Minor cartilage damage may improve on its own within a few weeks, but more severe damage will often require surgery.

Initial treatment and self care

If you've injured your joint and your symptoms are not too severe – for example, you're still able to put weight on and move the joint – you can often look after yourself using PRICE therapy.

PRICE stands for:

• Protection – protect the affected area from further injury by using a support, such as a knee brace
• Rest – rest the affected joint as much as possible during the first 2 or 3 days (crutches may help if you've injured your knee or ankle), then try gradually returning to light activity over the next few days and weeks
• Ice – apply an ice pack or a bag of frozen vegetables wrapped in a towel to the injured area for 15-20 minutes every 2-3 hours during the first 2 or 3 days
• Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further; you can use a simple elastic bandage or an elasticated tubular bandage available from a pharmacy
• Elevation – keep the injured area raised and supported on a pillow whenever you can to help reduce swelling

If your joint is painful, take ordinary painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Visit your GP if your symptoms have not started to improve after a few days of PRICE therapy.

Physiotherapy

Physiotherapy can be helpful if you have difficulty moving the affected joint. Your GP may be able to refer you to a physiotherapist, or you may choose to pay for private treatment.

A physiotherapist can teach you exercises to help strengthen the muscles surrounding or supporting your joint. This may help reduce pain and pressure on the joint.

Physiotherapy can also be useful when you're recovering from the surgical procedures described below.

Surgery

Severe cartilage damage does not tend to heal very well on its own, so surgery is often necessary in these cases.

Surgery is usually performed using arthroscopy – a type of keyhole surgery where instruments are inserted into the joint through small cuts (incisions) – although sometimes larger incisions need to be made.

It's normally carried out under general anaesthetic, where you're asleep.

Some of the main procedures are:

• lavage and debridement – the joint is cleaned out to remove any loose tissue, and the edges of the damaged area are trimmed to make them smooth; it may sometimes be possible to repair the damage at the same time
• marrow stimulation (microfracture) – tiny holes are made in the bone beneath the damaged cartilage, which releases bone marrow into it; the marrow cells then begin to stimulate the production of new cartilage
• mosaicplasty – small plugs of healthy cartilage from non-weightbearing areas of a joint, such as the side of the knee, are removed and used to replace small areas of damaged cartilage
• osteotomy – the alignment of the leg is altered slightly to reduce pressure on the damaged area and improve pain; this usually involves adding or removing a wedge of bone from the shin or thigh bone, and the bone is fixed with a plate until it heals
• joint replacement – replacing the whole joint with an artificial joint, such as a knee replacement or hip replacement, is occasionally necessary if the damage is particularly severe

Talk to your surgeon about which type of surgery they think is best for you, what the possible risks are, and how long they expect it will take you to recover.

You'll usually need to take things easy for at least a few weeks after surgery, and you may not be able to return to strenuous activities and sports for several months.

Less common surgical procedures

There are also a number of alternative surgical techniques sometimes used to treat cartilage damage, including:

• allograft osteochondral transplantation (AOT) – similar to mosaicplasty, but the replacement cartilage is obtained from a recently deceased donor, and is used to repair larger damaged areas
• autologous chondrocyte implantation (ACI) – the surgeon first takes a small sample of cartilage cells from the joint; these are then used to grow more cells in a laboratory and the new cells are used to replace the damaged cartilage
• artificial scaffolds – a special patch or gel is used to repair the damaged cartilage; it may be used in combination with marrow stimulation or on its own

These procedures are only carried out in a few hospitals in the UK and are not routinely provided on the NHS. You may be able to pay for them privately, but they can be very expensive.

For more information about autologous chondrocyte implantation see:

• NICE guidance: autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee
• NICE guidance: autologous chondrocyte implantation using chondrosphere for treating symptomatic articular cartilage defects of the knee