Does worn knee cartilage grow back?

Key points in 30 seconds

1. Worn cartilage doesn't grow back to how it was. How much it hurts can change.
2. How worn it looks on images and how much it hurts don't go hand in hand.
3. Losing thigh muscle makes it hurt more — breaking this loop is the key.
4. Going down (stairs, hiking downhill) puts more strain on the knee.
5. If pain keeps you up at night or the distance you can walk keeps shrinking, we recommend seeing an orthopedic doctor.

What we often hear

• "I was told my cartilage is worn."
• "They said it won't grow back. Is there nothing I can do?"
• "The inside of my knee aches."

Does worn knee cartilage grow back?

Worn cartilage doesn't grow back to how it was. But how much it hurts and how far you can walk can change. It's honest to talk about these two separately.

We won't use the phrase "we'll regenerate your cartilage." Instead, we'll tell you what can change.

Does the amount of cartilage wear match the amount of pain?

They don't go hand in hand. Some people do well even though their images show a lot of wear, and some people are in a lot of pain with only a little wear.

Pain comes less from the cartilage itself and more from inflammation around it, a stiff joint capsule, and weakened muscles. These are things we can work on.

So there's no need to lose heart over imaging results alone. On the other hand, we don't brush off pain just because the images look fine.

What do you do?

While treating the inflammation and pain, we bring back the muscles that support the knee. We also look at reducing the weight on the knee.

The muscles at the front of the thigh support the knee. If you don't use them because of pain, they waste away, and when they waste away, it hurts more. Breaking this loop is the key.

Exercise starts with holding rather than bending and straightening the knee. For example, sit with your knee straight and just tense and relax your thigh. You can do this without pain.

Because it's a weight-bearing joint, losing weight reduces the load too. But we also know this isn't easy for someone whose knees hurt so much they can hardly move.

What about stairs and hiking?

Going down is harder on the knees. The force on the knee gets bigger especially when going down stairs and coming down a mountain.

That doesn't mean you have to stop completely. But during painful periods, it's better to cut back on going downhill and switch to things that put less weight on the knees, such as walking on flat ground or cycling.

When should I think about surgery?

If pain keeps you from sleeping at night, your legs are visibly bowing more, or the distance you can walk keeps shrinking so daily life becomes hard, we recommend seeing an orthopedic doctor.

Putting off surgery isn't always good. If things don't start heading in the right direction after a few months of our treatment, we'll tell you so.

What are the limits of this assessment?

What we work on is pain and function, not reversing structure that has already worn down.

One more note. Part of it progresses with age, so care needs to continue even after you get better. We're telling you in advance that this isn't the kind of thing that ends with one round of treatment.

We don't say we can bring cartilage back. But there are definitely ways to use that knee so it wears less.

If you gave up after being told your cartilage is worn, come see us. We'll start with what can be protected in your current condition.

Results differ from person to person depending on how worn the knee is and muscle strength.