What is cartilage?

Cartilage is a white very smooth material that your body makes to cap the ends of bones.  This smooth surface is what contacts other bones in your body.  Your knee, for example, is the contact point of the femur bone and tibia bone.  It is held together by strong ligaments and moved by muscles.  Cartilage is an amazing material as the contact between two cartilage surfaces is smoother than a piece of melting ice on another piece of ice.  There is almost no friction at all between cartilage surfaces.

How does it become damaged ?

Cartilage DamageCartilage is damaged when a joint is moved in an unnatural way.  Twisting a knee too far, or a sudden impact injury can cause damage to cartilage.  Its ability to remodel and heal is very limited, unlike other areas in the body like your skin – get a cut and it just heals up.  When the cartilage surface starts to wear away, it causes inflammation in the joint, which, in turn, causes pain.

Can I grow new cartilage?

For the most part, cartilage does not re-grow once damaged.  It continues to wear away and once this process has started, it is hard to stop.  Many claims are made in modern medicine about growing new cartilage.  Some hold water but most do not. New approaches in orthopedic research are looking at ways to get your cartilage cells to get going again, by growing them in a lab and then putting them back into your knee.  This may be the best option available today.  There are clinical trials available if you are interested.  Ask Dr. Hacker for more information.

Do gel injections grow new cartilage?

No.  They do not.  This is a myth.  These injections contain a natural compound called hyaluronic acid.  This a component of normal joint fluid.  For some reason, overloading the joint with this compound decreases joint inflammation. It does not cause new cartilage to grow.  They are given as a series of injections once a week for 3 to 5 weeks.  You can read more about these injections here.

Real Treatment Options for new cartilage:


This procedure is done as a simple outpatient arthroscopic surgery in which tiny holes are created deep in a cartilage defect.  These holes allow bone marrow filled with stem cells can come into the joint and cause a tissue like cartilage to grow.  It is a little more fibrous than normal cartilage and as a result is called fibrocartilage.  While not as perfect as the real thing, it tends to relieve pain in many people quite well.

Cartilage Transplants

This is often a great option for young patients with large areas of cartilage that has been damaged.  This requires a fresh graft from a donor.  The cartilage from the good knee is taken out and transplanted directly into your knee.  Rejection is extremely rare.  The goal is for the new cartilage to fill in a damaged area and become a normal joint surface.

NeoCart: Using your own cartilage cells to grow a new joint surface

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I am very excited about this new investigational device for damaged cartilage.  Your own cartilage cells are sent off to lab where they are grown, and sent back in a patch that is glued into a damaged area.  If interested, please let me know ASAP and we can see if you may qualify for this phase 3 clinical trial.

Dr. Scott Hacker is a Sports Medicine Orthopedic Surgeon in San Diego, CA, Team Surgeon to the US Olympic Team. He specializes in sports medicine and sports injuries, knee and shoulder surgery.

If you have questions about cartilage injuries, or have a cartilage injury, please feel free to contact me at Ask Dr. Hacker or through my office.

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