Nonoperative treatment options for symptomatic cartilage lesions

Abstract

Chondral injuries represent a spectrum of disorders that include both partial and full-thickness defects. The natural history of full-thickness cartilage lesions remains unclear. Repair or regeneration of normal functioning hyaline cartilage, in the mature adult, has yet to be confirmed following known cartilage restoration procedures and treatments. As such, the initial management of these lesions is largely nonoperative. Those nonoperative treatment modalities that are available to clinicians include physical therapy, activity modification, bracing, patient education, topical medications, systemic medications, and intra-articular medications. However, it is important to consider that patient responses to these initial treatment modalities are often unpredictable and idiosyncratic. Evidence-based treatment protocols and reliable predictors for identifying efficacious treatment strategies have yet to be established in this group of patients. Given this lack of data, the goals of therapy should be focused on reducing pain and inflammation, increasing flexibility, increasing strength, and optimizing function for a timely return to activities of daily living. This chapter discusses each of these interventions in detail. Current literature and controversies are explored. Ultimately, nonoperative modalities can be effective at relieving pain and improving function in affected patients and as such should be a first-line approach in the management of these lesions. © 2007 Humana Press Inc.