Management of Articular Cartilage Injuries in the Knee

Oct 29, 2024

Articular cartilage is living tissue that forms a smooth, durable surface at the end of each bone in the joint, allowing the bones to move against each other without friction. Fluid produced within a joint lubricates the cartilage, allowing the opposing bones to slide over one another smoothly. Healthy cartilage within a joint is key to making it easier for that joint to move comfortably with very little friction.
Articular Cartilage

Articular Cartilage Injuries

Although articular cartilage is generally very durable and designed to handle heavy forces and stress, it is prone to injury or damage. Cartilage has a limited blood supply, so it does not heal itself well after injury. Injuries can result from acute trauma, repetitive stress, or even normal wear and tear over time.

Damage to cartilage can lead to significant pain and impact your ability to move, but surgical techniques are available to repair or restore it. Restoring articular cartilage can improve function, reduce pain, and, most importantly, delay or prevent the onset of arthritis. While cartilage damage can happen in any joint, the knee is most commonly affected.

Damaged Cartilage

Symptoms of Articular Cartilage Injuries in the Knee

Injuries to the articular cartilage in the knee can manifest in many ways. Some of these symptoms may overlap with other types of knee injuries. These symptoms include:

  • Joint pain
  • Swelling
  • Catching sensations when bending the knee
  • Cracking, popping, or clicking with movement
  • Joint locking (difficulty fully straightening or bending the knee)
  • A sensation of giving way or instability
  • Stiffness and decreased range of motion

Diagnosing Cartilage Injuries in the Knee

If you suspect you may have an articular cartilage injury, it is essential to see an orthopedic surgeon. Diagnosing a cartilage injury includes a detailed medical history, a thorough physical exam, and imaging tests like X-rays and MRIs.

  • X-rays help assess bone alignment and reveal any damage to the underlying bone.
  • MRIs provide a detailed view of the cartilage and other structures in the knee, such as ligaments and the meniscus. They can identify the location of the damaged cartilage, the size and shape of the cartilage defect, and any injury to the underlying bone.
  • Often, a minimally invasive procedure called knee arthroscopy is necessary to fully visualize and assess the extent of the damaged cartilage.
Knee Arthroscopy

Treatment Options for Cartilage Injuries in the Knee

There are several ways to treat cartilage injuries, including both non-surgical and surgical treatment options.  The right treatment plan depends on several factors, including age, activity level, overall health, post-treatment expectations, severity of cartilage injury, and location of cartilage injury.

Non-Surgical Treatments

Non-surgical options aim to reduce pain and slow further cartilage damage. These are often the first line of treatment, particularly after an injury or when dealing with advanced cartilage degeneration, like osteoarthritis.

Common non-operative treatments include:

  • Activity Modification: Avoid sports or activities that cause pain in the joint.
  • Anti-Inflammatory Medications: Over-the-counter options like ibuprofen or naproxen to manage pain and inflammation.
  • Physical Therapy: Improve strength and range of motion to alleviate pain.
  • Corticosteroid Injections: Reduces inflammation and pain directly within the joint.
  • Viscosupplementation Injections: Hyaluronic acid injections to help reduce swelling and increase joint lubrication.
  • Platelet-Rich Plasma Injections: Uses your own blood components to promote healing.

Surgical Treatments

Surgical treatment is often the best option for damaged cartilage, as cartilage has a relatively poor blood supply and limited capacity to repair itself.  While some surgeries aim to relieve the symptoms patients may experience, most aim to repair or restore the damaged articular cartilage. While some procedures can be performed arthroscopically, it’s important to note that these surgeries are typically not suitable for patients with extensive cartilage loss, such as those with advanced osteoarthritis.

Surgical options include:

  • Microfracture: Stimulates the growth of new cartilage by creating small holes in the bone beneath the damaged cartilage.
  • Osteochondral Autologous Transfer System (OATS): Transfers healthy cartilage from one joint area to the damaged area.
  • Osteochondral Allograft: Uses donor tissue to replace damaged cartilage.
  • Matrix-Induced Autologous Cartilage Implantation (MACI): Cultivates new cartilage cells from the patient’s own cells and implants them into the damaged area.
  • Alignment Correction Osteotomies: Adjust the alignment of the knee to reduce pressure on the damaged cartilage.

Cartilage restoration surgeries typically yield excellent results, particularly in younger, active patients, allowing many to return to pre-injury activity levels. However, not all patients are suitable candidates, especially those over the age of 55.

Long-Term Considerations

If a cartilage injury at a young age is left untreated, it can lead to the development of osteoarthritis. The treatments discussed here are not designed to manage osteoarthritis. In advanced cases, joint replacement surgery may be required to relieve pain and restore function.

Categories: Knee Pain