Patient question

My surgeon says I need cartilage surgery and an osteotomy or ACL repair at the same time. Why?

Dr. Pablo GelberOrthopaedic Knee Surgeon

Quick answer

A cartilage repair only lasts if the knee around it is stable and evenly loaded. If a bowed leg, a torn ACL, a missing meniscus or an unstable kneecap caused the damage, fixing the cartilage alone leaves the same force working against it, explains Dr. Pablo Gelber, knee surgeon at Aman Hospital in Doha.

Treating the cause as well as the hole

Think of the cartilage defect as the result and the underlying problem as the cause. Repair tissue is fragile while it matures, and it is placed in the same spot that has already failed under load. Correcting the cause gives it a fair chance.

Common combinations

Osteotomy (realignment): a bow-legged or knock-kneed alignment overloads one side; cutting and realigning the bone shifts weight towards the healthier side
ACL reconstruction: an unstable knee keeps shifting and shearing the surfaces, damaging both the repair and the meniscus
Meniscus repair or, in selected cases, meniscus transplant: the meniscus spreads load, and without it the cartilage takes concentrated pressure
Kneecap stabilisation, such as MPFL reconstruction or a tibial tubercle procedure: repairs behind the kneecap fail if the kneecap keeps slipping or tracking off-centre

One operation or two?

Many combinations can be done in a single operation, which means one anaesthetic and one rehabilitation. Sometimes it is safer to stage them, for example when stiffness is a concern or a two-stage cartilage technique is used. Meniscus transplant and some grafts depend on tissue availability, which varies. Recovery after combined surgery follows the slowest component, usually the cartilage.

Questions worth asking at your consultation

Ask what caused the defect, what would happen if only the cartilage were treated, whether the procedures will be done together or in stages, and how the recovery plan changes. At Aman Hospital in Doha, Dr. Gelber shows you the scan and X-ray findings so you can see why each part of the plan is recommended.

Frequently asked questions

Is an osteotomy a big operation?

It is more involved than an arthroscopy, and it usually adds a period of protected weight-bearing while the bone heals, typically several weeks. It can protect the cartilage repair and delay arthritis in suitable patients.

Can I have the cartilage repair now and the ligament later?

Sometimes, but leaving an unstable knee untreated exposes the repair to the same forces. Your surgeon will explain the order that gives the knee the most protection, which is often doing both together.