Articular cartilage injury

Articular cartilage is an extremely smooth and resilient structure, which covers the bone’s articulating surfaces (those surfaces that come into contact with other bones). Its function is to allow for the smooth gliding between two bony surfaces of the joint. It has no blood supply and once injured if injured often leads to permanent damage.

Injury to articular cartilage is quite common and is often not diagnosed.

Recent advancement in the understanding, diagnosis and treatment of articular cartilage injury has now made it possible to effectively manage and provide treatment in the majority of patients. We have experience in providing treatment for these injuries in the form of articular cartilage transplantation, Autologus Grafting, Chondroplasty and Microfracture.

 

How is it injured?

Injury to the articular cartilage usually occurs after sports injuries. It commonly affects the Tibio femoral (main weight bearing) or the Patellofemoral (knee cap) joint.

Injuries resulting from a forceful impact on the knee joint, such as a tackle in football or rugby are commonly associated with injuries to other structures within the joint such as Anterior cruciate ligament, Posterior cruciate ligament and damage and tear of the Meniscus. Direct impact on the knee cap (Patella) or dislocation of the patella can also cause damage to the articular cartilage.

Sometimes spontaneous damage can occur in conditions like Osteochondritis Disseacans, in which part of the bone and its covering articular cartilage becomes dead due to lack of blood supply.

 

Types of Damage

Damage is graded from I-IV and can vary from obvious defects in the bone (grade IV) to very minor microscopic damage (grade I). Injury to the articular cartilage causes inflammation and pain in the knee joint and in the long term may accelerate the onset of osteoarthritis.

What are the symptoms?

• Recurrent pain and swelling in the knee joint.
• Aching pain after activity or at rest.
• Feeling of roughness and locking inside the knee joint (Crepitaion). Knee movements may be associated with audible 'clunks' or 'clicks'.

 

Diagnosis

Articular cartilage injuries can sometimes be difficult to diagnose.

Diagnosis is based on the following:

• Listening to the patient's history and mechanism of injury
• Surgeon’s expertise in the field of knee surgery
• X-ray and MRI scan. In some cases damage cannot be seen even though it is present.
• Gold standard – Direct visualisation by performing Keyhole surgery
  (Arthroscopy)

 

Treatment options

What can Patients do?
Rest, Ice, Anti inflammatory and simple movement and exercise. If problem continues then surgery may be required.

 

Surgery

Various types of surgery are performed for articular cartilage injuries.

These depend on the severity and type of injury, size, area affecting inside the knee, other associated injury and cause of injury.

Brief description of these techniques:

• Debridement- The surgery involves making the rough area as smooth as possible by removing loose edges.
• Microfracture- The surgery stimulates scar cartilage to grow and fill the lesion. Scar cartilage has limited life span and will degrade with time.

Replacement of cartilage 

Oseochondral Autologus grafting – It is a technique by which a piece of cartilage and the bone underneath is taken from the area of least use and transplanted to the area of missing cartilage and bone. This technique is quite effective and has good success rate. It can be done either by arthroscopic or open surgery.

Autologus cartilage implantation (ACI)

This technique involves two-stage surgery. In the first stage a small piece of patient's cartilage is taken from the affected knee by keyhole surgery. The cells are then sent to a laboratory to be grown on a membrane. This is done as a day case surgery.

Second surgery is performed six weeks later. This involves Open surgery and transplantation of cartilage to the injured area of the knee.

Patients are in hospital for 2-3 days. They use the walking aid for 6 weeks and also have physiotherapy. Average recovery time for normal activity is 6-8 weeks and return to sports is 6-9 months. Success rate of surgery is around 80-90 percent depending upon surgeon's experience and patient’s motivation and strict adherence to the rehabilitation programme.