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Flowchart

Options for management of joint cartilage damage

Focal pathology, eg osteochondritis dissecans or avascular necrosis

NAMIC

Traumatic incident

Intervention

re-surfacing

Direct blow with focal cartilage damage

Intervention

Total knee replacement

Focal cartilage defect

visco supplementation

Badly-aligned bone break, meniscus incompetence

Cartilage fraying limited to one side

Bone exposure limited to one side

Normal gradual age-related joint deterioration

unloader brace

meniscus transplant

Gradual cartilage softening on both sides

Deterioration spreads to involve both sides

Painful generalised arthritis

Gradual but generalised cartilage fraying

Intervention

steroid injections

Gradual but generalised exposure of bone

Alteration of forces going through knee

Cartilage softening limited to one side

Normal forces going through knee

corrective orthotics

No intervention

re-alignment osteotomy

partial knee replacement

Intervention

Intervention

OATS

focal implant

stem cell injections

Intervention

sorborubber heels

walking cane

ACI, MACI

anti-inflammatory

microfracture,
nanofracture