Cartilage Restoration Surgery Guide (2026)

Q: How long does restored cartilage last?

Studies show ACI/MACI results lasting 10-20+ years in appropriate candidates. Microfracture results tend to degrade after 5-7 years. Long-term success depends on patient selection and rehabilitation compliance.

Q: Is cartilage restoration covered by insurance?

MACI and ACI are FDA-approved and increasingly covered by insurance when medically necessary. Microfracture and OATS are standard covered procedures. Prior authorization is usually required.

Q: Can cartilage grow back?

Cartilage does not regenerate naturally. Cartilage restoration procedures stimulate new cartilage growth (microfracture produces fibrocartilage; ACI/MACI produce hyaline-like cartilage that is closer to normal).

What Is Cartilage Restoration?

Cartilage restoration refers to a group of surgical procedures that repair, regenerate, or replace damaged articular cartilage in the knee. Unlike bone, cartilage has very limited ability to heal on its own because it lacks blood supply. Left untreated, cartilage damage progressively worsens and can lead to arthritis and eventually the need for knee replacement. Cartilage restoration aims to delay or prevent knee replacement — especially important for younger, active patients.

Types of Cartilage Restoration

Microfracture: Small holes drilled into the bone beneath the cartilage defect to stimulate healing with fibrocartilage (scar cartilage). Best for small defects (<2 cm²). Quick procedure, 6-8 week recovery.

OATS (Osteochondral Autograft): Healthy cartilage plugs harvested from a non-weight-bearing area of your knee and transplanted to the damaged area. Best for small-to-medium defects. Single surgery.

ACI (Autologous Chondrocyte Implantation): Two-stage procedure. First, cartilage cells are harvested and grown in a lab for 4-6 weeks. Then, the expanded cells are implanted into the defect. Best for medium-to-large defects. Produces hyaline-like cartilage (closest to normal).

MACI (Matrix-Induced ACI): Modern version of ACI where cells are grown on a scaffold membrane, then implanted in a single surgical step. Currently the gold standard for larger cartilage defects.

Who Is a Candidate?

Ideal candidates for cartilage restoration are:
• Under 50 years old (younger patients have better healing)
• Isolated cartilage defect (not widespread arthritis)
• Healthy knee alignment and intact ligaments
• Active lifestyle with motivation for lengthy rehabilitation
• Failed conservative treatment (therapy, injections)

Cartilage restoration is NOT appropriate for advanced osteoarthritis affecting the entire joint — that requires knee replacement.

Recovery

Cartilage restoration has the longest recovery of any knee procedure:

• Weeks 1-6: Non-weight-bearing or partial weight bearing (crutches). Continuous passive motion (CPM) machine.
• Months 2-4: Progressive weight bearing, stationary bike, pool therapy.
• Months 4-6: Light jogging, strengthening exercises.
• Months 9-12: Return to full activity including sports.

Full cartilage maturation takes 12-18 months. Commitment to rehabilitation is critical for success.

Frequently Asked Questions

How long does restored cartilage last?

Studies show ACI/MACI results lasting 10-20+ years in appropriate candidates. Microfracture results tend to degrade after 5-7 years. Long-term success depends on patient selection and rehabilitation compliance.

Is cartilage restoration covered by insurance?

MACI and ACI are FDA-approved and increasingly covered by insurance when medically necessary. Microfracture and OATS are standard covered procedures. Prior authorization is usually required.

Can cartilage grow back?

Cartilage does not regenerate naturally. Cartilage restoration procedures stimulate new cartilage growth (microfracture produces fibrocartilage; ACI/MACI produce hyaline-like cartilage that is closer to normal).

Find Cartilage Restoration Surgeons

Search 45,377 knee surgeons across 50 states.

Find Knee Surgeons Browse All Procedures