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I have two medium-sized holes in the joint cartilage of my left knee. The docs have recommeded surgery to repair the problem. They say it should be done sooner than later. How long do I have before I reach the point-of-no-return on this?

It sounds like you may have some defects in the articular cartilage of the knee. Articular cartilage refers to the fibrous structure directly over the bone protecting the joint and helping produce smooth gliding action. Knee articular cartilage doesn't repair well by itself. There isn't a lot of blood supply to the area. So left untreated, patients with this problem often develop knee pain, early osteoarthritis, loss of function, and eventually disability. That's why surgeons often recommend surgical repair sooner than later. In the last 10 years, joint resurfacing techniques such as microfracture (MF) and autologous chondrocyte implantation (ACI) have been developed to address this problem. In the microfracture procedure, tiny holes are drilled into the joint surface to create bleeding and stimulate a healing response. In the implantation procedure, normal, healthy articular cartilage cells are removed from the patient and taken to a lab. In the lab, scientists use the cells to grow more cells -- enough to fill the hole or defect in the patient's joint and repair the damage. Early intevention and treatment is often recommended for moderate-to-severe defects because the patients who have the best results have the surgery early after injury (within the first 18 months). Studies show that patients have up to three years from the time of injury to the time of treatment before it may be too late for a safe and effective repair using these techniques. Regeneration of cartilage is less likely to occur when patients have had painful symptoms for long periods of time. Early treatment helps preserve the entire joint surface and prevents changes in the metabolism of cartilage cells that could otherwise spell disaster with joint degeneration and destruction leading to osteoarthritis.

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