Articular Cartilage Injury
Cartilage (Chondral) Damage
Cartilage Injury: The cartilage layers of the knee can be injured on their own but are more commonly damaged at the time of knee ligament injury. In other patients where the protective meniscus has been damaged or removed (by prior surgery) the cartilage layers can be hugely overloaded – they rely on the meniscus to spread our weight over as large a surface area as possible. This can lead to accelerated wear and cartilage loss at a young age. This painful condition is better known as arthritis. Our goal, therefore is to prevent further damage and to try to stimulate healing.
Signs of Cartilage Injury:
Acute damage: Cartilage damage may cause mechanical symptoms of clicking, catching, locking or giving way. This is because the cartilage tends to form “flap-shaped” tears which can then get stuck preventing normal frictionless gliding of the joint surfaces. More significant injuries can cause the cartilage layer to be peeled away from the underlying bone, exposing it in the process. As well as mechanical symptoms this is commonly painful.
Chronic damage: Cartilage damage and wear over a longer period leads to thinning, bone exposure and pain. Painful arthritis is covered separately here.
Diagnosis: A thorough clinical examination along with an Xray and MRI scan will show the extent of damage and the presence of other injuries which may also be present. This will allow proper planning and an informed discussion about the treatment options.
Treatment Options: This depends on many factors including the position and size of the cartilage injury and other patient-related factors.
Non-operative measures: Some tears that are small and do not give rise to mechanical symptoms such as catching or giving way may respond well to a period of physiotherapy and strengthening in order to gain better muscle stability and control in your knee.
Operative treatment: When symptoms include pain or mechanical symptoms that effect your life or make simple tasks difficult then a keyhole procedure (arthroscopy) can help to stabilize the loose cartilage layer. If the cartilage has lifted off the bone then it may be repairable or techniques to stimulate healing of the exposed cartilage can be used to fill the defect and relieve pain. These techniques include Chondroplasty, bone marrow stimulation and scaffolds to grow a new cartilage layer (stem cell regenerative techniques).