Cartilage preservation surgery covers microfracture, osteochondral autograft transfer (OATS), osteochondral allograft, and matrix-induced autologous chondrocyte implantation (MACI), chosen mainly by defect size, depth, and joint alignment. Articular cartilage has no direct blood supply, so it doesn’t heal well alone. Small lesions suit marrow stimulation or plug transfer, while larger ones often need cell-based or graft-based repair.

According to Dr. Arpit C Dave, Arthroscopic Surgeon in Dahisar, “A repair holds up only when it matches the defect, because a technique that suits a 1 cm lesion won’t survive a 4 cm one.”

Meniscus damage often comes with cartilage injury, and meniscus tear treatment can be done in the same sitting.

Defects beyond roughly 3 to 4 cm², or ones reaching deep into bone, generally need cell-based or graft-based reconstruction.

• MACI: Cartilage cells taken during one arthroscopy are grown in a lab and seeded onto a collagen membrane, then fixed into the defect in a second operation weeks later.
• Allograft: Fresh donor bone with its cartilage layer can replace big or deep defects, which helps when the bone underneath is damaged too.
• Alignment: And if the leg’s alignment overloads one side of the knee, a corrective osteotomy usually goes alongside any repair, since new cartilage doesn’t last under that kind of stress.
• Rehab: Weight-bearing stays limited for several weeks, then graded physiotherapy builds back over six to twelve months before sport.

Bigger defects heal slowly. Patience pays off, because that’s where a durable repair changes the outcome most. For a related knee problem, read about pain behind the knee.

Surgery is considered when a defined cartilage lesion causes symptoms that don’t respond to non-surgical care. Not every defect needs an operation.

• Symptoms: Persistent catching, swelling after activity, and deep joint-line pain lasting beyond a few weeks often point to a structural cartilage problem rather than simple strain.
• Imaging: MRI maps the size and depth of the defect, and it’s what separates a lesion that needs repair from one that only needs watching.
• Failed rehab: If three to six months of physiotherapy, activity changes, and injections haven’t settled the pain, surgery enters the conversation.
• Arthritis: Widespread wear across the whole joint is a different problem altogether, so focal repair generally isn’t offered once arthritis has taken over.

Many small, early lesions improve with load management and physiotherapy, and that’s always tried first. Imaging and rehab history are reviewed before surgery is advised, and when ligaments are torn as well, ACL tear surgery is planned alongside the cartilage repair.

Key Takeaways

• Microfracture and OATS suit small defects under about 2 cm² in a stable knee.
• MACI and allograft are reserved for larger or deeper lesions.
• Misaligned legs need correction, or the repair won’t last.
• Recovery after cell-based or graft-based repair usually runs six to twelve months.
• Surgery is considered only after non-surgical care has failed.