Millions of people in Germany suffer from cartilage wear – the editorial team of the Leading Medicine Guide spoke with Prof. Dr. Wachowski about modern cartilage therapies.
Cartilage damage is among the most common joint disorders and can significantly restrict mobility and quality of life. Modern therapeutic approaches aim to promote natural cartilage regeneration and alleviate long-term symptoms. Thanks to new scientific insights and innovative treatment methods, patients today have better chances of achieving sustainable restoration of joint cartilage.
The main causes of cartilage damage are diverse and often arise from a combination of mechanical stress, injuries, and degenerative processes.
„Cartilage damage can have different causes. In many cases, it develops spontaneously, meaning genetically determined, due to early wear in specific areas of the joint that are either overloaded or subjected to uneven strain. A common cause is also improper loading due to misalignment, such as in people with bow legs or knock knees, which increases pressure on the inner or outer side of the joint and leads to wear and cartilage damage over time. There are also trauma-related causes, such as a blow, a dislocated kneecap, traffic accidents, or other external forces. We differentiate between diffuse damage and focal injuries in otherwise healthy joints“, explains Prof. Dr. Wachowski at the beginning of our conversation, and adds:
„Many people also wonder whether athletic overuse, such as strength training or incorrect movement patterns, can harm cartilage over the long term. Often, people assume that load is inherently damaging, but that is not entirely correct. When load occurs consistently and over many years, the tissue typically adapts, and no damage results. Of course, extreme load, such as heavy physical labor like tiling, can be more problematic. In sports, however, especially in consistent, controlled training without sudden overload, the risk of cartilage damage is relatively low. There is even an interesting study from Nepal involving porters who carry heavy loads daily. Despite extreme physical work, these individuals have very few joint issues because the load is constant. This shows that continuous, even loading is more beneficial, whereas sudden overload or abrupt changes in stress can be damaging. The key is to increase and reduce load gradually in order to avoid overuse“.
The symptoms of cartilage damage usually develop gradually but may also appear suddenly. Typical symptoms include pain during movement, especially after extended periods of rest (known as start-up pain), as well as pain during load-bearing or specific motion patterns. Sometimes patients experience a „grinding sensation“ in the joint, joint noises, or catching sensations. Many also report a feeling of instability or insecurity in the joint during sports or walking. Particularly with progressive wear, swelling, restricted mobility, pinching sensations, or stiffness may develop. In advanced stages, joint inflammation may occur, worsening symptoms. Over time and without adequate treatment, additional problems such as cartilage abrasion, loss of joint cartilage, and the development of osteoarthritis may arise. 
Diagnosing cartilage damage is indeed challenging because symptoms can present very differently.
„Right from the first impression and during the medical history, meaning the patient’s report of symptoms, it becomes clear that cartilage damage is a true chameleon. Symptoms may fluctuate, sometimes more pronounced and sometimes less. There may be swelling in the joint that later disappears, or a symptom-free period. Unlike cruciate ligament or meniscus tears, which usually present very typical symptoms, cartilage damage often does not. Symptoms are more diffuse and variable. In advanced cases, X-rays may show indirect signs, such as narrowing of the joint space, indicating significant cartilage loss. After injuries where cartilage or bone fragments have broken off, something may also be visible on X-rays. However, MRI is essential for a reliable diagnosis. It is the most important tool for identifying cartilage damage and assessing the exact extent of the injury. Without MRI, it is nearly impossible to make the right treatment decision“, emphasizes Prof. Dr. Wachowski.
Conservative treatment is usually sufficient when cartilage damage is minor, superficial, and not yet causing significant limitations in mobility or severe pain.
Regarding this, Prof. Dr. Wachowski explains: „Whether a conservative approach is sufficient depends largely on the extent of the damage. We differentiate between partial-thickness damage, such as diffuse thinning, and full-thickness defects where the entire cartilage layer or even the underlying bone is affected. For less pronounced, diffuse damage, conservative therapy is often recommended. Especially in younger patients, it is important to examine the cause, such as alignment issues (bow legs or knock knees), which can lead to ongoing overload and progression of the injury. In such cases, correcting the misalignment may be beneficial to reduce stress and slow progression. For well-defined full-thickness defects, surgical treatment such as cartilage repair may be appropriate“, and continues:
„Regarding conservative therapy, hyaluronic acid injections are primarily a symptomatic measure, especially for diffuse damage. They offer temporary relief by improving lubrication and reducing irritation, but they do not eliminate the underlying defect and only work short-term. Symptom relief is typically the goal. Patient involvement is also important: physical activities such as cycling, swimming, joint-friendly sports, or Nordic walking can help reduce symptoms because movement keeps the joint healthy and improves perceived pain. There are also supplements like oral hyaluronic acid, collagen, or oyster shell calcium. However, scientific evidence for their effectiveness is inconclusive, so insurance providers generally do not cover them. Patients who wish to try them may do so, as they are generally harmless, but their benefit is uncertain. Social media currently promotes supplements like collagen or creatine heavily, but investing in a gym membership for regular and targeted training is often far more beneficial. You usually achieve much more with exercise than with expensive tablets“.
However, if symptoms persist despite conservative measures, worsen, or the defect enlarges, surgical cartilage therapy should be considered. Especially in cases involving significant limitations in movement, catching sensations, or recurrent joint inflammation, early surgical treatment is advisable to prevent further deterioration, such as developing osteoarthritis.
Cartilage therapies are especially suitable for patients with limited cartilage damage, meaning small to medium-sized defects where natural joint movement is still largely preserved.
A wide range of modern procedures is available today for treating cartilage damage, all aimed at targeted regeneration of cartilage-like tissue and significantly improved healing potential.
„When discussing cartilage reconstruction, it is important to clarify whether we are truly talking about restoring or regenerating cartilage tissue. Generally speaking, actual cartilage regeneration is only possible where no cartilage remains. If cartilage thickness is reduced by, for example, 50 percent, conservative or surgical measures cannot restore the original full cartilage layer. In large full-thickness defects, where even bone is exposed, surgical techniques can stimulate new cartilage growth. These techniques include microfracture, where during arthroscopy, the remaining cartilage layer is removed to expose bone. Small holes are then drilled into the bone, allowing blood to emerge and form a cartilage substitute. However, this tissue is inferior fibrocartilage, offering only short- to medium-term relief. For small, low-load defects, this may be sufficient. For larger defects, additional techniques exist, such as the use of an acellular matrix, where a resorbable membrane is placed over or into the defect to isolate stem cells and promote better regeneration. This approach is suitable for defects up to about five square centimeters. Another technique is minced cartilage, a one-step cartilage transplantation in which healthy cartilage is harvested from a non-weight-bearing area of the joint, minced, and implanted into the defect. This method is relatively new, with limited research, but results so far are promising, especially for medium-sized defects between 2.5 and 4 square centimeters. For defects larger than 5 square centimeters, classical autologous chondrocyte implantation is used. Cartilage cells are harvested, cultured in a laboratory, and re-implanted weeks later in a second procedure. This technique is well-studied but labor-intensive and requires a longer recovery period. True regeneration is only possible in small to medium defects; for extensive damage, reconstruction is typically achievable only surgically“, explains Prof. Dr. Wachowski, and describes the healing phase for patients:
„During the healing phase after cartilage or joint surgery, patients typically require crutches for six to eight weeks. During this period, the knee, for example after kneecap surgery, often must not be fully bent to avoid disrupting the healing process. After this phase, load-bearing is gradually increased, including the gradual return to sports activities. Activities involving frequent stop-and-go movements can typically be resumed at the earliest nine to twelve months after surgery. For patients already suffering from osteoarthritis, the situation is different, as arthritic changes affect the entire joint and significantly impair or prevent cartilage regeneration. The arthritic environment contains inflammatory and signaling substances that greatly limit the joint’s regenerative capacity. Therefore, cartilage-regenerating techniques are usually not effective in osteoarthritis. For younger osteoarthritis patients without extensive damage, correcting leg alignment can be useful to reduce joint loading. In cases of advanced extensive damage, various types of joint replacement are considered. These include individually customized implants, partial replacements for specific joint compartments, and ultimately total knee resurfacing. These procedures range from small specialized implants to more complex prostheses to restore joint function and relieve pain“.
In general, cartilage therapies do not carry significant risks or side effects beyond the usual surgical risks. Most procedures use the patient’s own tissue, which nearly eliminates the risk of allergic reactions.
„The only external process involved is the laboratory cultivation of the patient’s own cartilage tissue for transplantation. These are routine procedures with standard surgical risks such as infection, bleeding, or wound-healing problems. The primary risk is treatment failure, meaning the therapy does not produce lasting success. While uncommon, it is important to inform patients about this. Even with successful treatment, a cartilage defect still predisposes the joint to early wear, meaning that even a well-executed therapy cannot entirely prevent ongoing degeneration“, says Prof. Dr. Wachowski, offering additional preventive advice:
„However, there are fundamental measures everyone can take to protect cartilage. Joint-friendly sports such as cycling are protective because they promote cartilage health through moderate loading, whereas activities involving frequent microtrauma, such as soccer or basketball, may cause long-term damage. Chronic overload from repeated microtrauma can lead to damage over the years. Therefore, it is essential to stay active and find the right balance between loading and rest. If high-impact sports are especially important to someone, they should be balanced with joint-friendly activities. This helps keep the joint in good condition and improves tolerance to stress. Active movement is always better than complete inactivity“.
The practice DUO - Duderstadt Trauma Surgery and Orthopedics stands out thanks to its complete range of treatment options.
„This begins with conservative measures such as consultation, physiotherapy, and physical therapy, which serve as the first steps toward improving mobility and reducing pain. Medications may also play a role, such as hyaluronic acid injections to reduce symptoms and relieve the joint. Orthopedic aids, such as offloading braces, can also be helpful, especially when certain joint compartments bear excessive load. These treatments can often preserve years of pain-free quality of life. If conservative approaches are insufficient, we offer the full spectrum of surgical options, ranging from minimally invasive arthroscopic procedures to open surgeries such as cartilage reconstruction, autologous chondrocyte implantation, and ultimately joint replacement. Even in advanced cases, alignment correction can sometimes improve joint loading. Our goal is to find the best individual solution for each patient, whether conservative or surgical, to maintain function and quality of life over the long term“.
Thank you very much, Professor Dr. Wachowski, for your insights into cartilage therapy procedures!
- Expert in Knee Surgery: Professor Dr. med. Martin Wachowski is considered one of Germany’s leading specialists in knee surgery, endoprosthetics, and sports orthopedics.
- DUO Practice in Duderstadt: A renowned practice known for innovative treatment methods and scientifically grounded approaches.
- Minimally Invasive Techniques: Use of keyhole surgical techniques and modern implants for rapid recovery and long-term joint regeneration.
- Complex Procedures: Application of advanced techniques such as ALL augmentation for revision ACL reconstructions and reconstruction of collateral ligaments.
- Scientific Contributions: Numerous publications, research projects, and development of physiological knee endoprostheses.
- Leadership at University Medical Center Göttingen: Former head of knee and shoulder surgery, supervising over twenty dissertations since 2006.
- Professional Engagement: Active member of national and international societies, including the German Society for Biomechanics and the German Knee Society.
- Teaching Awards and Events: Recipient of the University of Göttingen teaching award in 2015; speaker and organizer of lectures and academic events.
- Sports Medicine Expertise: Collaboration with professional and recreational athletes for injury treatment and optimization of training methods.
- Patient-Centered Care: Holistic approach with individualized consultation and comprehensive pre- and postoperative care.
- First Choice for Knee Problems: A trusted practice for patients with knee injuries, osteoarthritis, meniscus damage, and ligament issues.
