Does Cartilage Heal on Its Own?

By Chris Centeno, MD /

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cartilage healing

Whether or not cartilage heals on its own, according to a new study, depends on your age, and, unfortunately, that age may be much lower than we realized. We’ve known for a long time that the healing cells in our cartilage, such as our hip and knee joints, drastically decrease as we age, slowing or stopping the cartilage’s ability to self-heal. But cartilage also consists of collagen, the most abundant protein in our body, and this new study founds some stunning results related to collagen and cartilage healing.

New Study Shows Cartilage Doesn’t Self-Heal

During the new study, researchers looked at the knee-joint cartilage in 8 subjects with arthritis and 15 subjects with normal, healthy cartilage. Subject ages ranged from 18 to 76 years. Researchers concluded that “the collagen matrix of human cartilage is essentially permanent,” and there is no cartilage self-healing that takes place after the bones stop growing, which would be at some point in our teen years. Yes, you read that right—age 15 or 16 would be about the average age for bones to stop growing, so from that point on, there is no collagen regeneration in the cartilage. Your body, on its own, cannot regenerate the cartilage it loses in its adult years. To grasp this a bit better, you need to understand what cartilage is and what it is made of.

What Is Cartilage?

Cartilage is a firm, flexible, connective tissue that lives between our bones and protects, cushions, and absorbs shock from the joints. Cartilage allows our joints to move smoothly and without friction. It is the breakdown of this cartilage that defines the diagnosis of arthritis, and arthritis can occur in any joint in the body, such as the knee, the hip, the shoulder, the facet joints of the spine, even in the cartilage of our hand and foot joints.

The cartilage in a joint is made up of cartilage cells plus the collagen-rich extracellular matrix (ECM). Collagen is the main protein found in our connective tissues, which is fitting as its literal definition is “glue,” so it’s abundant in tissues in our body that connect, cushion, and hold things together: cartilage, ligaments, skin, bones, discs in our spine, muscles, tendons, and so on. Collagen comes in a variety of types depending on the body part it has been created for. The collagen of muscle, for example, is softer and more stretchy than that of cartilage, which is more firm and less stretchy. The ECM composition is essential to the task it has been created for. When cartilage becomes arthritic, it tends to have more of the collagen type (collagen X, or ten) that makes it too soft and less durable, making it less able to withstand normal wear-and-tear forces.

Regarding the collagen matrix being permanent, the author of the study above stated, “This finding has important implications for the tissue engineering and regenerative medicine fields, where the structural permanence of collagen will need to be contemplated when designing new cartilage repair strategies.”

Preventative Measures to Protect Your Cartilage

Unfortunately, every time you go for a walk or climb stairs or exercise, this puts wear and tear on cartilage, and cartilage cells and bits of the of the collagen matrix are lost. If our cartilage is truly unable to self-heal, as this study shows, how do we properly care for our joints? Is arthritis simply inevitable? Do we throw our hands in the air at the tender age of 16 or so, when our bones stop growing, and just accept the progressive decline of our joints? Of course not! We take preventative measures to protect the cartilage we have. Preventative measures include supplements, proper exercise, and exploring regenerative medicine approaches to treatment before a small problem becomes a huge one.

Supplements

High-quality supplements are a great way to protect the healthy cartilage you have and can also help with the pain and inflammation of arthritis as you age. High quality is the key term here, and I can’t emphasize enough how important this is. If you pull your supplements off the discount bulk-stock shelf at Costco, you might as well skip the purchase and flush your cash down the toilet. In the world of supplements, you really do get what you pay for. I’ve discussed these supplements many times in past posts. A few follow:

Exercise

Exercise and proper exercise techniques are also important, but the amount and level of exercise depends on the status of your joints. If your knees are bone on bone (no cartilage left), for example, high impact exercise can hurt your knees; however, if you have healthy cartilage, you should exercise regularly to keep your cartilage healthy. Running, for example, seems to have a protective effect on normal, healthy cartilage. If you have some cartilage loss, you can opt for low- or moderate-impact exercise, and switch from running to walking, as running in this case can cause more damage.

Regenerative Medicine

When treatment is needed due to arthritis or joint injuries, regenerative medicine focuses on nonsurgical options and treating the root cause of the issue (not just the issue itself). As continued advancements and recognition allows regenerative medicine to take a more prominent spot on the health-care stage, I suspect prevention will be a much bigger focus as we care for our joints. Maintaining our cartilage health proactively and intervening before a small problem becomes a huge problem will significantly limit the reactive and emergent orthopedic care—things like joint replacements and other invasive surgeries—that takes center stage in today’s traditional approach. In addition, given the amount of research that exists on cartilage repair and stem cells, it’s a safe bet that they will feature heavily in the new “repair before despair” mentality.

The upshot? The progressive decline of our joints after our bones have stopped growing isn’t “just nature,” so throwing your hands up and accepting it, especially based on one study, would be a big mistake. Our natural diet and activity levels have changed drastically in the last 100 years, and our joints are suffering from our more sedentary and processed lifestyles. We’re seeing a welcomed shift as consumers learn more in this age of information about what’s truly healthy and what isn’t, but technology and nature could still be a few decades away from catching up to one another. Until then, prevention and turning to regenerative medicine for treatment when necessary are the keys to keeping your cartilage healthy as you age.

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19 thoughts on “Does Cartilage Heal on Its Own?

  1. Seth Hirsch

    Excellent blog as usual. I am 73 (bmi 27) with an American/Boulder lifestyle.I have severe right hip arthritis. I swim ,bike hike and play tennis (the latter 2 in pain controlled sorta with NSAIDS (and supplements)Would you consider me a good candidate, a fair candidate for PRP/stem cells or forgetaboutit…thank you. Seth Hirsch.

    1. Regenexx Team Post author

      Seth,
      Boulderites tend to be healthier than most, but establishing Candidacy is more involved as it is intended to give the patient an accurate idea of what, in their specific case, the chances of this working are. You can either submit your Candidate form online and we can discuss Candidacy, your MRI’s and full medical history by phone, or you can set up an exam right in Broomfield at the Centeno Schultz Clinic. On the surface though, NSAIDS interfere with your body’s normal repair system and tend to make arthritis worse. (in addition to the Cardiac risk). PRP, while the procedure of choice for many things, would not helpful in severe hip arthritis. The question would be whether you’d be a Candidate for the same day, or cultured procedure. http://www.regenexx.com/the-regenexx-procedures/hip-surgery/

  2. Jack Skryd

    So how does stem cell treatments help knee joints , wrist or hand problems ad well as lower back problems to avoid surgery

    1. Regenexx Team Post author

      Jack,
      That’s probably best explained here: http://www.regenexx.com/stem-cell-cartilage-regeneration/ The crucial part of all the joint issues is correct diagnosis and treatment of of both the problem, and the underlying cause of the problem. Please see: http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ and http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

  3. Donut Man

    Does stem cell treatment result in the production of “true” hyaline cartilage, or is it an inferior pseudocartilage such as microfracture produces?

    1. Regenexx Team Post author

      Donut Man,
      In humans, nobody knows the answer to that question. In animal models, it results in better and more hyaline like cartilage than microfracture.

  4. Lisa Ryan

    My husband has to have a complete shoulder replacement. We were told that he has little to no cartalige left. He is in chronic pain and can not sleep due to pain. Do you think he would be a canidate ? If not, do you have any suggestions? He is 50 yrs old and we are told too y young to be getting g a shoulder replacement.

    1. Regenexx Team Post author

      Lisa,
      Agree!. If you’d like us to take a look, please have him submit the Candidate form so he can upload his MRI, medical history. etc. and we can determine if he’d be a good Candidate. Please see: http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/

  5. Michelle Robinett

    How do we tell good quality Glucosamine and chondroitin from the bad quality? Is there a supplier you trust?

    1. Regenexx Team Post author

      Michelle,
      With Gloucosamine, it’s important to get a supplement that has both types, please see: https://regenexx.com/blog/glucosamine-types/ This will tell you which brands to avoid! https://regenexx.com/blog/stem-cell-supplements/

  6. Rob

    I damage my wrist and now the doc has cleaned it out but said the next opp would be to fix it so it does not move

  7. Joann donahue

    No mention that stem cell treatments grow cartilage.. Then what is the purpose of having the treatment?

  8. Ron Browne

    My understanding is that stem cells can differentiate into chondrocytes and cartilage based upon the presence of various transcription factors https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580463/figure/F2/
    Is it possible that the Regenexx – C procedure could incubate the stem cells with such factors in order to facilitate cartilage formation?

    1. Regenexx Team Post author

      Ron,
      Yes, we use various adjuvants in culture to push stem cells in that direction…

  9. Lee

    Articular cartilage can grow back slowly, but must meet the following conditions.
    Adjacent tissue must be in first place.
    Imflemation must be minimised.
    Good nutrition.
    Good overall health.
    Keep all above at least a year, the regrowth will be greater than the damage, some new cartilage gained.

    By far, only stem cell can do this job.
    Steroids stops imflemation, destroying health tissue.
    Hyaluronic acid can not reduce inflammation low enough.
    Surgery damage micro-curculation.
    Pill only can hurt stomach.
    Stem cell works, but not in a magical way.

  10. Taralika

    I have osteoarthritis of knee. My doctor has suggested total knee replacement. I want to search for alternatives of surgery. Can anyone has avoided knee replacement and gone better ?

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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