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My cousin and I are seeing the same surgeon for two different knee problems. She has a torn ACL and I have a hole in my knee cartilage. She's been scheduled for surgery right away. But it seems to me like I have a much worse problem than her. I have way more pain and more trouble even walking. Yet the surgeon is dragging her heels to fix it. Should I look for a different doctor?

It's not always easy to compare one knee problem to another because they have different degrees of severity, treatment, and outcomes. Patient age, general health, and specific diagnosis all contribute to the surgeon's decision about the best way to treat a problem and the ideal timing in which to do it. Surgical treatment for cartilage defects (cracks, fissures, or holes) doesn't have such a great track record yet. The three most common surgical procedures include microfracture, autologous chondrocyte implantation (ACI), and mosaicplasty have been studied extensively. Researchers have not been able to show that one method is better than another. In fact, there's enough evidence to suggest that patients who don't have surgery do just as well as those who do have surgery. That calls into question the cost-vs-benefits of conservative (nonoperative) care versus surgical treatment of this condition. There's no doubt that the degree of patient complaints with chondrocyte lesions is greater than for patients with other conditions like anterior cruciate ligament (ACL) tears or osteoarthritis. Patients with cartilage defects suffer more pain and have worse function, mobility, and health-related quality of life when compared with patients who have other knee problems. Surgeons, scientists, and other researchers are actively looking for better ways to treat this problem. Until we have enough evidence to point to one treatment technique over another, don't be surprised if the surgeon doesn't jump right into scheduling an operation to treat the problem surgically. Each patient must work with the surgeon to understand their condition and the treatment options to choose from. Don't be afraid to ask your surgeon what she is thinking in your case. You may find that she is giving careful consideration and looking at all factors when forming a plan of care for you. Your own individual patient characteristics as well as the evidence published in medical journals will guide the final decision.

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