The development of degenerative joint disease in the young active patient is an increasing and difficult problem. In this review, evidence for the role of nonoperative and operative treatment strategies is assessed with the objective of establishing guidelines for management, and identifying areas for future research. Glucosamine and chondroitin supplements, as well as steroid and hyaluronan injections are probably useful early in the disease. Arthroscopic debridement, capsular release, and microfracture are temporizing measures that can provide pain relief and defer more invasive surgery. Attempts to restore the cartilage surface with osteochondral autologous transplants or autologous chondrocyte implantation may be suitable as second-line therapy for focal defects, although resurfacing of more extensive lesions with biological membranes has proven more difficult. Because prosthetic arthroplasty is relatively contraindicated in young patients, particularly contact athletes, the search for an ideal solution remains elusive, and more clinical and basic science research is needed.
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