DESCRIPTION AND SYMPTOMS
WHAT IS KNEE CARTILAGE? WHAT ABOUT OSTEOCHONDRAL INJURIES?
Knee cartilage is the tissue (made up of cells -chondrocytes, that are covered by a dense, shiny, whitish substance) that covers the knee joints. Its function is to support the loads that the knee bears and allows adequate sliding between the bones of the joint.
Cartilage sits within a liquid medium in the joint. This joint fluid, which nourishes the joint, is made up of, amongst other liquids, hyaluronic acid, glucosaminglucans, and chondroitin sulfate.
What about knee cartilage injuries?
A knee cartilage injury, called an osteochondral injury, involves the breakdown of part of the joint’s cartilage. This injury can occur due to different causes:
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- Chondral injury is defined as the isolated injury of a part of the cartilage. It occurs with trauma to the knee, for example, high jump. Repetitive microtrauma can also sometimes also cause injury. For this reason, chondral injuries are frequent in some sports such as football or basketball and in some professions such as mechanics, bricklayers, etc. This injury can also occur spontaneously if a patient suffers from Osteochondrosis Dissection, a disease of unknown origin, that causes spontaneous cartilage damage. No matter the cause, with this kind of injury, a piece of cartilage is injured and may even detach from the surface. When this fragment detaches we call it a free body and it must be removed.
- Osteoarthritis is a very common condition that appears with aging. It involves the thinning of cartilage in a generalized way throughout the joint. Over time this thinning increases until the joint is completely unstructured. This leads to the otherwise normal sliding between the bones to not move properly. The patient feels pain and swelling of the knee.
Other related knee injuries:
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SYMPTOMS OF A KNEE CARTILAGE INJURY
Uniquely, the symptoms of a cartilage injury are known for not being proportional to the size of the damage, so a small injury can cause great pain and vice versa. Symptoms of knee cartilage injuries may include:
Intermittent effusion (swelling). Often the only symptom that appears.- Pain, which manifests during movement, especially in bending movements such as squatting.
- Locking or popping of the knee. This is because broken cartilage fragments “float” in the knee, which can cause sudden pain and inability to move it until it is removed.
Intermittent effusion (swelling). Often the only symptom that appears.To establish a complete diagnosis, X-Rays and MRI scans are taken.
IF THE INJURY IS NOT TREATED IN TIME
If you do not treat this injury in time, the negative consequences it produces can grow and affect various aspects of daily life:
Work
The wear and tear of the knee cartilage can interfere with the standard requirements of certain jobs for which an optimal level of health is needed.
Sport
The body cannot regenerate cartilage, so injuries to it means that people who do not treat it in time will, eventually, have to stop all sports activities.
Pain and Chronic Inflammation
Repeated pain over the joint is sometimes so severe that it prevents the knees from bending normally. In extreme cases, deformations occur.
TREATMENT
WHAT IS THE TREATMENT FOR AN OSTEOCHONDRAL INJURY?
Initially, a conservative treatment based on physiotherapy is started, especially in those cases where the injury is not at risk of detaching. Injections of hyaluronic acid or platelet-rich plasma into the joint can also be used to temporarily improve inflammation and pain. And, in certain cases, the doctor may prescribe insoles to correct the support of the affected limb.
When these conservative methods fail, surgery will need to be performed. In cases of generalized osteoarthritis, surgery consists of implanting a knee prosthesis; while in isolated injuries (condal injuries) different types of treatment are chosen depending on the size and location of the injury.
HOW IS ARTHROSCOPIC SURGERY PERFORMED TO TREAT OSTEOCHONDRAL INJURIES?
Surgery to repair damaged cartilage can be done arthroscopically, by inserting a camera called an arthroscope and tiny surgical tools through the small incisions made.
Depending on the size of the injury, different treatments can be performed:
- Fragment Fixation: in cases where the fragment has not detached, it can be reattached using a screw.
- Nanofractures: If a cartilage fragment has detached, it must be removed. In the area that is now devoid of cartilage, small holes are made to encourage bleeding and produce a scar (fibrocartilage) to refill the space….
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This technique is usually only performed on small injuries. In some cases, gels or structured membranes can also be used to help repair the injury. To ee an animation of this procedure, click here:
Mosaicoplasty: In larger knee cartilage injuries, we take a cartilage graft from the upper knee of the patient themself and place it in the injured area. Watch an animation of this procedure here:
Allografts: In the largest cases of knee cartilage injuries, repairs can be made using a graft from the bone bank.
FREQUENTLY ASKED QUESTIONS
How long does an arthroscopic knee surgery for osteochondral injuries take?
The duration varies depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient. In the case of arthroscopic surgery on the knee, duration is generally between 30 and 60 minutes.
What is recovery like after arthroscopic knee surgery?
- Rehabilitation is long, with the patient not being able to put weight on the operated knee for 30-40 days after the surgery. Following surgery, a sports rehabilitation and physiotherapy plan should also be followed.
- The return to sporting activities will not be possible until at least 6 months after surgery.
What are possible complications from arthroscopic knee surgery for injuries to the joint?
Occasional complications that can result from arthroscopic surgery for knee cartilage injuries include::
- Infection
- Inflammation of the veins (venous thrombosis)
- Excessive inflammation, bleeding and damage to the small vessels and nerves near the operated area
REFERENCES
Shetty AA, Kim SJ, Nakamura N, Brittberg M. Articular Cartilage: Histology and Physiology. En: Techniques in Cartilage Repair Surgery. Heidelberg: Springer; ESSKA 2014. P. 17-22.
If you want to learn about treatment options, including arthroscopic surgery, for knee cartilage injuries, you can speak with Dr. Villanova directly by clicking here:
This post is also available in: Spanish
