Conservative management of focal chondral lesions of the knee and ankle : current concepts

Abstract

Focal chondral defects of the knee and ankle remain a challenging clinical condition, particularly in young and active patients, as they often cause pain, mechanical symptoms, and functional limitation without necessarily progressing to osteoarthritis (OA). This narrative review summarises current evidence on non-operative strategies for managing focal chondral lesions in non-arthritic joints, emphasising the role of rehabilitation as the central component of care. A thematic literature search was conducted across major databases for studies published between 2000 and 2025, selecting articles based on clinical relevance. Structured rehabilitation programmes based on load optimisation, neuromuscular retraining, and progressive strengthening represent the foundation of conservative management. Pharmacological agents and intra-articular injectables may provide temporary relief, although the evidence supporting their efficacy remains heterogeneous and primarily short-term. Nutraceuticals and physical modalities show encouraging but inconsistent results, limited by methodological variability and undefined dosing. Overall, conservative treatment should be tailored to the individual patient’s biomechanical and biological profile, integrating rehabilitation with selected adjuncts when appropriate. Future research should focus on developing standardised rehabilitation protocols, identifying predictors of recovery, and clarifying the biological mechanisms that sustain symptom improvement in focal cartilage pathology.