What's the best treatment for chondrolysis of the knee? I've been diagnosed with this problem and I'm searching for some solutions. It may be related to an ACL repair I had done two years ago.

Chondrolysis refers to the loss of articular cartilage, the smooth cartilage that allows the two joint surfaces to slide and glide against each other easily. Thinning of the cartilage narrows the joint space, putting more pressure on the joint and causing painful symptoms that eventually lead to joint arthritis.

With chondrolyis of the knee, the cartilage can be fragmented in one or all three compartments of the knee. That includes the top and bottom and both sides (medial and lateral) of the femur (thigh bone), tibia (lower leg bone), and patella (kneecap). The cartilage may be worn down partially or all the way to the bone in all three areas. Full-thickness chondrolysis is the precursor to joint degeneration leading to arthritis.

Treatment isn't always successful in stopping the degenerative process. It may depend on what caused the problem in the first place. There are some reports that have linked the use of a pain-pump after ACL surgery to chondrolysis. Evidently, the drug contains a numbing agent called bupivacaine that is toxic to the chondrocytes (cartilage cells). Not only does it kill these cells, it also keeps the joint from forming new chondrocytes to replace the damaged ones.

Depending on how severe the problem is, conservative care may be the first line of treatment. Rest, steroid injections, microfracture, activity modification, and the use of antiinflammatories are often tried. Some patients are encouraged to manage their symptoms for as long as possible before eventually having a total knee replacement. Viscosupplementation (injection of a slippery fluid into the joint) may be helpful for some patients with chondrolysis but it has not been shown effective with chondrolysis linked with pain pump use.

Successful treatment options for bupivacaine-induced chondrolysis are limited at the present time. There is a need for further research in this area. Your surgeon will be able to best advise you what steps to take and what course of action might be the most successful in your case.