weight HA may be better at reducing pain than low molecular weight HA. In addition, products derived from chickens may cause more inflammatory reactions than products that don’t come from chickens.
You should avoid prolonged standing, walking, jogging, running, or heavy lifting for the first 48 hours after receiving a hyaluronic acid injection.
For patients who report pain relief following hyaluronic acid injections, it may take up to four weeks to notice any significant improvement, and the lasting effects can vary from two to six months. Hyaluronic acid injections may be repeated about every six months.
Hyaluronic acid may be recommended for patients with diabetes who have knee osteoarthritis because hyaluronic acid injections do not raise blood sugar the way corticosteroids do.
Hydrogel
The injectable is a non-degradable substance, meaning the body does not break it down. Research suggests it is similar in effectiveness to hyaluronic acid injections.Some people experience up to two years of pain relief following Arthrosamid injections.
As of 2023, the treatment is available in England and other countries, but awaiting approval from the U.S. Food and Drug Administration (FDA).
Platelet-Rich Plasma
The first step in PRP injections is having your blood drawn. The whole blood is then spun in a centrifuge to separate the plasma from red and white blood cells. This produces concentrated blood platelets that are injected into the joint in two or three places.
Initially, you will likely need a series of injections every two weeks. Once the therapeutic effect is reached, the results can last up to a year.
PRP therapy is sometimes combined with gel injections with promising results. While research is limited, one study found a combination of PRP and HLA provides better and longer-lasting relief than either alone.
If more conservative treatments do not bring relief, surgery may be needed. Here is a look at surgical procedures used to treat damaged or missing cartilage.
Arthroscopy
Knee arthroscopyis the most common type of surgical procedure performed to repair, remove, or replace damaged cartilage in the knee joint that can cause pain and limit the range of motion of the knee joint.
During knee arthroscopy, a surgeon uses an arthroscope—a tool about the width of a pencil with a camera and light attached—to view the inside of your knee joint. This allows the surgeon to examine the inside of the knee joint without making a large incision along the outside of the knee, which is performed with open knee surgery.
The procedure also protects the surrounding knee structures, including skin, muscles, tendons, and ligaments from being damaged due to the smaller incisions.
Different types of arthroscopic knee procedures to manage the loss of cartilage include microfracture surgery, autologous chondrocyte implantation, and osteochondral autograft transplantation.
Knee Cartilage Replacement
Microfracture
Withmicrofracture surgery, a surgeon will use a drill to create mini fractures in the bones of the knee joint after removing an area of damaged cartilage. Creating small holes in the bone helps stimulate bone marrow cells, which can help spur the growth of new cartilage cells.
Microfracture surgery has variable outcomes since the new cartilage that forms is often fibrocartilage rather than hyaline cartilage, the type of cartilage that covers joint surfaces.
Fibrocartilage is denser and not able to withstand the same force demands as hyaline cartilage. As a result, it provides less cushioning and pressure relief and has a higher risk of breaking down after one or two years.
Autologous Chondrocyte Implantation
Autologous chondrocyte implantation involves removing cartilage cells arthroscopically and then growing them in culture in a laboratory for four to six weeks. These new cells are then reimplanted into the knee in areas of damage during another surgery to promote new growth of cartilage.
Osteochondral Autograft Transplantation
Osteochondralautograft transplantationinvolves removing intact cartilage cells from healthy areas of the knee joint and transplanting them to areas of damage.This procedure is typically only used in areas of focal damage localized to a specific area that is 10 to 20 millimeters in size.
Because osteochondral autograft transplantation is not used to treat widespread cartilage damage in the knee joint that is characteristic of osteoarthritis, most candidates for this type of procedure are younger than 50 years old and have cartilage damage as a result of direct knee joint trauma.
Total Knee Replacement
Around half of all Americans diagnosed with knee osteoarthritis will undergototal knee replacementto treat their symptoms.
A total knee replacement is often the last resort used to treat severe symptoms of knee osteoarthritis when the cartilage of the knee joint has significantly worn down, limiting everyday activities and making standing, walking, and going up and down stairs very challenging and painful.
During the operation, a surgeon will make a long incision down the center of the knee to access the knee joint. The kneecap will be moved aside to expose the ends of thefemur(the upper leg bone), andtibia(the lower leg bone).
The ends of each bone will be shaved off and capped with metal hardware that is screwed into the leg bones. These metal components replace the damaged joint surfaces of the knee that have degenerated over time due to cartilage loss.
Knee Replacement Surgery: Overview
Complications of Cartilage Loss
Loss of cartilage within the knee joint can result in complications affecting the integrity of the knee joint surface due to increased pressure demands, which can lead to the development of bone spurs, subchondral bone sclerosis, and cysts and lesions.
Bone Spurs
Bone spurs, called osteophytes, are outgrowths of bone that develop within joints due to increased pressure between bones from lack of cartilage.Bone spurs are common in the kneesince it is a major weight-bearing joint that withstands high-pressure demands.
Causes and Treatments of Bone Spurs
Subchondral Bone Sclerosis
Subchondral boneis the type of bone directly under the cartilage at the ends of bones. Sclerosis is the process of abnormal hardening or stiffening of body tissues that can occur in multiple structures, such as arteries, nerves, and bones.Subchondral bone sclerosisin the knee occurs when the bones at the end of the femur and tibia that join to form the knee joint thicken as a result of becoming exposed from loss of cartilage.
Cysts and Lesions
As a result of damage to the subchondral bone from cartilage loss, further damage can occur to the remaining cartilage from lack of cushioning in the knee, causing lesions or tears in the remaining cartilage.Subchondral cysts—abnormal growths of fluid-filled sacs—can also develop in the subchondral bone, which may be painful and limit proper mobility of the knee joint.
Ongoing knee pain and disability from cartilage loss can be frustrating, but there are ways you can cope with an injury or conditions like osteoarthritis. Maintaining healthy lifestyle habits to reduce inflammation and stress to the joints can help make it easier to manage symptoms and prevent worsening of cartilage loss.
Ways to cope with cartilage loss include:
Summary
Cartilage in the knee can wear down over time. Eventually, you may have no cartilage left in your knee. When this happens, you may need advanced treatment options such as joint injections or surgery.
Cartilage loss in the knee can lead to complications like bone spurs, cysts, and lesions. If you have cartilage loss in your knee, it’s important to follow healthy practices like losing weight, exercising, and seeing a healthcare provider or physical therapist.
21 Sources
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Feller JF.Practical MR imaging of articular cartilage.
Dickson BM, Roelofs AJ, Rochford JJ, Wilson HM, De Bari C.The burden of metabolic syndrome on osteoarthritic joints.Arthritis Res Ther. 2019;21(1):289. doi:10.1186/s13075-019-2081-x
Li Y, Su Y, Chen S, et al.The effects of resistance exercise in patients with knee osteoarthritis: a systematic review and meta-analysis.Clin Rehabil. 2016;30(10):947-959. doi:10.1177/0269215515610039
Kong H, Wang XQ, Zhang XA.Exercise for osteoarthritis: A literature review of pathology and mechanism.Front Aging Neurosci. 2022;14:854026. doi:10.3389/fnagi.2022.854026
Sedaghatnezhad P, Shams M, Karimi N, Rahnama L.Uphill treadmill walking plus physical therapy versus physical therapy alone in the management of individuals with knee osteoarthritis: a randomized clinical trial.Disabil Rehabil. 2021;43(18):2541-2549. doi:10.1080/09638288.2019.1703146
Kolasinski SL, Neogi T, Hochberg MC, et al.2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131
American Academy of Orthopedic Surgeons.Viscosupplementation treatment for knee arthritis.
Ferkel E, Manjoo A, Martins D, Bhandari M, Sethi P, Nicholls M.Intra-articular hyaluronic acid treatments for knee osteoarthritis: A systematic review of product properties.Cartilage. 2023;14(4):424-432. doi:10.1177/19476035231154530.
Bliddal H, Beier J, Hartkopp A, Conaghan PG, Henriksen M.One-year performance of polyacrylamide hydrogel vs. hyaluronic acid: A randomised controlled study.Osteoarthr Cartil. 2022;30:S370-1.
Bliddal H, Beier J, Hartkopp A, Conaghan PG, Henriksen M.A prospective study of polyacrylamide hydrogel for knee osteoarthritis: Results from 2 years after treatment.Osteoarthr Cartil. 2022;30:S371-2.
Hong M, Cheng C, Sun X, Yan Y, Zhang Q, Wang W, Guo W.Efficacy and safety of intra-articular platelet-rich plasma in osteoarthritis knee: a systematic review and meta-analysis.Biomed Res Int. 2021;2021:2191926. doi:10.1155/2021/2191926
Aw AAL, Leeu JJ, Tao X, Bin Abd Razak HR.Comparing the efficacy of dual platelet-rich plasma (PRP) and hyaluronic acid (HA) therapy with PRP-alone therapy in the treatment of knee osteoarthritis: A systematic review and meta-analysis.J Exp Orthop. 2021;8(1):101. doi:10.1186/s40634-021-00415-1
American Academy of Orthopedic Surgeons.Knee arthroscopy.
Orth P, Gao L, Madry H.Microfracture for cartilage repair in the knee: A systematic review of the contemporary literature.Knee Surg Sports Traumatol Arthrosc. 2020;28(3):670-706. doi:10.1007/s00167-019-05359-9
Mistry H, Connock M, Pink J, et al.Autologous chondrocyte implantation in the knee: Systematic review and economic evaluation.Health Technol Assess. 2017;21(6):1-294. doi:10.3310/hta21060
Stone AV, Christian DR, Redondo ML, Yanke AB, Southworth TM, Tauro TM.Osteochondral allograft transplantation and osteochondral autograft transfer.Oper Tech Sports Med. 2018;26:183-8. doi:10.1053/j.otsm.2018.06.007
Saltzman BM, Leroux T, Cole BJ.Management and surgical options for articular defects in the shoulder.Clin Sports Med. 2017;36(3):549-572. doi:10.1016/j.csm.2017.02.009
Tangredi BP, Lawler DF.Osteoarthritis from evolutionary and mechanistic perspectives.Anat Rec (Hoboken). 2020;303(12):2967-2976. doi:10.1002/ar.24339
Wong SH, Chiu KY, Yan CH.Review article: Osteophytes.J Orthop Surg (Hong Kong). 2016;24(3):403-410. doi:10.1177/1602400327
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