Knee Cartilage Defects Explained: When Chondroplasty With Chondrofiller Is Better Than Microfracture or Platelet Rich Plasma

Knee cartilage injuries are a frequent and often misunderstood cause of persistent knee pain, swelling, and mechanical symptoms. These injuries affect athletes, physically active individuals, and even people with no clear history of trauma. Once damaged, knee cartilage does not regenerate easily, making treatment decisions especially important.

Over the past two decades, treatment options for knee cartilage defects have expanded beyond simple arthroscopic smoothing. Procedures such as microfracture surgery and biologic injections like platelet rich plasma have gained popularity. More recently, chondroplasty combined with chondrofiller has emerged as an option designed to improve both symptom relief and cartilage healing.

Understanding when chondroplasty with chondrofiller is more appropriate than microfracture surgery or platelet rich plasma requires a clear look at how cartilage injuries behave, how each treatment works, and what outcomes patients can realistically expect.

Articular cartilage is the smooth, white tissue covering the ends of the bones inside the knee joint. Its primary function is to allow frictionless motion and absorb load during activities such as walking, running, squatting, and jumping.

Knee cartilage defects occur when this protective layer becomes damaged or worn. Common causes include:

• Sports-related twisting injuries
• Direct trauma or falls
• Repetitive impact activities
• Knee instability or malalignment
• Early degenerative joint changes

Unlike muscle or bone, cartilage has no direct blood supply. Because of this, even small defects may fail to heal and can gradually enlarge over time. Research published by the American Academy of Orthopaedic Surgeons shows that untreated focal cartilage defects can progress to early osteoarthritis, particularly in younger and active individuals.

Cartilage itself has no nerve endings, but cartilage defects disrupt normal joint mechanics. This leads to:

• Increased stress on surrounding bone
• Inflammation of the joint lining
• Swelling and fluid buildup
• Catching or locking sensations
• Progressive joint stiffness

As the defect worsens, pain becomes more frequent and may limit sports participation, exercise tolerance, and daily activities.

Early cartilage damage is often treated with physical therapy, activity modification, weight management, and anti-inflammatory medications. While these measures can reduce symptoms, they do not restore cartilage structure.

When symptoms persist, physicians may consider:

• Chondroplasty
• Microfracture surgery
• Platelet rich plasma injections
• Cartilage scaffold-based repair techniques

Each approach has distinct biological effects and long-term implications.

Chondroplasty is a minimally invasive arthroscopic procedure aimed at stabilizing damaged cartilage. During surgery, the orthopedic surgeon removes loose, frayed cartilage and smooths the defect edges.

Chondroplasty improves joint mechanics and reduces irritation but does not stimulate new cartilage growth on its own. For this reason, it is increasingly combined with biologic materials such as chondrofiller.

Chondrofiller is a biocompatible cartilage repair matrix designed to fill focal cartilage defects. It acts as a scaffold that supports cell migration and tissue remodeling within the damaged area.

Key properties include:

• Ability to conform to irregular cartilage defects
• Stability within the joint environment
• Support for cartilage-like tissue formation
• Compatibility with surrounding healthy cartilage

Studies in orthopedic journals such as The American Journal of Sports Medicine indicate that scaffold-based cartilage repair can produce more durable cartilage fill than mechanical smoothing alone.

Microfracture surgery involves creating small holes in the bone beneath the cartilage defect. This allows bone marrow cells to enter the defect and form repair tissue.

While microfracture surgery can reduce pain in the short term, the new tissue formed is fibrocartilage, not true articular cartilage. Fibrocartilage is less durable and less resistant to mechanical stress.

Long-term studies published in The Journal of Bone and Joint Surgery show that microfracture outcomes often decline after five to seven years, especially in active patients.

Platelet rich plasma is derived from a patient’s own blood and contains concentrated growth factors. It is injected into the knee to reduce inflammation and support healing.

Platelet rich plasma may help with pain and inflammation, particularly in mild cartilage wear. However, it does not fill cartilage defects or restore cartilage structure.

Systematic reviews in Sports Medicine report that platelet rich plasma improves symptoms but has limited ability to repair established cartilage defects.

Chondroplasty combined with chondrofiller may be preferable when:

• The cartilage defect is localized and well-defined
• The patient is young or physically active
• Long-term durability is a priority
• The defect is too large for platelet rich plasma alone
• The patient wishes to avoid bone injury associated with microfracture surgery

Unlike microfracture surgery, chondrofiller does not rely on bone marrow stimulation, preserving subchondral bone integrity.

Chondroplasty with chondrofiller offers several advantages:

• Avoids weakening the bone beneath the cartilage
• Encourages organized tissue repair
• Produces cartilage-like tissue closer to native cartilage
• Reduces risk of long-term joint degeneration

According to the International Cartilage Regeneration and Joint Preservation Society, scaffold-based cartilage repair techniques are increasingly favored for focal defects in active patients.

Platelet rich plasma is best suited for inflammatory conditions rather than structural defects. In patients with visible cartilage loss, injections alone may temporarily reduce pain but do not address the underlying mechanical problem.

Chondroplasty with chondrofiller physically fills the defect while supporting biological healing, offering a structural solution rather than symptomatic relief alone.

Patients who benefit most include:

• Athletes with cartilage injuries
• Individuals with persistent knee pain despite therapy
• Patients with early cartilage degeneration
• Those without advanced osteoarthritis
• Patients seeking to delay joint replacement surgery

Clinical decision-making should always involve imaging studies and orthopedic evaluation.

• Controlled weight-bearing
• Swelling management
• Gentle range-of-motion exercises

• Progressive strengthening
• Restoration of joint stability
• Gradual return to functional activities

• Sport-specific conditioning
• Return to impact activities when cleared

Studies in The British Journal of Sports Medicine emphasize that structured rehabilitation is essential for cartilage scaffold maturation.

Early and mid-term studies suggest that patients undergoing chondroplasty with chondrofiller experience:

• Sustained pain reduction
• Improved joint function
• Slower progression of cartilage damage
• High patient satisfaction

Long-term data continues to evolve, but outcomes are promising compared to traditional cartilage repair techniques.

As with any procedure, risks include:

• Incomplete defect filling
• Persistent swelling
• Joint stiffness
• Need for future intervention

Careful patient selection significantly reduces complication rates.

No single cartilage treatment is ideal for every patient. Microfracture surgery, platelet rich plasma injections, and chondroplasty with chondrofiller each have a role depending on:

• Defect size and depth
• Patient age and activity level
• Long-term goals
• Overall knee health

Shared decision-making with an orthopedic specialist is essential.

Knee cartilage defects require thoughtful, individualized treatment. While microfracture surgery and platelet rich plasma injections remain useful tools, chondroplasty with chondrofiller offers a balanced approach that combines mechanical stabilization with biological repair.

For patients seeking durable outcomes, preservation of joint integrity, and a return to active lifestyles, chondroplasty with chondrofiller may represent a meaningful advancement in cartilage repair strategies.

Also Read:

• Chondroplasty With Chondrofiller: A Complete Guide to Cartilage Repair for Knee Pain and Sports Injuries