NSIC Articles

The Cartilage Challenge: When and Why You Might Need a Transplant

Cartilage is the silent enabler of joint health, allowing smooth, friction-free movement and shock absorption. Yet, it’s also one of the least forgiving tissues in the body. Once damaged, it does not regenerate naturally, and untreated cartilage defects can spiral into long-term joint dysfunction or even early-onset arthritis.

At Noida Sports Injury Center, we routinely see patients struggling with joint pain, instability, or mechanical symptoms caused by cartilage lesions—often undiagnosed or mismanaged in their early stages. In this article, we break down the science and decision-making behind cartilage transplant procedures, addressing when they are necessary, why they’re effective, and how a proper diagnosis and personalized surgical approach can restore joint function and delay more invasive interventions like joint replacement.

Understanding Cartilage: Structure, Function, and Limitations

Articular cartilage is a specialized, avascular, aneural connective tissue that covers the ends of bones within synovial joints. Composed mainly of type II collagen and proteoglycans, its unique structure allows it to withstand mechanical loads while providing a low-friction surface.

However, due to its lack of blood supply, cartilage has very limited intrinsic healing capacity. Even small defects, if left untreated, can lead to progressive cartilage loss, subchondral bone exposure, and degenerative joint disease.

Causes of Cartilage Damage

Cartilage damage can result from:

1. Trauma – Acute injuries in athletes (e.g., twisting of the knee, direct impact)
2. Degeneration – Early or localized osteoarthritic changes in active individuals
3. Overuse or Repetitive Microtrauma – Especially in runners, footballers, or those with poor biomechanics
4. Post-surgical complications – Damage after procedures like meniscectomy or ACL reconstruction
5. Osteochondritis Dissecans – A condition where a fragment of bone and cartilage separates from the joint surface

Common symptoms include:

• Joint pain during weight-bearing
• Swelling after activity
• Locking, catching, or grinding sensations
• Decreased range of motion
• Instability or "giving way" of the joint

While initial treatment often includes NSAIDs, physiotherapy, and activity modification, focal, symptomatic cartilage lesions that do not improve with conservative care may require surgical intervention.

When Should You Consider a Cartilage Transplant?

Cartilage transplant, also referred to as cartilage restoration surgery, is considered when:

1. Younger or middle-aged patients (< 50 years) have focal full-thickness cartilage lesions without diffuse arthritis
2. The defect size is greater than 1-2 cm², making microfracture less effective long-term
3. Conservative management has failed to relieve symptoms
4. The goal is to preserve joint integrity and delay or avoid joint replacement
5. Mechanical symptoms (e.g., catching, locking) are caused by unstable cartilage flaps or fragments
6. There is a desire to return to high-level activity or sport

At Noida Sports Injury Center, we use MRI with cartilage mapping and diagnostic arthroscopy to precisely evaluate the size, depth, and location of the defect, as well as the condition of the surrounding cartilage and subchondral bone.

Types of Cartilage Transplant Techniques

The choice of technique depends on the size of the lesion, the patient’s age, activity level, and previous surgeries.

1. OATS (Osteochondral Autograft Transfer System)

• Autograft harvested from a non-weight-bearing area
• Best for small to medium-sized defects (1–2 cm²)
• Immediate integration of hyaline cartilage and subchondral bone

2. Osteochondral Allograft Transplantation

• Graft taken from a cadaver donor
• Used for large lesions (>3 cm²) or in revision surgeries
• Preserves native joint biomechanics with hyaline cartilage

3. Autologous Chondrocyte Implantation (ACI) / MACI

• A two-stage procedure: Cartilage cells are harvested, cultured in a lab, and re-implanted
• Suitable for medium to large defects in younger patients
• MACI (Matrix-induced ACI) uses a scaffold for better cell delivery

4. Fresh Osteochondral Allograft with Meniscus Transplant (if needed)

• For combined meniscal and cartilage loss
• Prevents further joint degeneration in salvageable knees

5. Microfracture (Bone Marrow Stimulation)

• Used for small defects in low-demand patients
• Encourages fibrocartilage growth (inferior to native cartilage)
• Often a temporary solution; not recommended for large, high-load areas

Postoperative Recovery and Rehabilitation

Recovery is a critical determinant of success in cartilage restoration. Rehabilitation protocols are tailored to the procedure, defect size, and patient goals, but generally follow these phases:

• Weeks 1–6: Limited weight-bearing, brace support, early range-of-motion exercises
• Weeks 6–12: Gradual weight-bearing, neuromuscular re-education, isometric strengthening
• Months 3–6: Functional training, proprioceptive work, and aerobic conditioning
• Month 6 onward: Return to sport-specific drills, strength symmetry evaluation, and gradual clearance for impact activities

Cartilage maturation continues up to 18–24 months post-surgery. Long-term success depends heavily on patient compliance, physiotherapy, and realistic goal setting.

Outcomes and Success Rates

When performed in the right patient, by an experienced surgical team, cartilage transplants can offer:

• Pain relief
• Improved joint function
• Delay in the need for joint replacement
• Return to sports or high-level activity

Long-term studies show over 80–90% success rates in appropriately selected cases. However, outcomes are less predictable in:

• Patients over 50 with early arthritis
• Obese individuals
• Those with untreated limb malalignment or ligamentous instability

That’s why at Noida Sports Injury Center, we take a multi-disciplinary approach, addressing biomechanics, alignment, meniscal integrity, and overall joint health before deciding on surgery.

Final Thoughts

Cartilage injuries may seem minor at first, but their progression can be silently devastating. If you’re a young or middle-aged patient experiencing persistent joint pain, swelling, or mechanical symptoms, especially after sports or trauma, it’s crucial to get a specialist evaluation.

Cartilage transplant surgery is not just about relieving pain—it’s about preserving the joint for the future. At Noida Sports Injury Center, our advanced arthroscopic techniques, precise diagnostics, and expert rehab protocols give our patients the best chance at full recovery and long-term joint health.

If you're dealing with a cartilage injury or unexplained joint discomfort, schedule a consultation with our orthopedic specialists today. Let’s treat it early—before it becomes a lifelong problem.