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Flowchart

Options for management of joint cartilage damage

Focal pathology, eg osteochondritis dissecans or avascular necrosis

Traumatic incident

Direct blow with focal cartilage damage

Focal cartilage defect

Badly-aligned bone break, meniscus incompetence

Normal gradual age-related joint deterioration

Gradual cartilage softening on both sides

Gradual but generalised cartilage fraying

Gradual but generalised exposure of bone

Normal forces going through knee

No intervention

Intervention

OATS

focal implant

Intervention

sorborubber heels

walking cane

anti-inflammatory

visco supplementation

steroid injections

Alteration of forces going through knee

Cartilage softening limited to one side

Cartilage fraying limited to one side

Bone exposure limited to one side

Intervention

corrective orthotics

unloader brace

Intervention

re-alignment osteotomy

meniscus transplant

partial knee replacement

Intervention

Total knee replacement

Deterioration spreads to involve both sides

stem cell injections

re-surfacing

Painful generalised arthritis

Intervention

ACI, MACI

NAMIC

microfracture,
nanofracture