Knee Cartilage Injuries & Management

Anatomy & Function

Cartilage is a glistening white smooth tissue covering the ends of bones where it articulates with other bone and form a joint. It is toughened yet flexible enough to cushion the gliding of the bones forming the joint. Knee is a large weight bearing joint with forces up to 8 times body weight passing through it with every step.

Articular Cartilage helps in reducing friction by acting as a slippery cushion and a shock absorber. This allows for smooth movements of the knee joint.

MRI of the knee showing articular cartilage.

MRI of the knee showing articular cartilage.

Cartilage Damage

Apart from the above mentioned unique properties it has a limited blood supply so any damage to the cartilage will not heal optimally on its own.

The most common form of cartilage damage is age related degeneration or wear and tear of the joint known as osteoarthritis.

Contrary to the age related degeneration, primary injuries to the articular cartilage usually occur in young and active population. It can lead to early deterioration of joint causing secondary osteoarthritis.


  • Knee Pain: Damage to the articular cartilage of knee occurring in an otherwise healthy patient presents most commonly with knee joint pain.
  • Swelling and Stiffness: The pain is usually associated with swelling, knee effusion and stiffness, especially worse during walking, jogging or sports activities.
  • Feeling of Knee Giving Away: Patients may also experience symptoms of their knee giving away, catching, instability or may have a grinding sensation in the knee during day to day activities.
  • Locking: Sometimes the cartilage breaks from the bony end and comes to lie freely in the joint known as a ‘loose body’. This loose body might cause episodes of locking of knee. The patient might not be able to extend (straighten) or bend their leg from a particular position.

These are all symptoms that slowly deteriorate over time, causing a significant morbidity in day to day activities. Young athletes may find themselves off field and may affect their career. Over time the condition may lead to degenerative changes secondary to the cartilage injury and altering of the normal biomechanics of the joint.


  • Trauma/Injuries: The condition is particularly common among athletes and active adults engaging in sports. Here the injury is usually a result of the direct impact on the articular cartilage which may be small or large in size with a varying amount of depth of lesion. Lesions reaching the bone lying directly under the cartilage (called subchondral bone) are a result of significant trauma.
  • Overuse: Other common cause is repetitive overuse of the joint in active adult population leading to microfractures of the underlying bone and cartilage which progresses to a full depth cartilage injury.
  • Congenital(since birth): Some people with abnormalities of the joint by birth are predisposed to the cartilage injury as abnormal forces act on certain areas of the knee which would be otherwise distributed in a normal adult. Such individuals have altered biomechanics of the knee.
  • Osteochondritis dissecans: Conditions such as Osteochondritis dissecans occur more frequently in children. Here the underlying bone loses its vascularity or blood flow. The bone upon losing the blood supply slowly dies or gets degraded. The body tries to form new bone and replace the dead bone but in the process the overlying piece of cartilage is damaged.

Certain endocrine/hormonal abnormalities, vascular diseases, unknown causes or simply hereditary factors predispose to the development of osteochondritis dissecans.


  • History & Examination:Physician will take a detailed history preceding your condition and any injuries or surgeries around the knee. They will conduct a thorough physical examination including clinical tests and measurements to check for instability.
  • X-Ray/CT Scan: Usually a radiograph/X-ray is the first investigation done to check for bony integrity ruling out fractures which can be further aided with a superior CT scan.
  • MRI: For cartilage injuries the best investigation is an MRI which can provide a detailed view of all the sectors of the cartilage and any damage to the surrounding ligaments and knee pads (meniscus) which stabilize the knee.
  • Diagnostic Arthroscopy:  Arthroscopy when used for diagnosis is the gold standard. Here a tiny camera is inserted through a keyhole providing a telescopic view of the entire knee joint. Treatment of the condition can also be done at the same time using arthroscopic instruments.


Treatment depends on a number of factors like age of the patient, the size of defect,demands of the patient and ability to tolerate rehabilitation.

NonSurgical Treatment

Nonoperative treatment usually consists of anti-inflammatory medications, physical therapy and braces to unload the injured cartilage. Some other options like steroid injections or viscosupplementation are controversial especially in young patients. All conservative options focus on relieving the pain and giving time for the cartilage to repair itself. But the defect rarely heals on its own and generally progresses over time.

Surgical Treatment

Surgical techniques can be compared to filling a pothole and options involve either the use of minimally invasive Arthroscopic technique or invasive open procedures called arthrotomy.

Generally arthroscopic surgeries provide earlier return to previous activity and lesser hospitalization. Most of them are day care procedures. Arthroscopic surgery utilizes 2-4 keyhole incisions through which a mini camera is inserted providing a telescopic view and fine pencil size instruments are inserted to do surgical procedure.

Debridement / Chondroplasty

In this surgery, usually performed with an arthroscope, the friable cartilage is simply removed and cleaned. Although it promises a very fast rehabilitation and recovery but success rates are variable and is successful in very small and superficial defects. The cleaned up area is filled with a tissue by the body but this tissue is not as good as the original cartilage itself.

Microfracture Technique

Several small micro-holes are created in the underlying bone through keyhole surgical techniques like arthroscope. Multiple drills cause marrow bleeding in the defect thereby allowing cells with regeneration potential to fill the defect and over time these cells form the new cartilage tissue.The technique is quite effective in small defects and is cost effective being a single stage procedure. But it requires the patients to remain non weight bearing for a long period of time.


It involves filling of the defect from patients own cartilage as a graft taken from a non weight bearing portion. The defects are filled and the body’s own grafted cartilage incorporates into the defect along with bone plugs. The procedure can be done for small full thickness defects in weight bearing area and require the availability of normal cartilage for grafting.

This technique avoids the problems of graft rejection and high costs. The non weight bearing areas of the cartilage are accessed through keyhole surgery using arthroscopy and matched to shape exactly the size of the defect. Rehabilitation is expedited and offers good results. As there are multiple grafts planted in the defects hence looking like mosaic. The surgery is usually day-care and patients usually return to their previous activities after a period of physical therapy.

Allograft Osteochondral Transplantation

The bone and cartilage graft is taken from a cadaver i.e preserved cartilage and bones from a dead donor. The graft is matched and shaped to fill the defect. The graft is especially prepared and processed to prevent transfer of infections.

This is useful in patients with larger defects in young patients. It is done through open technique. A right size graft is shaped to exactly match the defect and fixed. The grafted cartilage is incorporated in the defect with time and the patient can then resume his daily activities.

Fixation of fragments

In case of children and young patients, especially those suffering from osteochondritis dissecans, a large fragment can be simply fixed back to the underlying bone with sutures or screws. Helpful in fresh cases when the cartilage fragment is usually hanging by a tissue in the joint.

This helps in retaining the patient’s anatomy and native bone and cartilage. The sutures and screw fixation can be done using arthroscopy technique which not only treats but helps to detect any other cartilage problems within the knee as the whole joint is inspected using the telescopic camera.

Autologous Chondrocyte Implantation

In this two step surgery usually spanning several weeks the patient’s own cartilage cells are first harvested from the non weight bearing areas of the joint and then grown in a special medium in the lab. Over the course of several weeks the cells multiply and they are then placed in the defect of the cartilage which is covered by periosteum (covering of the bones).

The cells have regeneration potential meaning they can form the native cartilage when placed in the defect. The surgery is usually performed using an open technique in which the knee joint is opened and the area is directly accessed. Rehabilitation takes several weeks and the patient can then resume his activities.

Knee replacement

Reserved for older age group with chronic cartilage damage leading to osteoarthritis changes. Here the joint surfaces are replaced with prosthetic material to re-create the normal motion of the knee. The joint is divided into two compartments one on the inner side and the other on the outer side. The inner side is more frequently involved and in patients with a normal outer side and undergo a semi knee transplant called Unicondylar knee arthroplasty using a minimally invasive technique. It offers an expedited rehabilitation and resumption of activities.

In patients with widespread osteoarthritic changes a total knee replacement is usually performed where both the bones forming the knee joint are replaced with prosthetic material and the normal axis and balance of the knee joint is restored to recreate the biomechanics.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.