What Is Joint Preservation and Who Is It For?

Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 20, 2026

March 5, 2026

Joint preservation is about keeping your own knee for as long as possible by preventing arthritis from getting worse and, when we can, even reversing some of the damage.

I think about many of my patients as “young people with old knees.” They are not really candidates for knee replacement yet, but their pain and swelling are significant enough that ignoring it is no longer an option.

My husband, Dr. Andreas Gomoll, and I recently made a short video discussing joint preservation.

Transcript

Okay. >> So, joint preservation. >> So, um basically joint preservation is um a a phrase that talks about trying to preserve the knee. And usually what we're talking about is trying to prevent further arthritis or reverse it if we can. >> Yeah. In a way, young people with old knee is not really candidate for knee replacement, but enough pain that something needs to be done. >> And sometimes it's just a little defect. So, there's just sometimes a little piece of cartilage that's peeling away. And you can do something quite minor like a gel injection or you can do what's called a condroplasty where you arthoscopically go in and you just clean up the little flap and it can make the knee feel much better. Um often it stops the swelling but that's not enough for everybody. >> No, because sometimes the defects are bigger um and then you need to kind of fill them like you fill a pothole on a road hopefully just better. >> So you can fill them with something that's called cellbased treatment. So cellbased treatment is we go in, we do an arthoscopy. We take a little piece of cartilage size of a fingernail clipping and we send that to a lab and they can grow more cartilage from that >> and that's called Macy. Or we can do something called denovo where there's uh juvenile cells. So a a younger organ donor when we take their cells and we transplant it into the knee. And in both those cases, we're asking those cartilage cells to grow, which can take a long time, and >> it it worked pretty well, but it doesn't give you the cartilage that you started with. >> No, it it it comes fairly close. Nothing is perfect. And that's a little bit more like seeding grass. So truly something grows inside your knee, but then there are other options called osteocchondrial options. Either um taking a piece of cartilage and bone from you or from a donor. And >> when you take it from a donor, um we try to size match them. So we we're we're not taking um we want to match the anatomy as much as possible. And the nice thing about that is the cartilage is fully formed and cartilage um can live in another in somebody else's body. It doesn't it doesn't have rejection per se. It's not like a heart transplant where you have to take drugs to prevent rejection. Um but you do still have to have growth or bone ingrowth into that um that cartilage plug. >> And to uh stick with the landscaping analogies, that's a little bit more like sawing. So yeah, it still needs to kind of heal. The roots, quote unquote, the bone needs to heal, but at least it's fully grown cartilage. >> And then lastly, we have some new techniques, which we have cardial, which is coral, which we put into cartilage defects, and the body is pretty good at growing cartilage over [laughter] >> the dog bomb. Um, yeah, it it tries to help your body heal itself. >> It's way too

When Cartilage Damage Is Small

Sometimes the problem inside the knee is just a small defect, almost like a little flap of cartilage peeling away from the surface.

In those cases, we can often use relatively minor interventions such as a gel injection or an arthroscopic chondroplasty, where I go in with a camera and small instruments to gently clean up that flap so it no longer catches and causes swelling.

When Defects Are Larger

Larger cartilage defects behave less like a flap and more like a pothole in the road that really needs to be filled in properly.

To address those, we use cell-based treatments: during arthroscopy I take a tiny piece of your cartilage (about the size of a fingernail clipping), send it to a lab where they grow more cells, and then we place those cells back into the defect so they can grow, a bit like seeding new grass.

One approach is called MACI, which uses your own cells, and another is de novo, where juvenile cartilage cells from a younger organ donor are transplanted into your knee to encourage new cartilage growth.

Osteochondral Options

For some patients, an osteochondral approach is more appropriate, where we transplant a plug of cartilage and bone either from you (autograft) or from a donor (allograft).

When we use a donor graft, we carefully size-match it to your knee so the plug fits the defect as closely as possible, and one key advantage is that the cartilage is already fully formed and can survive in another person’s body without the type of rejection issues seen in a heart transplant, though the bone beneath still has to heal and grow in.

If seeding grass is a good analogy for cell-based treatments, osteochondral options are more like laying sod: the cartilage is already mature, but it needs time for the “roots” (the bone) to heal and integrate.

Newer Techniques: CartiHeal

We also have newer techniques such as CartiHeal, which uses a coral-based material placed into cartilage defects to act as a scaffold for your body to heal itself.

The body is actually quite good at working with cartilage when we give it the right environment, and implants like this aim to guide that healing process in a more predictable way.

If you have knee pain, swelling, or cartilage damage and have been told you are too young for a knee replacement, joint preservation may give you options that match the size and type of your defect rather than jumping straight to replacement.

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Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health.