Common cartilage problems we treat
- Pain that limits walking, lifting, or sleep
- Stiffness, swelling, or reduced range of motion
- Sports injuries: acute or overuse
- Arthritis or post-traumatic joint changes
- Conditions other doctors couldn't resolve
Cartilage Reconstruction for Damaged Joints
When trauma or early arthritis damages the cartilage in your knee, hip, or ankle, joint-preserving cartilage reconstruction can rebuild the surface, keeping your natural joint and delaying replacement. LAOSS surgeons offer the full spectrum, from microfracture to autologous cell-based MACI.
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Board-certified surgeons and podiatrists across eight Los Angeles area neighborhoods.
Book a visitOr call (323) 264-7600
What sets LAOSS apart
- Same- or next-day appointments at eight Los Angeles-area offices
- On-site imaging; PT coordinated with your in-network provider
- Conservative-first care, surgery only when needed
- Board-certified specialists, not generalists
Key takeaways
- Cartilage reconstruction is joint-preserving surgery (microfracture, MACI, OATS, and osteochondral allograft) that rebuilds the cartilage surface instead of replacing the whole joint.
- Best suited for younger, active patients (typically 20 to 50) with focal cartilage damage from sports injury, osteochondritis dissecans (OCD), or post-traumatic lesions, not widespread arthritis.
- Some procedures are done arthroscopically; others need a small open incision. The right technique depends on lesion size, depth, location, and your activity goals.
- Recovery runs 4 to 12 months; return to running is usually around month 4, contact sports around months 9 to 12. Same-day evaluation available at all eight LAOSS offices.
What is cartilage reconstruction?
Cartilage reconstruction is a category of joint-preserving surgery that rebuilds damaged cartilage instead of replacing the whole joint. When the smooth articular surface inside a joint is lost (from a sports injury, a fall, osteochondritis dissecans (OCD), or an early-stage focal arthritis lesion), LAOSS surgeons can often restore that surface and keep your own joint working.
The four techniques we use most are microfracture (drilling tiny holes to recruit healing cells), MACI (Matrix-Induced Autologous Chondrocyte Implantation: your own cartilage cells grown in a lab and re-implanted), OATS (Osteochondral Autograft Transfer: moving a small plug of healthy cartilage-and-bone from a non-weight-bearing area), and osteochondral allograft (a matched donor graft for larger defects). Most are performed in the knee, but the same principles apply to the ankle, shoulder, and hip.
This is a different conversation than knee replacement. Cartilage reconstruction is for focal damage in a joint that's otherwise healthy: typically active patients in their 20s, 30s, and 40s who want to stay running, hiking, lifting, or playing for another two or three decades before a replacement is ever on the table.
Watch: Autologous Chondrocyte Implantation (ACI)
This repairs your knee's damaged articular cartilage. That's the cartilage covering and protecting the ends of your bones. Repairing it helps you stay active. This surgery is done with two procedures. They are performed weeks apart.
Inside the cartilage.
Articular cartilage is the slick white surface that lets bone glide on bone. It has no blood supply of its own, which is why it heals poorly when injured. Reconstruction techniques work around that limitation, by recruiting marrow cells (microfracture), transplanting healthy tissue (OATS, allograft), or growing your own cartilage cells outside the body and putting them back (MACI). The right choice depends on lesion size, depth, location, and your activity level.
Common reasons we do cartilage reconstruction.
Common symptoms
- Focal articular cartilage defect on MRI
- Osteochondritis dissecans (OCD) lesion
- Traumatic chondral or osteochondral injury
- Early focal arthritis in a young active patient
- Loose body or unstable cartilage flap in the joint
- Chondromalacia patella that has progressed to full-thickness damage
- Failed prior cartilage procedure
- Mechanical symptoms: catching, locking, or giving way
Common causes
- Acute sports injuries: pivoting, landing, or direct impact to the joint
- Untreated ACL or meniscus tear that overloaded the cartilage
- Osteochondritis dissecans, often in adolescence or early adulthood
- Repetitive high-impact loading from running, jumping, or contact sports
- Conservative care (PT, injections, activity modification) that didn't resolve symptoms
How we diagnose cartilage damage
Cartilage injuries are hard to read from the outside. The joint may swell, catch, or hurt after activity, but the damage itself is invisible without the right imaging, which is why an accurate diagnosis is the gating step before any reconstruction decision.
At LAOSS your first visit includes a focused history (mechanism of injury, prior procedures, activity goals), a hands-on joint exam, and same-day X-ray to rule out bony causes. When a cartilage lesion is suspected, we order an MRI with cartilage-specific sequences; this is what tells us the size, depth, and exact location of the defect, and whether the underlying bone is involved.
Most patients leave the first visit with a diagnosis, a candid read on whether they're a surgical candidate, and a plan, not just another referral. Set up your evaluation to get a clear answer about your joint.
Cartilage procedures performed by our surgeons
Not every cartilage injury needs surgery. Many patients do well with conservative care, and even when reconstruction is the right call, the specific technique depends on the size and location of the defect. Here's the full menu, and the criteria we use to choose between them.
Conservative care
Step 1Conservative care first
For smaller lesions, recent-onset symptoms, or patients who aren't yet surgical candidates, we start here.
- Activity modification (offloading the joint while it calms down)
- Physical therapy: quadriceps and hip strengthening, neuromuscular control
- Anti-inflammatory medication and a structured icing protocol
- Corticosteroid injection for short-term symptom relief
- Viscosupplementation (hyaluronic acid gel injection)
- PRP (platelet-rich plasma) injection for biologic support
- Unloader bracing for medial- or lateral-compartment damage
Surgical care
When neededSurgical reconstruction techniques
When conservative care plateaus and the MRI shows a clear focal defect, we match the technique to the lesion.
- Microfracture: small (<2 cm²) defects, lower-demand patients, day-surgery option
- MACI (Matrix-Induced Autologous Chondrocyte Implantation): medium-to-large defects (2 to 10 cm²), two-stage procedure, durable for active patients
- OATS (Osteochondral Autograft Transfer): small-to-medium defects with bone involvement, single-stage, uses your own tissue
- Osteochondral allograft: large defects (>2.5 cm²), salvage cases, donor graft
- Concurrent procedures: meniscus repair, ligament reconstruction, or osteotomy to correct alignment and protect the new cartilage
Why experience matters.
Why experience matters
Cartilage reconstruction is one of the most technique-dependent procedures in orthopedics. The surgeon's case volume, lesion-matching judgment, and arthroscopic skill drive the durability of the repair.
- Lesion-by-lesion matching of technique to defect size, depth, and location
- Arthroscopic precision honed across hundreds of cartilage cases
- Concurrent management of meniscus, ligament, and alignment issues
- MRI interpretation and surgical planning done by your surgeon, not handed off
The LAOSS approach
Joint preservation is a long game. We start with the least-invasive option that has a real chance of working, escalate only when it doesn't, and plan every surgery around protecting your joint for the decades that come after it.
- Same-day imaging and MRI coordination at most offices
- PT coordinated in your insurance network from week one
- Board-certified surgeons performing the procedures themselves
- Direct access to your specialist between visits and through recovery
Am I a candidate?
Cartilage reconstruction works best for a specific profile: focal damage, healthy surrounding cartilage, an active patient who wants to keep their natural joint. If most of these match, an evaluation is the next step.
You may be a candidate if
These signs typically point toward an in-person evaluation with a cartilage specialist.
- You're between roughly 20 and 50 and want to delay or avoid joint replacement
- Imaging shows a focal cartilage defect rather than widespread arthritis
- Pain, catching, or swelling limits running, sports, or work
- Conservative care (PT, injections, activity modification) hasn't fully resolved symptoms
- Your joint is mechanically stable or any instability is correctable in the same operation
What evaluation includes
Your first visit is built to give you a real answer the same day, including a candid read on whether reconstruction fits your case.
- Detailed history: mechanism of injury, prior surgeries, activity goals
- Hands-on exam focused on the affected joint
- Same-day X-ray; MRI ordering with cartilage-specific protocol when needed
- Lesion-matched plan (microfracture vs. MACI vs. OATS vs. allograft)
- Clear timeline for recovery and return to your sport or job
ImportantSeek urgent evaluation for sudden severe joint pain after an injury, locking that won't release, rapid swelling, or any sign of infection (fever, increasing redness, or warmth at a surgical site).
Your cartilage reconstruction recovery roadmap.
Cartilage takes time to mature. The repair is fragile in the early weeks and gets stronger month by month, which is why protected loading and patient adherence are as important as the surgery itself.
- Weeks 0 to 6
Protected phase
Early on we protect the repair from compressive load while keeping the joint moving. The cartilage is still healing in. Pushing too hard now is the most common way to compromise the result.
- Protected weight-bearing per procedure (often crutches for 4 to 6 weeks)
- Continuous passive motion or daily ROM work to nourish the cartilage
- Brace per surgeon protocol; ice and elevation
- Quad activation and gentle hip strengthening from week one
- Weeks 6 to 16
Progressive rehabilitation
Load increases on a clear schedule. PT shifts from protection to rebuilding strength, balance, and confidence in the joint.
- Progressive weight-bearing and gait normalization
- Strengthening, proprioception, and neuromuscular control
- Stationary cycling, pool work, and elliptical added in
- Coordinated PT through your in-network provider
- Months 4 to 12
Return to activity
Light running typically returns around month 4; pivoting and contact sports closer to 9 to 12 months. We benchmark each milestone before clearing it.
- Return-to-run progression with functional testing
- Sport-specific drills before return-to-play clearance
- MRI check-in at one year for larger reconstructions
- Maintenance plan to protect the joint for the long run
Risks & considerations
What to weigh before you decide.
We talk through the risks and benefits with every patient. Informed consent is a conversation, not a form.
General considerations
Every orthopedic operation carries a small set of standard risks. We screen, prepare, and monitor for these on every patient.
- Infection (rare with modern technique and prophylaxis)
- Bleeding, swelling, or bruising at the surgical site
- Reaction to anesthesia or medications
- Blood clot risk; managed with movement and prophylaxis as needed
Cartilage-specific considerations
Cartilage reconstruction has its own profile of risks tied to how the repair heals. These are part of every pre-op conversation.
- Stiffness from prolonged protected weight-bearing, managed with structured PT
- Incomplete cartilage fill or repair that doesn't fully take
- Need for a follow-up procedure in a small percentage of cases
- Graft-site discomfort with OATS; donor matching delay with allograft
- Two-stage timeline with MACI (biopsy, then implantation weeks later)
Meet the cartilage specialists at LAOSS
Cartilage reconstruction sits at the intersection of sports medicine and joint preservation. At LAOSS, you'll work with board-certified surgeons who do this work routinely, matching technique to lesion, coordinating PT through recovery, and planning every procedure around protecting your natural joint for the long run.
Meet your cartilage specialists.
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Accepting new patients
David Barba, MD
Hip & Knee Surgeon
Speaks English and Spanish
Habla español
- Wilshire
- East Los Angeles
Common cartilage reconstruction questions
- Knee replacement removes the joint surfaces and replaces them with metal and plastic implants; it's used for advanced, widespread arthritis. Cartilage reconstruction preserves your natural joint by rebuilding a small, defined area of damage. It's intended for younger, active patients with focal cartilage loss in an otherwise healthy joint, with the goal of delaying or avoiding replacement entirely.
Don't wait on pain.
Book a visit with a cartilage reconstruction specialist at any of our eight Los Angeles-area offices.
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Greater Los Angeles
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