Knee Articular Cartilage Injuries
An injury to the cartilage that lines the bones in our joints is a common cause of knee pain seen by orthopedic surgeons. Knee cartilage injuries can lead to eventual arthritis of the knee. Injuries can occur to the cartilage lining the femur, tibia or patella and are often associated with direct hits to the knee such as a dashboard injury in the car to the knee or with contact sports. They can also occur over a gradual period of time such as with aging or with mal-alignment deformities of the knee.
Patients often present with pain with range of motion and with weight bearing activities such as walking, running, bending, and kneeling. Pain may be accompanied by knee swelling and loss of motion.
The diagnosis is made with a careful clinical examination by your orthopedic surgeon. Radiographs (or x-rays) are helpful in ruling out arthritis or other reasons for cartilage wear such as mal-alignment deformities. Diagnostic studies such as an MRI scan or an ultrasound scan can pick up cartilage tears.
Initial treatment may require ice, compression and elevation. Your doctor may recommend an aspiration to remove accumulated knee fluid to allow for faster return to full range of motion. Therapy, bracing, and activity modification may be recommended for chronic cases or in degenerative cartilage wear cases such as early arthritis. Surgery may be recommended for the patients with acute injuries or in patients with high demand activities such as professional and recreational athletes and dancers. Patients with associated acute meniscus tears or ligament injuries may also be advised to proceed with surgery to prevent further injury to the cartilage.
Your orthopedic surgeon can best advise you as to the appropriate treatment strategy. Return to full recovery is multi-factorial and depends on size, location, chronicity, tear type and patient age as well as the surgical technique. Diligent physical therapy is paramount for a successful outcome.
(Link to Meniscus tear and ACL section sections above).
Surgery can be performed arthroscopically with the use of a camera placed through minimally invasive incisions into the knee. Open surgery may be advised in certain settings depending on the surgery performed. There are several surgical options available to treat cartilage tears. 1) Debridement - The cartilage may be simply debrided using a shaver to remove and unstable flaps. 2) Microfracture - A microfracture technique may be used to place small holes into the exposed bone. This allows bleeding of the marrow stem cell out of the bone, which can generate into a new lining of cartilage tissue. 3) Transplantion - Cartilage may also be transplanted from one region of the knee to another. Plugs of cartilage and bone are taken from one area of the knee and inserted into the area of cartilage loss. 4) MACI (matrix autologous chondrocyte implantation) - A small amount of cartilage may be harvested from your knee. This cartilage sample is then grown in a lab and expanded into a much larger volume and placed onto a scaffold which is then re-implanted into the knee joint at a second surgery. 5) Cartilage may also be transplanted from a cadaver into the knee.
After surgery, the patient is placed in a brace. Rehabilitation is essential after surgery to restore normal knee motion, strength, and function.