Cartilage
Injury

The cartilage is a flexible connective tissue found throughout the body. Its main functions are to hold bones together and serve as a shock absorber to facilitate frictionless movements between joints to prevent damage, especially when stretching or bending. The cartilage does not have blood vessels, which aid in cell repair, and so its healing is relatively slower than other tissues. Damage in the cartilage is typically caused by overuse, wear and tear, injury or illnesses, and affects weight-bearing joints like the knees and ankles.

Another common cartilage injury is damage to the articular or hyaline cartilage. Similar to meniscus tears, this form of damage results from direct trauma and wear and tear. It can also be caused by degenerative ailments like osteoarthritis.

Left untreated, both meniscus tears and articular cartilage injury can cause severe knee pain, inflammation and immobility.

Knee cartilage injuries typically result from a sudden or direct blow or twist to the cartilage. Athletes and those who actively participate in high-impact sports, both contact or non-contact, have a higher risk of getting meniscus tears or other cartilage trauma from tissue overuse.

Aside from chronic overuse, cartilage damage also occurs naturally with age through wear and tear. The tissues in the knees gradually become worn out and more susceptible to tearing. The risk of damage is particularly higher for those who are overweight or born with a physical joint defect.

Certain illnesses also lead to the deterioration of knee cartilage. The most common example is osteoarthritis, which is characterized by the gradual breakdown of the cartilage in the joints. Other common ailments that produce the same effect include autoimmune diseases such as rheumatoid arthritis and lupus. Gouty arthritis of the knee is also one of the more rare causes of knee pain.

Non-Surgical Treatment

For mild to moderate cases of knee cartilage injury, orthopaedic surgeons and healthcare providers prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms of knee pain. Some medicines may also be administered to stop the progression of damage done to the cartilage.

Additionally, physiotherapy, home treatments and lifestyle changes are recommended to help the patient manage the pain and better facilitate healing. Supportive devices such as crutches, canes and leg braces can be used to avoid putting extra pressure on the affected knee.

Surgical Options

Serious cartilage injuries that cannot be managed by physical therapy and medications may require surgery. Depending on the symptoms manifested and the severity of the pain and damage, options available include the total replacement of the injured cartilage, or naturally stimulating the body to regrow new cartilage. These include:

• Arthroscopic lavage and debridement – Used to treat loose cartilage on the joint, this method uses an arthroscope (an optical micro-instrument equipped with a camera) to clean off the joint by vacuuming the loose cartilage.
• Marrow stimulation – This technique involves creating microfractures on both damaged cartilage and underlying bone, which results in the formation of blood clots. These marrow cells will then encourage the development of new cartilage. A new developmet would be to use an additional collagen matrix, such as Cartifill or Hyalofast, to help secure these marrow cells in the region of the cartilage defects/ ulcers. This further improves the healing of the cartilage.
• Mosaicplasty – This method involves the extraction of healthy cartilage from non-weight-bearing joints, which will then be used to replace the damaged one on the knees.
• Allograft osteochondral transplantation – Similar to mosaicplasty, this method involves the replacement of a damaged cartilage with a new one. The difference is that the replacement cartilage will be extracted from a deceased donor.
• Autologous chondrocyte implantation – In this method, healthy cartilage samples will be extracted from the knee via arthroscopy, and then cultured and left to grow in a lab. The cartilage cells would increase up to 50x after a few weeks, and this resulting sample will be used to replace the damaged knee cartilage.

Alternatively, knee and hip replacements may be done for more serious conditions.