I was always a good athlete, involved in year-round sports activities even after high school. But now I’ve got a bunch of tiny holes in my knee cartilage that really seem to bother me. I’ve looked into various options and it seems like surgery is my next step. What can I expect for future sports participation after I recover?

Cartilage covers the ends of bones that make up the knee joint. This type of cartilage is called hyaline or articular cartilage. It is made up of cartilage cells called chondrocytes. Damage to this structure can cause holes called defects or lesions. Continued daily use of the joint puts pressure on the damaged area leading to pain, swelling, and sometimes locking or catching of the knee.

When these symptoms result in loss of function, the surgeon can perform a debridement or microfracture procedure. Debridement removes any loose fragments and smoothes the cartilage surface of the joint. Microfracture is the drilling of tiny holes through the cartilage to the joint surface. This technique stimulates bleeding and sets up a healing response.

A third treatment option for first-line care of cartilage injuries is an osteochondral autograft transplantation. This involves harvesting a layer of cartilage and bone from a healthy area of the same patient’s joint and transferring it to fill in the hole. Any of these first-line treatment approaches work well for inactive or low-demand patients with a small lesion.

Being active increases the risk for failure of the procedure but patients are encouraged to stay as active as they like. Revision surgery is always possible. The surgeon will also evaluate you for alignment problems that may have contributed to the problem in the first place. Many times, the cartilage wears down through all its layers because the bones forming the knee joint are angled unevenly. The surgeon can correct this by performing a procedure called an osteotomy. A wedge of bone is placed along the side of increased pressure in order to shift the point of weight-bearing contact over toward the other side of the joint. This helps even out the weight-bearing surface of the knee.

A postoperative rehab program is also a good idea. Once you regain knee joint motion, then you can start to build up strength in the muscles around the joint. Good muscular support can help take pressure off the joint and protect you from other types of injuries, especially during the healing recovery phase of this procedure.