Is it a cartilage defect or a worn joint?

What is an osteochondral defect?

A chondral defect is one damaged area in the smooth cartilage cover. An osteochondral defect reaches into the bone right under that cartilage.

Either one may follow an injury or a loose bit of tissue. The words describe what was seen, but they don't prove what's causing your soreness.

I'd ask where the defect sits and whether it matches the tender area. Ask if nearby cartilage, bone, and the meniscus still look sound.

How does ordinary joint wear feel different?

Wear from arthritis often affects more than one part of the joint. You may feel stiff after rest, sore after a long walk, or swollen later.

The ache may be broad instead of tied to one exact movement. Still, you can't sort out the likely cause without an exam and weight-bearing X-ray.

Age doesn't settle the question by itself, and neither does an old injury. What you feel must make sense beside the exam and images.

What facts matter at a visit?

Tell your clinician where the soreness starts and which movement brings it on. Mention any catching, locking, swelling, or trouble fully straightening the joint.

Ask whether the damage is narrow, deep, stable, and surrounded by healthier cartilage. Those details affect whether watching it, building strength, or discussing surgery makes sense.

A finding that causes no matching trouble may only need watching for now. But new locking, giving way, or fast swelling deserves another look.

Sources

1. In a meta-analysis of 63 studies covering 5,397 knees of 4,751 adults with NO symptoms and no injury, the pooled prevalence of cartilage defects on MRI was 24% (95% CI 15% to 34%), rising from 11% in adults under 40 to 43% in adults aged 40 and over. Meniscal tears were present in 10%, bone marrow lesions in 18% and osteophytes in 25%.

   Culvenor AG, et al. — Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.. Br J Sports Med, 2019. DOI: 10.1136/bjsports-2018-099257.

2. A review of 31,516 knee arthroscopies documented 53,569 hyaline cartilage lesions in 19,827 patients. Grade III lesions of the patella were the most common and grade IV lesions were predominantly on the medial femoral condyle. Patients under 40 with a grade IV lesion made up 5% of all arthroscopies, 74% of them with a single chondral lesion.

   Curl WW, et al. — Cartilage injuries: a review of 31,516 knee arthroscopies.. Arthroscopy, 1997. DOI: 10.1016/s0749-8063(97)90124-9.

3. In 25,124 knee arthroscopies performed over 15 years, chondral lesions were found in 60% of patients. Of the documented lesions, 67% were localized focal chondral or osteochondral lesions, 29% were osteoarthritis and 2% osteochondritis dissecans. Patients with one to three localized grade III-IV lesions under age 40 - the classic cartilage repair candidate - were 7% of all patients, rising to 9% under age 50.

   Widuchowski W, et al. — Articular cartilage defects: study of 25,124 knee arthroscopies.. Knee, 2007. DOI: 10.1016/j.knee.2007.02.001.

4. Among 993 consecutive knee arthroscopies (median age 35), articular cartilage pathology was present in 66% of knees, a localized defect in 20%, and a localized FULL-THICKNESS (ICRS grade 3-4) lesion in 11%. Of those full-thickness lesions, 55% - about 6% of all knees - measured more than 2 cm2, the threshold at which the treatment algorithm changes.

   Arøen A, et al. — Articular cartilage lesions in 993 consecutive knee arthroscopies.. Am J Sports Med, 2004. DOI: 10.1177/0363546503259345.

5. In 51 patients whose Outerbridge grade 3 or 4 chondral lesion (mean size 2.1 cm2) was found incidentally during ACL reconstruction and deliberately left untreated, outcomes at 10 and 15 years were not statistically different from matched ACL-only controls on Lysholm, Tegner or IKDC objective scores. At 10 years the subjective IKDC was modestly lower in the defect group (79.6 versus 83.7 points); by 15 years even that difference had gone.

   Widuchowski W, et al. — Untreated asymptomatic deep cartilage lesions associated with anterior cruciate ligament injury: results at 10- and 15-year follow-up.. Am J Sports Med, 2009. DOI: 10.1177/0363546508328104.