Joint preservation is the umbrella term for options that keep the natural joint surfaces working, instead of replacing them with metal and plastic the way joint replacement does.
When a patient's joint surface is damaged or worn out, joint replacement entails removing those worn out surfaces and replacing them with artificial ones. Preservation is the evolving set of options that maintain and protect those surfaces instead. They range from altering activity and loading, through injections and biologics, to surgeries that involve neither replacement nor fusion. The surgical ones come in three kinds: repairing, realigning or grafting.
Whether preservation suits your condition turns on the pattern of damage. Damage concentrated in one area, surrounded by healthy surface, may well be repairable or graftable. Damage spread across a whole joint cannot be fixed by these methods alone. Both the scan and the physical exam need to be considered to decide if preservation is the right option for you.
Our Atlanta practice assesses candidacy for exactly this, and if preservation would not help you, we say so. Being told you need a replacement does not always mean the other options were considered, and preservation is the right call only for the right joint.
Joint damage moves only one way, and delay retires options that do not come back, so evaluation is worth doing sooner rather than later.
The procedures that keep a joint rather than replace it: the BEAR® Implant for a torn ACL, cartilage and meniscus work in the knee, cartilage repair in the ankle, the hip conditions arthroscopy addresses, and the orthobiologics behind regenerative medicine. Choose a condition, then pick a video.
A torn ACL is the clearest case of a joint that cannot mend itself, and the BEAR® Implant is the preservation answer to it.
| Compare | ACL reconstruction | BEAR® Implant |
|---|---|---|
| What happens to the ACL | Removed and replaced with a graft | Restored; the native ligament heals across the implant |
| Graft or donor tissue | Required, usually tendon from the same knee | None |
| The donor site | A second area of the knee to heal, and a possible source of weakness | No donor site |
| Knee anatomy and landmarks | Rebuilt with a substitute | Preserved as they were |
| What stays in the knee | The graft, permanently | Nothing foreign: the implant is resorbed within about eight weeks |
The torn ends of an ACL sit in joint fluid that dissolves the blood clot a wound needs to heal across, so a complete tear has traditionally meant reconstruction: the ligament is removed and replaced with a graft, usually tendon taken from elsewhere in the same knee.
The BEAR® Implant (Bridge-Enhanced ACL Restoration) is a resorbable collagen implant that the surgeon places between the torn ends of the ligament and loads with a small amount of the patient's own blood. The implant shields that clot from the joint fluid and gives the body's cells a bridge to grow across, so the ACL heals as one continuous ligament. Within about eight weeks the implant is absorbed and replaced by the patient's own cells, collagen and blood vessels, and the new tissue keeps remodeling and strengthening from there.
The implant's maker backs it with Level 1 clinical evidence. In its randomized trial, patients treated with the BEAR® Implant reported knee function at two years similar to reconstruction, their measured knee laxity at two years matched reconstruction, and their hamstring strength was statistically better at six and twelve months, a trend that held at two years. Those are the study's findings, not a promise about any one knee: the implant suits a specific range of tear patterns, and candidacy is decided from the tear, the tissue that remains and the time since injury, on MRI and in the exam room.
Reconstruction remains the right operation for many knees, and ACL surgery covers both paths in full. The BEAR® Implant videos in the Video Vault above, from the implant's maker, walk through the science, the procedure in the operating room and what a patient can expect; the vault's other groups cover the cartilage, meniscus, ankle, hip and orthobiologic work this page describes.
Joint replacement is a standard of care. It is also not what Atlanta Sports Medicine Institute does, and that difference is the point of this page.
It is a well-regarded and effective operation, but not an ideal one for every patient. The prosthesis itself has a limited lifespan. The more active the patient, and the younger, the faster the implant wears out. Many active pursuits, high-impact ones above all, may be limited or advised against after a replacement. Most of all, a replacement closes off every future biological option. It is a good option for many patients, and the treatment of choice when a joint has broken down completely, worn in every compartment.
A good joint replacement surgeon answers one question: what do we do with a joint that is completely worn out? At Atlanta Sports Medicine Institute the focus is a different question: what can this joint keep doing, and for how long?
This may be especially important for the younger or busier patient, who is more likely to be bothered by post-surgical restrictions on activities.
Joint preservation is ideal for the patient who still has a joint left to save. A joint that has been preserved can still later be replaced.
Much knee pain pairs surface breakdown with an alignment problem, and the same logic applies at the hip; hip pain is where that conversation opens on this site.
Because cartilage has virtually no blood supply, it cannot repair itself well, so cartilage surgery aims to preserve or recover a healthy surface rather than rely on regrowth. Most of this work happens inside the knee, and knee surgery is where those techniques live on this site. The same principles reach many other joints. The ankle is the clearest example: a patch of damaged cartilage can be addressed instead of fusing or replacing the joint, and ankle surgery covers how.
If the bone and cartilage fragment is still viable and partially attached, it can sometimes be fixed with screws or anchors to allow healing.
Whenever possible, it is better to keep and reattach your own natural joint surface than any other option.
One approach perforates the bone at the base of the defect and lets reparative tissue rise into the gap.
Small and medium-sized defects may also be repaired by transfer of cartilage (with the underlying bone) from non-weight-bearing areas of the joint.
Larger defects require matched grafts.
The bone is cut at a chosen spot and held with a plate. The new alignment steers weight away from the damaged area. Fix only the surface while the bone stays crooked, and the same spot wears out again.
This is why many cartilage-restoring surgeries include a stabilizing procedure. A patella that continually dislocates or an ankle that continually gives out will continue to damage the surfaces every time the event occurs. The cartilage repairs may not last if the stresses that caused the original damage have not been altered.
No procedure on that list is the best one in the abstract. The right one is set by the size, depth and bony involvement of the defect, and by whatever else the joint carries.
New products keep appearing to fill defects; the goal they serve has not moved.
I've been dealing with an injured knee for several years because of a sports injury. Dr. Langer has been very helpful developing exercises that have helped ease the pain considerably. With his help, I may be able to prevent a knee replacement.
In arthroscopy the surgeon views the joint using an arthroscope. This is a pencil-thin camera that is introduced into the joint. One or two more small incisions admit the instruments. The path moves muscle and joint capsule aside rather than dividing them the way a standard incision does. The image is magnified on a display monitor. Arthroscopy allows the surgeon both to see and gain access to areas that would otherwise be difficult to visualize or reach.
Contrary to what one might think from the size of the incisions, arthroscopic surgery is still a major surgical procedure. How long it will take to recover is dependent on what procedure is performed. Simply trimming off or smoothing a torn lip is far less involved than the reconstructive procedure of ligament repair or a cartilage graft.
Certain procedures still need an open incision, for the best result or to be technically possible at all: precisely squared surface grafts, for instance, or realignment bone cuts, called osteotomies. And in a severely worn joint, an arthroscopic clean-out of loose debris can look appealing, but lost cartilage does not regenerate, so any relief is temporary.
One arthroscopic field stands apart here: hip arthroscopy differs enough, in approach and in what it addresses, that it earns a page of its own.
Your recovery is based on your healing, not on the size of your incision. Although your incisions will be very small, the new cartilage must grow into your bone, and the bone that we cut must heal back into solid bone.
Your surgeon sets the dates from your healing as the imaging shows it. What follows is only the general shape.
In the early stages, we try to avoid putting weight on repaired areas. The most common way repairs fail is to load the new surface before it has time to settle, so these restrictions are strictly enforced.
The criterion for bearing weight is not the calendar but the healing of the bone or graft, confirmed by imaging. Some repairs that look small on the operative report take the longest before walking is allowed.
Motion comes before load. Immobilization breeds stiffness, and stiffness is much harder to undo than strength is to rebuild, which is why motion leads the rehab.
The milestones are determined not by time, but by what your joint is able to do. The sequence runs: walking unaided, then uneven ground and stairs, and finally the demands of your own life, up to walking without thinking about it at all.
Rehab speed rides on smoking, metabolic health, the tissue being repaired, your weight, and how closely you keep to the post-operative rules.
The most difficult orthopedic surgeries to recover from are those that require the repaired area to heal before putting weight on the leg. Bone cuts and cartilage grafts are at the more difficult end of recovery.
As a Div I football player, I am extremely selective of who I see for my sports injuries. Dr. Langer did my ACL reconstruction and I'm back, ready for the upcoming SEC season. Thanks Dr. Langer!
Many people have had a phase of conservative, or non-operative treatment, before reaching a surgical solution. Non-operative options include changing how often and how long the joint gets loaded. Braces can shift weight to the healthier side of the joint, and physical therapy builds muscle strength and retrains balance. Injections and anti-inflammatory medications may also help. Regenerative medicine is also part of the non-operative treatment options, although these methods are explained separately.
Conservative treatment is beneficial to calm inflammation and to improve the daily joint tolerance. However, non-operative treatment methods cannot correct underlying anatomical problems such as filling gaps in the cartilage, correcting deformities or fixing torn or detached pieces. Therefore, conservative treatment methods may prolong the useful life of a joint but cannot solve a problem mechanically or anatomically.
Failure of non-operative treatment can be assessed in several ways. Injections no longer last as long as they used to. Physiotherapy builds strength, yet the joint still catches or locks. More broadly, when daily life and recreation keep shrinking because of pain, conservative care is failing, and the anatomy behind the symptoms deserves a look.
Preservation is a position before it is a method. The position shows in the first question asked: what does this joint still have, rather than what has it lost.
Behind that question sits training. Completed advanced fellowship training in Hip Arthroscopy with Marc Philippon, MD. A fellowship concentrates on one joint after residency, and the reasoning built inside that concentration generalizes to the others; staying inside the specialty's ongoing debates is the other half of the work. Member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS). The rest of Dr. Langer's training reads the same way.
That training also carries an obligation to honesty. Some joints cannot be saved, and if that is your situation you are far better off with a frank assessment than with overblown optimism.
If you have been told you need a joint replacement and want the alternatives thoroughly explored, ask for that opinion; it is always worth exploring before consenting to an operation. Request an appointment and bring any previous imaging you have.
If pain is limiting the way you train, work, sleep, or move, an evaluation can turn uncertainty into a practical next-step plan.
Book an appointment →Explain what you want to return to, not only what hurts.
Look for the combination of findings that best explains the symptoms.
Understand the likely cause, whether imaging helps, and what comes next.
Atlanta Sports Medicine Institute helps active patients understand what may be driving their symptoms and compare appropriate treatment paths. The experience should be precise, understandable, and tied to the activities each patient wants to return to.
An arthroscopy is usually a same-day, outpatient procedure under anesthetic, which can make it feel minor. That is not always true: a simple trimming of torn tissue and an extensive grafting of a joint surface can pass through the same small incisions, with very different recoveries behind them. Knowing what was actually done, not just the operation's name, is how you judge the size of your own surgery.
In most cases you will be the sorest during the first couple of days after surgery. It helps to have a plan in place to manage the soreness. A standard plan pairs a nerve block during surgery with oral medications, icing, and elevation. After the first few days, recovery is your own, and no one can predict your pain precisely. However small the incision, the internal work can be substantial, and it can be genuinely uncomfortable.
With support, a boot or crutches, walking often comes sooner than people expect. Walking without support is a different milestone: it waits on healing, and it depends on your specific repair. Even then the answer is specific to you, so an average will not necessarily apply; your surgeon sets the date from imaging and the exam in clinic.
Joint preservation covers a range of approaches used to treat damaged cartilage, ligaments, and joint surfaces before a joint reaches the point of needing replacement. Techniques in this field continue to be refined, including arthroscopic methods that allow surgeons to address problems through small incisions rather than open surgery. Your surgeon can discuss which options may apply to your specific joint condition, since the right approach depends on the location and extent of the damage, your activity level, and your overall health.
Ask your care team which treatments they recommend for your situation and why.
Recovery timelines after knee surgery depend on the specific procedure performed, the extent of the repair, and your individual healing. Some patients are able to walk with support soon after arthroscopic procedures, while more involved repairs may require a longer period before full weight-bearing is allowed. Your surgeon will give you a walking and weight-bearing plan tailored to your procedure, and following it closely supports proper healing.
Physical therapy is often part of the process of safely regaining strength and mobility.
Arthroscopy is generally considered less invasive than traditional open surgery because it uses small incisions and a camera to guide the surgeon, but that does not mean it is without risk or recovery time. It is still a surgical procedure performed under anesthesia, and the impact on you depends on what is being repaired inside the joint. Ask your surgeon how your specific arthroscopic procedure compares to open surgery in terms of recovery and what to expect.
Joint preservation refers to treatment approaches aimed at protecting and repairing a joint's own cartilage, ligaments, and structures instead of replacing the joint. Surgeons use a variety of instruments and techniques as part of these procedures, and your surgeon can explain which specific tools and methods are used in your treatment plan. If you have questions about the equipment or approach used in your procedure, bring them up during your consultation.
Atlanta Sports Medicine Institute provides joint preservation care. Contact the practice to schedule a consultation and learn more about the evaluation and treatment options available for your joint condition.
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