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I'm an older athlete (78-years old), but still very active running marathons and participating in iron man competitions in the seniors division. I've had a bum knee for a couple of years now because of degererative changes in my knee. The doctor tells me there are holes in my knee cartilage. Can something be done for this problem? Is my age against me?

Older athletes pose some interesting and different challenges from younger adults. Degenerative changes affecting the knee can include the ligaments, meniscus, and/or joint cartilage. Lesions or holes in the articular cartilage (lining the surface of the joint) can be repaired. But in older adults, thinning of the entire surface can present some problems. Repairing isolated defects doesn't change the overall loss of joint surface. Surgical treatment for cartilage damage is still controversial. Results vary (some patients have a good result while others don't), and it's not clear why. Perhaps it's a matter of identifying patient factors that predict success or failure. Research is underway to help sort this all out. Some of the techniques used include drilling holes in the articular cartilage down to the bone, abrasion of the articular cartilage, and microfracture. These marrow stimulation procedures release tiny fat and blood droplets from inside the bone marrow. The result is to create or foster a healing response. Another approach is called autologous chondrocyte implantation (ACI). In this procedure, healthy cartilage cells are harvested or removed from the patient. They are transferred to a lab where they grow and multiply, a process called expansion. Then they are transferred back to the patient. The surgeon injects the new cells into the defect where they fill in and grow new chondrocytes (cartilage cells). Most of the research to date on all of these procedures has been done on young athletes. The technique is fairly new, so we don't have data to analyze long-term results. The first place to start is to see your physician. It may be that a simple program of medications and specific exercises would help enough to avoid surgery. If not, then some of the other treatment options can be considered.

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