Q: I am a 20-year-old competitive gymnast. I have a serious hole in the left knee cartilage that needs repair. I'm wondering if my sex (female) and my sports participation in gymnastics are in my favor or against it for healing naturally versus having surgery.

A: Probably the biggest reason orthopedics has focused so much in the last 10 years on the repair and healing of cartilage defects is because of athletes like you. Athletes from all disciplines can be affected -- these injuries have been reported in wrestlers, soccer players, gymnasts, tennis players, and many others.

A seemingly small thing like a small hole in the knee cartilage can cause significant pain, symptoms, and disability. Left on its own without any surgical intervention, tiny defects in the cartilage might be able to fill in with scar tissue and smooth over with joint movement.

But anything bigger than that can remain a problem -- especially if there are alignment issues contributing to the wear and tear of the joint. There are several ways to repair these defects now. All involve making sure the knee has good alignment and balanced joint and muscular biomechanics.

Results from surgery don't seem to be influenced particularly by whether the athlete is male or female. Other factors such as age and location of the defect may be much more significant.

For example, younger athletes who have smaller (and fewer) lesions seem to do the best.
Smaller defects tended to have less degenerative wear and tear but the plug to fill those holes wasn't so tough. It's more difficult to harvest a small amount of cartilage and the smaller grafts are more fragile. The larger graft plugs are more stable making them easier to harvest and insert.

Location of the lesion can be another key risk factor for successful outcomes. Lesions located on the femoral condyles (large round knobs at the end of the femur (thighbone) seem to respond better than damage or defects to the patella (kneecap).

No matter how big the defect or its location, studies show that patient cooperation and compliance with the postoperative treatment is very important. Doing too much too soon and returning to practice and competition before your surgeon approves it can result in less than satisfactory results.

Reference: László Hangody, MD, PhD, et al. Clinical Experiences with Autologous Osteochondral Mosaicplasty in an Athletic Population. In The American Journal of Sports Medicine. June 2010. Vol. 38. No. 6. Pp. 1125-1133.