What is cartilage restoration.
Cartilage doesn't heal on its own — it has no blood supply. When a piece of cartilage is lost from an injury or wear, the bone underneath is exposed. Without intervention, that defect typically gets larger.
Cartilage restoration uses one of several techniques to either grow new cartilage in the defect (microfracture, MACI) or transplant healthy cartilage from elsewhere (OATS, OCA). The right technique depends on the defect's size, location, and the patient's age and activity.
Who it's for.
- Patients under 60 told they need a knee replacement for focal cartilage damage
- Athletes with a discrete cartilage injury after a knee dislocation or impact
- Patients with localized "bone-on-bone" wear in one part of the knee, but the rest intact
- Patients seeking a second opinion before knee replacement
How Dr. Pradhan approaches it.
The first task is honest staging: is the cartilage damage truly focal (one well-defined spot), or is the whole compartment worn? Diffuse wear isn't a cartilage restoration problem — it's a preservation-or-replacement problem.
For focal defects, we match the technique to the defect. Small (under 2 cm²) defects often do well with microfracture or a single OATS plug. Larger defects need MACI (cultured cartilage cells) or osteochondral allograft transplant.
Concurrent factors — malalignment, meniscus loss, ligament instability — get addressed in the same operation. A cartilage transplant placed on a malaligned knee fails predictably. Realignment osteotomy is part of the conversation when warranted.
What recovery looks like.
Most cartilage restoration procedures require protected weight-bearing for 6–8 weeks while the new cartilage matures. Range of motion (often using a CPM machine) starts immediately.
Running typically returns at 6–9 months; return to cutting sports at 9–12 months. Patience is the trade — the cartilage itself takes time to mature.
We work directly with a small group of Dallas physical therapists who follow restoration protocols and understand the load progressions these grafts need.
Frequently asked.
Am I too old for cartilage restoration?
Most cartilage restoration is performed in patients aged 18–55. Older patients with isolated focal defects are sometimes candidates; older patients with diffuse wear typically are not. Imaging and an honest exam clarify the question.
Microfracture vs. OATS vs. MACI — which one?
It depends on defect size, location, depth, and your activity goals. Microfracture works well for small lesions; OATS for medium defects with healthy adjacent cartilage; MACI for larger defects or after a failed prior procedure. We choose with you in clinic.
Will cartilage restoration prevent a replacement later?
It delays it for many patients — often by years or decades — and in some patients eliminates the need entirely. Outcomes are best when the operation matches the defect and any contributing factors (alignment, meniscus loss) are addressed at the same time.
What does recovery actually look like?
Protected weight-bearing on crutches for 6–8 weeks, range of motion exercises and (often) a CPM machine, structured physical therapy for 4–6 months, return to running at 6–9 months, return to cutting sports at 9–12 months.
I was told I'm bone-on-bone and need a replacement. Should I get a second opinion?
If you're under 60, if your wear is one-sided, or if you have a discrete injury history — yes. There is a real chance you're a preservation candidate. That conversation is worth having.