Introduction
Anatomy
Cause
Symptoms
Diagnosis
Non-surgical treatment
Surgical treatment
Rehabilitation
Articular surfaces that have been injured by acute or repetitive trauma can experience articular cartilage damage. Damage to the articular cartilage may cause pain, loss of joint motion, effusion and swelling .It may then progress to joint degeneration.
Cartilage is a connective tissue composed of differentiated cells, the chondrocytes and an extracelluar matrix which contains various protein fibers. There are several types of cartilage in the body, including a specialized cartilage in the joint called “hyaline cartilage”. It covers the end of the bone to form a smooth joint surface, lubricated with synovial fluid to allow motion. Cartilage does not contain blood vessels. It gets its nutrient through diffusion. It grows and repairs slowly.
Acute or repetitive blunt trauma to the joint can damage the articualr cartilage. Difference in intensity and type of joint loading can cause different degrees of cartilage injury. There is no evidence that physiological loading to the joints will cause significant cartilage damage. Acute trauma such as the torsional shear during anterior cruciate ligament injury, or direct impact in patellofemoral joint dislocation may associate with significant damage to the articulating cartilage.
Recurrent pain and swelling
Recurrent grating and locking on motion (locking symptom may due to trapping of loose body within knee joint)
Doctors will ask about the symptoms, history of the complaint and will carry out a detailed physical examination which is essential to look for the possibility of articular cartilage injury. He will examine for associated injuries such as recurrent patellar dislocation, insufficiency of the anterior and posterior cruciate ligaments of the knee, and presence of meniscus pathology.
X-ray may help to detect those osteochondral lesions (bone + cartilage injury). As cartilage is radiolucent, lesions that involve only articular cartilage may not be identified by usual radiograph.
Magnetic resonance imaging (MRI) is an investigation that can provide good morphologic images of cartilage lesion. It is a noninvasive tool for soft tissue and articular cartilage imaging.
After acute trauma of the knee, it is advisable to have RICE therapy to the injured joint. This includes:
“Resting” the injured limb,
“ICE” application and
“Compression” therapy and lastly,
“Elevation” of the injured limb.
The patient should always seek medical attention for a detail examination, a proper diagnosis and appropriate treatment.
Conservative treatment also includes a course of analgesics and physiotherapy to control the pain and swelling, and to improve the range of joint motion.
For injures that are resistant to conservative means, or if the symptoms persisted or got worse, surgical management may be necessary.
Arthroscopic procedures such as, debridement of the lesion, various methods that aim at stimulating the formation of new articulating surface (e.g. microfracture technique, mosaicplasty), grafting with periosteum and cartilage cell transplantation etc..
Each of these options will have its own indications, merits and complications.. Your orthopaedic surgeon will be able to provide his expertise opinion on different options.
Exercise helps to improve the range of motion of the operated knee and helps to control swelling in the early post-operation period. Your doctor will advise you on the weight bearing status of your knee joint as it depends on the types of surgery you have received. You may need to limit your activity level at the initial stage of rehabilitation until the articular cartilage is ready.
Dr. HO, Po-yan