Knee Cartilage Restoration
Knee cartilage restoration covers a group of procedures — microfracture, osteochondral autograft transfer (OATS), and matrix-induced autologous chondrocyte implantation (MACI) — that repair isolated cartilage defects rather than treat widespread arthritis. These work best in younger, active patients with otherwise healthy knees. The goal is to fill the defect before the joint deteriorates further.
Find a Surgeon
Who Needs Knee Cartilage Restoration?
Good candidates are usually under 50, with a focal cartilage defect in a knee that is otherwise intact — no widespread arthritis, healthy menisci and ligaments, normal alignment, and a willingness to complete a long rehabilitation. Defect size guides technique: microfracture for smaller areas, OATS for mid-size defects, MACI for larger ones.
What to Expect
Recovery Timeline
Non-weight-bearing or very restricted weight bearing. A continuous passive motion machine is helpful. Range-of-motion exercises start early.
Progressive weight bearing. Stationary cycling and physical therapy.
Walking normally. Light jogging may start for microfracture patients — OATS and MACI patients wait longer.
Microfracture patients may be returning to sport. OATS and MACI patients are building toward it — typically at 12-18 months.
Full return to sport for MACI and OATS patients. Cartilage maturation continues up to 2 years.
Risks & Complications
- Failure to fill the defect with adequate cartilage (higher with microfracture)
- Graft failure or delamination (MACI/OATS)
- Donor site morbidity (OATS harvest site pain)
- Stiffness
- Infection (less than 1%)
- Need for repeat surgery or eventual knee replacement
Frequently Asked Questions
What is the difference between microfracture, OATS, and MACI?
Microfracture is the simplest: drill holes in the bone to trigger fibrocartilage growth. It works for small defects, but the repair tissue isn't true hyaline cartilage and can wear down over time. OATS transplants a real cartilage plug from a low-load area of the knee — better quality tissue, but limited by harvest size. MACI takes your own cartilage cells, grows them in a lab for 6-8 weeks, then implants them as a patch. Best tissue quality for larger defects, but it's a two-stage procedure and more expensive.
Who is a good candidate for cartilage restoration?
Patients under 50 with isolated defects in an otherwise healthy knee get the best results. Widespread arthritis, obesity, malalignment, and ligament instability all hurt outcomes and usually need to be addressed first.
Will cartilage restoration prevent knee replacement?
For well-selected patients, yes. Cartilage restoration can keep a joint functional for 10-15+ years in published studies. It won't cure underlying joint disease, but for true focal defects it can buy substantial time. Patients who eventually need knee replacement after cartilage surgery generally have comparable outcomes to those who went straight to replacement.
Find a surgeon for Knee Cartilage Restoration
Compare orthopaedic surgeons who perform this procedure.
Search surgeonsEstimated Cost
$10,000 - $50,000 (before insurance) depending on technique. Microfracture is least expensive; MACI is most expensive. Insurance coverage varies — MACI often requires pre-authorization.
Full cost breakdownRelated Specialty
Knee Specialists →Other Procedures
This information is for educational purposes only. Costs are estimates and vary by location, surgeon, and insurance. Always consult a qualified healthcare provider.