How to Repair Knee Cartilage Without Surgery?

What does knee cartilage damage mean exactly?

In all your joints, you have cartilage. It’s one of the many tissues in our bodies with several roles.

This cartilage can become damaged, soften, or be the site of inflammation; this is what we call chondropathy.

It literally means “cartilage disease.” It’s a quite broad medical term that encompasses various conditions!

Chondropathy can occur at any age, even at 15, 30, or 40 years old!

Be reassured that even if you may have never heard of it until you received this diagnosis, it is VERY common (which is why I’m writing an article about it!).

What are the symptoms of cartilage damage?

The symptoms of cartilage damage are not very specific. This means they are similar to many causes of knee pain, such as knee osteoarthritis, meniscus injury, or patellofemoral syndrome.

Here they are:

1. Pain: You experience pain during or after physical activity, or even at rest during the day or night.
2. Swelling of the knee, warmth, redness (inflammation). Or sometimes, swelling without redness or warmth.
3. Your knee makes sounds like crackling, popping, or grinding.
4. You have a sensation of joint stiffness, especially after a period of inactivity. Difficulty bending or straightening the knee.
5. You sometimes feel a sense of instability in the joint, a “giving way” sensation.

How to know if it’s indeed chondropathy? Diagnosis

So how do you determine if it’s cartilage damage causing your knee pain and not something else?

Your doctor conducts examinations (often an X-ray) to rule out other causes that would require different treatment, such as a knee fracture.

Your doctor may also prescribe an MRI or a CT scan of the knee, which provides a better view of the cartilage and, therefore, the chondropathy.

Chondropathy is sometimes asymptomatic, meaning that a problem with the cartilage may be observed during a knee MRI conducted for another reason, but you don’t experience any symptoms!

In this case, there’s no need to treat chondropathy!

Another important point to consider if you have doubts about the diagnosis: many issues that present similar signs and symptoms to chondropathy are treated in the same way as chondropathy!

In fact, increasingly, doctors, physical therapists, and research teams working on these subjects prefer to use the term “anterior knee pain” to refer to any knee pain (excluding fractures, sprains, or dislocations).

This is because making a precise diagnosis is often challenging and not very reproducible: two doctors or physical therapists with the same indicators might not give you the same diagnosis!

What are the different types of chondropathy?

Chondropathies are named differently based on three factors:

1. The precise location of the problem.
2. The specific type of problem encountered: how the cartilage is damaged.
3. The degree of cartilage damage: whether it is slightly damaged or “a lot.”

That’s why, if you have undergone examinations such as knee X-rays, a CT scan, or an MRI, you may come across various terms!

Here are some explanations of the terms that come up most frequently and that you may have read or heard about:

Type of Cartilage Damage	Explanations
Cartilage Damage of the Femoral Condyle	Refers to where the cartilage is damaged, at the knee, at the bottom of the femur (thigh bone)
Cartilage Damage of the Tibial Plateau	Also based on where the cartilage is damaged, at the knee, at the top of the tibia (one of the two leg bones)
Medial Femoro-Tibial Cartilage Damage	Refers to the location of the cartilage damage: in the knee, between the femur (thigh bone) and the tibia (leg bone), on the internal side of the knee
Lateral Femoro-Tibial Cartilage Damage	Refers to the location of the cartilage damage: in the knee, between the femur (thigh bone) and the tibia (leg bone), on the external side of the knee
Bicompartimental Cartilage Damage	Affects both the inner and outer parts of the cartilage
Femoro-Patellar or Patellofemoral Cartilage Damage	These are the terms used when your cartilage is damaged between the femur (thigh bone) and the patella (also called patella or kneecap)
Tri-Compartmental Cartilage Damage of the Knee	In medicine, the knee joint is divided into three parts, three compartments: 1/ the femoro-patellar compartment between the patella and the femur 2/ and 3/ the femoro-tibial compartment between the tibia and the femur, with the medial, internal side (2), and the lateral, external side (3). Your cartilage is damaged in these three areas
Cartilage Damage with Ulceration	This is more about how your cartilage is damaged. It means the cartilage is damaged, and its surface is no longer perfectly regular
Cartilage Damage with Bone Edema	There is a small edema in the bone under the cartilage. Linked to an accumulation of fluid in the joint due to a slight inflammation
Deep Cartilage Damage	Cartilage lesions are not only superficial; they go deeper into the cartilage
Asymptomatic Cartilage Damage	Sometimes, there are no symptoms of cartilage damage. This means a problem with the cartilage is visible if an MRI of the knee is performed for another reason, but you have no symptoms
Gonarthrosis with Cartilage Damage	You also have knee osteoarthritis (femoro-tibial or femoro-patellar)
Cartilage Damage Stage or Grade 1, 2, 3, 4	Sometimes your cartilage damage is classified according to its grade or stage. 1 is the minimum possible damage, 4 is the highest possible. In practice, this does not change much to the treatment options
Degenerative Knee Cartilage Damage	The wear and tear of your cartilage are probably more related to normal wear and tear rather than a significant impact or trauma

Are you not sure what type of cartilage damage you have? Lost among all these terms?

No worries at all! The treatment is based on the same general principles: what matters most is how you feel, not what your exams show!

Is there a difference between cartilage damage and knee arthritis?

Yes, there is a difference between knee arthritis and cartilage damage.

Cartilage damage is a broad category that includes many different cartilage problems, including osteoarthritis.

But if you’ve been told you have cartilage damage, it’s probably because you have a different type of cartilage damage than knee osteoarthritis (gonarthrosis).

Another important point: having cartilage damage doesn’t necessarily mean you’ll soon have knee osteoarthritis!

Even at 80 years old, most people have knee osteoarthritis, whether they had cartilage damage or not!

Is there a difference between cartilage damage and chondromalacia?

Yes, theoretically there is a difference between cartilage damage and chondromalacia.

Cartilage damage includes many cartilage problems, including osteoarthritis and chondromalacia.

Chondromalacia is a specific type of cartilage problem: the cartilage is softened.

But in practice, these two terms – cartilage damage and chondromalacia – are often used interchangeably.

What is the natural progression (without intervention) of cartilage damage?

Two good news for you:

1. Cartilage damage doesn’t necessarily worsen over time;
2. Even without doing anything specific, your symptoms can decrease, and you may no longer experience pain!

There are no clear studies that track the progression of cartilage damage with or without treatment over the years.

But our general knowledge about the functioning of the human body and pain strongly suggests that things can improve over time!

Because pain is something complex. And even with an anatomical problem, a lesion, a damaged structure, one may no longer feel pain!

I’m not the only one saying this: here are the statements of a research team from India 🇮🇳 that synthesized knowledge on patellar chondromalacia, a form of cartilage damage.

Patellar chondromalacia can be reversible (= disappear), or it can evolve into the development of femoropatellar arthritis.

Patients suffering from knee pain due to patellar chondromalacia often achieve complete healing. Depending on the cases, healing can occur in just one month or take years.

Adolescents often achieve long-term healing because their bones are still growing, and their symptoms generally improve after adulthood.

Habusta 2023

What to do in case of cartilage damage: treatments?

Here are a few words on the recommended initial management today to relieve anterior knee pain (which includes knee cartilage damage).

This involves conservative treatment = without surgery, without operation, without invasive procedures on the knee.

Well, if we’re not manipulating the knee, what do we do (if we really want to try something)?

According to this research team:

it seems judicious to initiate the patient in a program of quadriceps strengthening, especially the vastus medialis oblique (a part of the quadriceps).

D’ambrosi 2022

You will see later that I do not necessarily share this conclusion, and I will explain why.

In any case, the goal is not to repair the lesion (the cartilage is damaged, we cannot make it “grow back”). But “simply” to relieve your pain and other symptoms, which is already quite good :)!

And now, some insights into treatments for which my patients have asked me the most questions related to cartilage damage.

Treatment for Chondropathy	Effectiveness?
Wearing a knee brace or another type of brace	There is no high-quality evidence showing that braces really help. But it’s a method worth trying to alleviate pain in the moment.
Taping	Same conclusion as for knee braces.
Natural remedies, creams, glucosamine/chondroitin (dietary supplements), harpagophytum	I have written a comprehensive article on natural remedies for bone strengthening, including cartilage.
Knee replacement	Typically, knee replacement is done for advanced osteoarthritis, not just chondropathy.
Platelet-Rich Plasma (PRP) Injections in the Knee	PRP is primarily tested for osteoarthritis. At best, it provides relief from pain for about 6 months; see my more detailed article on PRP injections in the knee.
Hyaluronic Acid Injections in the Knee	They have been evaluated for decades to relieve pain associated with knee osteoarthritis and have not proven to be effective compared to a placebo (article to come). It is reasonable to think the same for chondropathy.
Corticosteroid Injections in the Knee	Roughly the same conclusion.
Taking anti-inflammatories or other pain-relieving medications	Occasional relief from pain in some individuals, not specifically tested in high-quality studies for this specific problem.

Feeling a bit overwhelmed with all of this?

I’m going to give you a “concrete action plan”!

How to treat cartilage damage: my advice as a physical therapist!

Based on the various treatments proposed for chondropathy, here’s what I recommend as a physical therapist.

What to do for your chondropathy, whether on your own or with assistance?

I consider these 4 criteria, which matter most to me.

If you don’t share these same criteria with me, then your therapeutic choice may be different, and there’s nothing wrong with that 🙂!

☑️ Maximum effectiveness (theoretical / empirical)
☑️ Minimum side effects
☑️ Minimum cost (in time, energy, money)
☑️ Minimum dependence on a third person or equipment

Mix all that together, and it gives you the following action plan:

1. Identify activities triggering or worsening the pain. Example: running, going up and down stairs.
2. Stop them until you have an almost pain-free knee or (my preferred version) reduce their frequency, intensity, or duration to find the “right dosage” for you! This dosage fluctuates over time.
3. Reintroduce very gradually in frequency, intensity, and duration.
4. Be confident and aware that pain is not necessarily a sign of a problem, and it is possible to work with it.
5. (Optional: not relevant for everyone) Do exercises or activities involving the contraction of knee and hip muscles. What we call muscle strengthening, regardless of the exercises performed!

You can implement this action plan on your own.

If it doesn’t resonate with you or you feel the need for guidance, you can contact a physiotherapist or another professional accustomed to treating knee problems!

I don’t offer this service through my website; it’s often requested, but offering individual support wouldn’t free up enough time for me to continue producing well-researched articles freely accessible to everyone, which I prioritize.

Why don’t I list the exercises to do?

Many physiotherapists and coaches publish online videos or programs presenting THE exercises to do to relieve knee pain or even prevent injuries.

And many of you ask me to show you THE exercises to do.

These physiotherapists and coaches respond to a significant demand from patients for THE exercises to do.

However, I personally don’t want to convey the idea that by doing a specific exercise, you will no longer have pain, or have less pain, or avoid injury!

This doesn’t align with our current understanding of how the human body and the knee function.

Studies on the effectiveness of exercises are of poor quality, partly because it’s challenging to evaluate.

There are no fundamentally better exercises than others “for everyone,” and, most importantly, it’s not at all certain that doing exercises (compared to simply adjusting your activity level) is more effective in relieving knee pain, whether due to chondropathy or something else.

What sport can you practice with cartilage damage?

You can do absolutely all sports with chondropathy! No sport is formally contraindicated, even with chondropathy at stage or grade 4!

So yes, you can even run with patellar chondropathy if you can manage the pain!

There is no clear link between the amount of sports practiced (at the amateur level) and the extent or frequency of cartilage lesions!

It even seems that running helps prevent (= somewhat avoids) cartilage wear!

✅ What you need to find is the right dosage of exercise for YOU, where you are currently. In relation to your feelings, your pains.

❌ But not in relation to the fear of possible wear!

Here are the sports that put the most stress on knee cartilage when practiced at a high level. However, it is reasonable to think that when practiced at an amateur level, these sports do not damage the cartilage:

⚽ football;
🏐 volleyball;
🏀 basketball;
🏋️‍♀️ weightlifting.

This does not mean that you absolutely have to avoid these sports in the case of chondropathy. It’s up to you to assess the risk-benefit balance in your case: does the practice of these specific sports bring you a lot of benefits and is it worth it, even if there is a slightly higher risk of cartilage wear?

Also, some sports like triathlon are not listed because there is not enough data about them.

These data mainly come from studies on osteoarthritis, not chondropathy, because more people suffer from knee problems due to (probably?) osteoarthritis.

But it seems reasonable to think that these conclusions are also valid for cartilage lesions in general, in the absence of other data!

Source: Trovato 2023

Who to consult if knee pain related to cartilage damage persists?

Here are different health professionals you can consult to help alleviate your knee pain or resume activities you can no longer do.

Your general practitioner: to have a comprehensive view of your problem by someone who knows you well. If necessary, they can refer you to other professionals.

Your physical therapist: at least for an assessment to see what they can offer you. Know that if you have already seen a physiotherapist and want to change, it’s possible, no matter what motivates you!

Physiotherapists are among the health professionals most accustomed to managing knee pain.

A rheumatologist: these are specialists in joints. They are accustomed to seeing people with chondropathy.

A sports medicine doctor: these doctors are also used to seeing people with chondropathy, especially among athletes.

One is sometimes tempted to seek multiple opinions to make sure nothing is overlooked or hoping that someone will finally propose a “real” remedy for chondropathy…

I understand what motivates this. But another possible (and not necessarily less good) attitude is to be satisfied with one opinion and let time do its work!

Can you work with cartilage damage?

Even if it is sometimes counterintuitive, it’s not the type of disease that determines whether you are entitled to sick leave (or whether it’s better for you to stop working), but the combination of these 4 things:

1. What you actually do at work: does it trigger your knee pain? Aggravate it?;
2. The possibility of adapting your work or not;
3. How you, for personal or professional reasons, consider returning to work;
4. The habits of your doctor in prescribing sick leave (physical therapists cannot issue sick leave).

Chondropathy is not part of the list of pathologies for which Social Security provides typical durations of sick leave for doctors.

Among my patients, I have observed all scenarios:

• People who never stopped working: working does not necessarily worsen either the pain or the wear;
• Others on sick leave for a few days during painful “flare-ups”;
• Others on sick leave for several weeks;
• And even others for several months.

***

I hope I have answered as many questions as possible about chondropathy! If you have comments or questions, feel free to ask in the comments, I always respond 🙂!