Which cartilage option fits the problem?

What may help before an operation?

Cut back long walks, stairs, or another movement that brings swelling. Keep the joint moving by slowly bending and straightening it as far as feels comfortable. Gentle exercises can strengthen the muscles around it. Losing weight may reduce strain when that applies to you. Rehab can also be shaped around what the exam finds. These steps won't replace missing cartilage, but they may ease daily movement.

Start with the movements your joint can manage without sharp pain.

What is microfracture surgery?

During microfracture surgery, the surgeon makes small openings in the bone under the damaged cartilage. Blood and marrow cells pass through those openings and form a covering over the bare spot. That covering isn't the same as the smooth cartilage you had before. Ask how the size of the damage and any earlier operation affect the likely result.

Microfracture may make later cell placement less likely to work in that same spot.

How do a cartilage-and-bone graft and MACI surgery differ?

A graft is a plug of cartilage and bone placed into the damaged spot. It may come from another part of your joint or from a donor. MACI means matrix-induced autologous chondrocyte implantation. A surgeon takes cartilage cells from your knee, a lab grows them, and a later operation places them in the damage. Both choices require rehab. Ask how long you may need a brace, walking aid, or help driving.

These operations are meant for a clearly damaged spot, not wear across the whole joint.

What can I try without surgery?

Platelet-rich plasma (PRP) begins with blood drawn from you. A clinician spins it to separate a portion rich in platelets, then places that portion into the sore joint. Concentrated PRP keeps more platelets from that blood sample. These choices may be discussed for soreness and movement, but they don't prove cartilage has returned. Keep doing the easy home movements your doctor allows. Report new locking, weakness, or fast swelling.

QC Kinetix offers regenerative joint preservation: its medical providers prepare PRP from your blood and place it into the joint without surgery.

Sources

1. A JBJS evidence-based review of chondral lesions of the knee sets management by lesion size, location, limb alignment and rotation, and patient demand rather than by product: osteochondral autograft transfer is described as durable and predictable for smaller lesions (under 2 cm2) in young active patients, while lesions of 2 cm2 or more are typically treated with osteochondral allograft transplantation, particulated juvenile articular cartilage, or matrix-associated chondrocyte implantation, with favourable mid- and long-term results reported for allograft or MACI in large lesions of 3 cm2 or more.

   Dekker TJ, et al. — Chondral Lesions of the Knee: An Evidence-Based Approach.. J Bone Joint Surg Am, 2021. DOI: 10.2106/JBJS.20.01161.

2. The Cochrane review of surgical interventions for isolated cartilage defects of the knee in adults found only three randomised trials, all comparing mosaicplasty with microfracture, reporting 133 participants in total with a mean defect area of 2.8 cm2. It found NO randomised trials of allograft transplantation or drilling at all, judged every trial at high or unclear risk of bias, and rated the quality of evidence very low for every outcome.

   Gracitelli GC, et al. — Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults.. Cochrane Database Syst Rev, 2016. DOI: 10.1002/14651858.CD010675.pub2.

3. At 14 to 15 years, the Norwegian multicentre randomised trial of 80 patients with a single symptomatic femoral condyle cartilage defect found no significant difference between autologous chondrocyte implantation and microfracture on any clinical scoring system. There were 17 failures in the ACI group versus 13 after microfracture, and more total knee replacements had been needed after ACI (6 versus 3).

   Knutsen G, et al. — A Randomized Multicenter Trial Comparing Autologous Chondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years.. J Bone Joint Surg Am, 2016. DOI: 10.2106/JBJS.15.01208.

4. The UK NIHR SISMIC trial set out to test whether adding a collagen scaffold to microfracture improves outcomes in defects of up to 4 cm2. It randomised 10 of a target 24 internal-pilot patients and closed WITHOUT an answer. Its background estimates about 10,000 symptomatic knee cartilage injuries needing repair each year in the United Kingdom, mostly in people under 35; notably, three of the screened patients were found at surgery to have lesions that had already healed.

   Whitehouse MR, et al. — Microfracture with or without collagen scaffold insertion for adults with chondral or osteochondral defects of the knee: the SISMIC RCT and its challenges during and after the COVID-19 pandemic.. Health Technol Assess, 2025. DOI: 10.3310/BRTS2415.

5. A systematic review of 27 studies of arthroscopic joint-preservation techniques for chondral lesions of the HIP found survival (no revision and no conversion to hip replacement) ranging from 59.1% to 100% for microfracture, 92.9% to 100% for autologous matrix-induced chondrogenesis and 94.4% to 95.7% for microfracture with a chitosan scaffold, on mostly non-comparative evidence.

   Akhtar M, et al. — Outcomes of Arthroscopic Joint Preservation Techniques for Chondral Lesions in the Hip: An Updated Systematic Review.. Arthroscopy, 2024. DOI: 10.1016/j.arthro.2023.11.019.

6. Pooling 16 of 30 studies covering 868 patients, non-operative management of osteochondral lesions of the TALUS achieved clinical success in 45% of patients (95% CI 40% to 50%) at a median 37 months, with radiographic progression of ankle osteoarthritis in 9% (95% CI 6% to 14%). Roughly half of these lesions do acceptably without an operation.

   Buck TMF, et al. — Non-operative management for osteochondral lesions of the talus: a systematic review of treatment modalities, clinical- and radiological outcomes.. Knee Surg Sports Traumatol Arthrosc, 2023. DOI: 10.1007/s00167-023-07408-w.

7. FDA's consumer alert states verbatim of stem cell products, exosome products, adipose-derived stromal vascular fraction, umbilical cord blood, Wharton's Jelly and amniotic fluid products: "None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain." The only stem cell products carrying FDA licensure are blood-forming cells derived from umbilical cord blood, licensed only for disorders of blood production, and there are currently no licensed exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA, Consumers (Biologics), 2020.