What are the options for a gel or treatment to regrow cartilage in the knee without surgery?

Non-Surgical Cartilage Regeneration Options for the Knee

Currently, there are no FDA-approved non-surgical gel treatments specifically designed to regrow knee cartilage without surgery, and evidence for such treatments is inconclusive according to guidelines from the American Academy of Orthopaedic Surgeons. 1

Current Treatment Landscape

Non-Surgical Options

• Hyaluronic Acid Injections:

  • While hyaluronic acid injections (viscosupplementation) are used for osteoarthritis, they primarily provide symptom relief rather than regenerating cartilage 2
  • These injections may help with pain reduction and improved joint function but do not demonstrate significant cartilage regrowth

• Physical Therapy and Activity Modification:

  • Recommended as first-line approach for cartilage injuries, particularly in older patients with lower activity demands 1
  • Focuses on strengthening muscles around the knee and improving joint mechanics

Surgical Cartilage Repair Techniques

For patients with unsalvageable cartilage damage, several surgical techniques exist, though evidence for superiority of any specific technique is inconclusive 1:

• Microfracture: Creates small holes in subchondral bone to stimulate fibrocartilage formation
• Osteochondral Autograft Transfer (OAT): Transfers healthy cartilage from non-weight-bearing areas to damaged regions
• Autologous Chondrocyte Implantation: Harvests, cultures, and reimplants patient's own cartilage cells
• Osteochondral Allograft: Uses donor cartilage and bone to replace damaged areas

Research on Emerging Technologies

Research is ongoing for cartilage regeneration using hydrogels and tissue engineering approaches:

• Hydrogels: Being investigated as delivery vehicles for cells or growth factors to stimulate cartilage repair 3
• Tissue-Engineered Constructs: Combine biomaterials with cells to create cartilage-like tissue 4

However, these approaches remain experimental and are not yet approved for clinical use. Most studies have been conducted in animal models with varying results 3.

Clinical Decision Making

For patients seeking cartilage regeneration options:

1. Assessment of Cartilage Damage:

   • Radiographs (including AP, lateral, sunrise/Merchant, and tunnel views) are recommended for initial evaluation 1
   • MRI may be necessary to characterize the extent of cartilage damage 1

2. Treatment Selection Based on Lesion Characteristics:

   • Small lesions (<2 cm): If surgical intervention is needed, chondroplasty or osteochondral autograft transfer may be considered 5
   • Larger lesions: May require more extensive surgical approaches if non-surgical management fails 5

3. Patient Factors to Consider:

   • Age and activity level
   • Presence of associated injuries (meniscal, ligamentous)
   • Alignment issues
   • Functional limitations and pain severity

Monitoring and Follow-up

For patients with cartilage injuries who remain symptomatic after treatment, regular follow-up with history, physical examination, radiographs, and/or MRI is recommended to assess healing and prevent progression to severe osteoarthritis 1.

Limitations and Caveats

• The evidence for cartilage regeneration without surgery remains limited
• Many experimental approaches show promise in animal models but lack long-term human data
• Claims of cartilage regrowth from supplements or injections should be viewed with caution
• Total knee replacement remains the definitive treatment for end-stage osteoarthritis when non-surgical approaches fail 1

Bottom Line

While research continues in the field of cartilage regeneration, there is currently no proven non-surgical gel or treatment that can reliably regrow knee cartilage. Management should focus on symptom control, preventing further damage, and considering surgical options when appropriate based on the specific characteristics of the cartilage lesion and patient factors.