Articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint. Cartilage helps the bones move smoothly against each other and can withstand the weight of the body during activities such as running and jumping. Articular cartilage does not have a direct blood supply to it, so has less capacity to repair itself. Once the cartilage is torn it will not heal easily and can lead to degeneration of the articular surface, leading to development of osteoarthritis.
The damage in articular cartilage can affect people of all ages. It can be damaged by trauma such as accidents, mechanical injury such as a fall, or from degenerative joint disease (osteoarthritis) occurring in older people
The symptoms of a chondral injury are not as obvious as those of a meniscus tear or ligament injury.
There are many factors which need to be thoroughly investigated for patients who have symptoms from chondral defects. Ligament tears of the knee can cause and accelerate chondral defects and may need to be reconstructed either before or at the same time as a cartilage resurfacing procedure to slow down the progression of arthritis. If patients have alignment problems, where they are bow-legged or knock-kneed into the site of their defect, the use of an unloader brace or straightening the bone through an osteotomy may be indicated depending upon their age and the amount of arthritis present in the knee.
In some instances, the chondral defects of the knee may be small enough to trial a period of rehabilitation. These patients may benefit from a program of rehabilitation, focusing on low-impact strengthening, primarily the quadriceps mechanism, to increase one’s absorption and overall strength. In addition, for patients who may have a lot of joint space irritation, called synovitis, a steroid injection or a platelet-rich plasma injection (PRP) may be indicated.
Cartilage replacement helps relieve pain, restore normal function, and can delay or prevent the onset of arthritis. The goal of cartilage replacement procedures is to stimulate growth of new hyaline cartilage. Various arthroscopic procedures involved in cartilage replacement include:
Articular cartilage is found at the ends of bones which are in a joint. Simply put, the function of articular cartilage is to serve as a shock absorber with activities. In addition, it allows for smooth movement, and is incredibly complex in its overall function. Any damage to the cartilage itself is called arthritis. This includes the terms chondromalacia, fissures, cracks, or post-traumatic osteoarthritis.
Unfortunately, articular cartilage does not heal with normal replacement cartilage tissue. When it does heal, it is usually a fibrocartilage tissue layer that heals, which may or may not be functional over the long term. A lot of this depends upon the size of the cartilage problem, and larger cartilage problems often have breakdown of the repair cartilage much quicker than those that are smaller and have good, normal cartilage edges (well-formed shoulders).
While there is not one specific thing that can prevent cartilage damage in the knee, there are a few measures that can be taken to delay the process.
Since excess weight can cause damaged cartilage to wear down more quickly, losing extra pounds may be helpful.
A person with cartilage damage should avoid high impact activities, such as prolonged running or jumping sports. These are very hard on the knee and can speed the progression of cartilage damage.
Even those with significant joint damage will benefit from mild to moderate activities, such as walking, bicycling, or running in water.
A fissure in the cartilage is basically a crack. This crack can be just in the surface tissue, which is common in the kneecap cartilage because it is so thick, or it may extend down to bone. Therefore, the size, width and depth, of the cartilage fissure is an important thing to assess because it can ultimately determine the prognosis of being able to return back to normal activities or if one would need to adapt their activities going forward to avoid further progression of the cartilage damage.
The newer techniques involving cartilage growth will not work if a patient is very bowlegged, knock-kneed, or has bone rubbing on bone. The newly grown cartilage would be quickly rubbed away by the worn surfaces. At some point in the progression of arthritis, only a total knee replacement can offer pain relief.
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