What is Articular Cartilage Injury?
Cartilage is an important structural unit of the body. It is present in places like the joints, the spine, the end of ribs, in the bronchial tubes, and the ear and the nose. Cartilages are firm, but flexible tissues. There are many types of cartilages found in the body. Among them, articular cartilages are the ones that are present on the surface of the bones. As the name suggests articular cartilages exist to render articulation to the bones and retain their lubrication. Complexities arise when these cartilages are damaged, behind which many causes can play an active role. For example, a sports injury can damage the cartilages around the knees. Other causes include the twisting of the Anterior cruciate ligament and a progressive knee injury. Articular Cartilage Injury can also be an isolated event.
Since there are no blood vessels in the cartilages, it takes quite long for them to heal. Symptoms Pain and inflammation of the knee Locking of the knee Generation of noises when the knee is moved
The best treatment option for damaged cartilages is RICE therapy if the injury is not too severe. rice can be broken down into Rest, Ice, Compression and Elevation.
For severe cases, interventional methods like osteochondritis dissecans surgery might be attempted. The objective of this surgery is to attach the detached fragment. Another surgery that works to restore the damaged cartilage is marrow stem cell transplant whereby the stem cell is implanted in the cartilage defect. Multiple arthroscopic modalities of treatment are now available for cartilage repair which are customised according to the specific condition.
Along with bones, the human structure is also supported by cartilage. Cartilage is a tough, flexible tissue that acts as a cushion between bones at joints. Some parts of the body such as the outer structure of the ear is completely made up of cartilage. Damage to the cartilage can cause pain, inflammation and in some cases even a degree of disability. Since cartilage does not have a blood supply, cartilage damage takes longer to heal than other injuries.
There are three main causes of cartilage damage
A physical examination may not be enough to diagnose cartilage damage as the symptoms of this condition are very similar to that of a sprain or ligament damage. In addition to a physical examination, a doctor may use Magnetic resonance imaging (MRI) or Arthroscopy. An MRI uses radio waves and a magnetic field to create a detailed image of the body. Arthroscopy involves the insertion of a tube-like instrument into the joint to determine the extent of cartilage injury.
Treatment for cartilage damage is both surgical and non-surgical.
Non-surgical treatment includes exercises, steroid injections and physical therapy.
If the patient does not respond well to this form of treatment, surgical options may be looked at. The type of surgery required depends on the age and activity level of the patient along with the extent of the injury.
Some of the surgical options include:
The shoulder is one of the most intricate joints in the body and given that it is subjected to a lot of lifting and movements, there are chances for it to tear or dislocate. The shoulder is a ball-and-socket joint with the socket in the shoulder, and the ball in the upper arm. The joint space between the two bones is surrounded by cartilage, and the space between the two is filled with fluid. Especially in athletes, due to forceful movement, this joint could get dislocated or the cartilage could tear.
The Bankart lesion is when there is a tear of the cartilage in the central anterior shoulder. This causes the cartilage to be damaged, allowing the humeral head to slip down from the socket. When the arm is extended down or to the side, it is commonly dislocated. This can happen posteriorly also, but this movement and so the injury is less likely than an anterior dislocation. If there is also a fracture of the shoulder bone with this dislocation, then it is known as bony or osseous Bankart lesion.
Causes: Bankart lesions can be acute or chronic. Acute is when there is sudden dislocation due to sports activity or accidents. Repetitive use of the shoulder can also lead to chronic Bankart lesions. This is usually seen in sportspersons like swimmers, tennis players, and weightlifters.
Signs and Symptoms:
The course of treatment depends on the cause and condition of the patient. An exercise regimen is prescribed as the first step in the treatment process. If there is inadequate progress, or if the pain seems to be recurrent, open or closed shoulder surgery may be recommended to include the following:
Any of these shoulder surgeries would be followed up with measures to reduce further injury. It is therefore advised to visit a doctor in case of any such discomfort as he/she will be able to find out the severity of the situation and devise a treatment plan accordingly.
Skin is one of the most obvious parts of our body which ages with an increase in the number of candles on our birthday cakes. As you age, joints tend to become stiffer and less flexible. The body does not recover from bumps and bruises as easily as it did before, and it becomes difficult to stand for extended time intervals. This is caused mostly by a breakdown of cartilage and inflammation of the synovium.
What is cartilage?
Cartilage is a flexible connective tissue. It connects the ends of two bones in a joint. It is softer than bone tissue but less flexible than muscle tissue. Cartilage is responsible for the smooth movement of joints.
With age, cartilage begins to degenerate. As the cartilage gets thinner, movement becomes more and more difficult. If left untreated, the cartilage may completely wear off leaving no buffer between the bones. This is one of the leading causes of knee replacement surgery.
What is synovium?
Synovium is a membrane responsible for keeping the cartilage healthy. It produces a thick fluid that keeps the cartilage and joint lubricated. In cases of osteoarthritis, this membrane can swell up and produce excess fluid. This in turn causes the joint to swell as well.
Along with age, factors like being overweight, genetics, gender and lifestyle also play a role in the condition of your joints. Being obese points towards a sedentary lifestyle and puts extra pressure on joints, leading to the thinning of cartilage. While men have higher chances of becoming osteoarthritis patients before 45, women have higher chances of developing this disease after 50. A healthy lifestyle is the easiest way to ensure that your joints work well even when you're old and grey.
Movement of the joints keeps the fluid in them moving. It also prevents the cartilage from shrinking and stiffening up. Exercise also makes the bones stronger, and slows the rate of bone tissue deterioration. Stretching exercises are also a good way to maintain the flexibility of joints.
Foods that are known as natural anti histamines, antioxidants and foods that fight inflammation promote healthy joints. Some of these are:
- Green tea: It prevents the breakdown of collagen and cartilage
- Nuts and seeds: These are rich in omega 3 fats that are essential for good bone health
- Ginger: It relieves pain and joint swelling
- Yogurt: It helps soothe tender joints and fights inflammation
- Pomegranate: It protects the cartilage against damage
Hot and cold therapy can also help relieve joint pain and reduce inflammation. As you get older, avoid putting too much pressure on your joints and give them adequate rest. Lastly, avoid smoking, as people who smoke have an increased risk of cartilage loss.
Have you undergone cartilage damage recently and are seeking ideal treatment measures? Cartilage damage is a common form of injury that involves your knees. Other joints such as the ankles, elbows and hips may also be affected by cartilage damage. Cartilage, the tough and flexible tissues covering the surface of your joints, acts as a shock absorber, allowing the bones to slide over each other. Cartilage damage may occur because of injuries such as gradual wear, sports injuries and osteoarthritis. While acute cartilage damage may heal on its own, severe damage may need treatment via surgical measures.
The most common surgeries that are undertaken in cases of cartilage damage include the following:
Lavage and debridement
In some cases, joint replacement surgery has to be carried out. In this procedure, the entire affected joint is removed and replaced with an artificial joint. Hip replacement and knee replacement are common examples of this kind of surgery.
Cartilage is a tough, flexible tissue found throughout the body. It acts as a cushion between the bones and covers the surface of the joints. People having damaged cartilage often suffer from inflammation, stiffness and pain in joints.
What causes damage to the cartilage?
What are the symptoms of damaged cartilage?
How can you diagnose that you have damaged cartilage?
With the help of many non-invasive tests, your doctor can diagnose whether you have damaged cartilage or not. Some of the common tests carried out to diagnose damaged cartilage include Arthroscopy and MRI (Magnetic Resonance Imaging).
What are the treatments available for damaged cartilage?
Treatment for damaged cartilage depends on the severity of the case and if you have injured your joint and still can walk and put on weight, you can be treated with PRICE therapy. PRICE stands for:
Physiotherapy can be helpful in strengthening the muscles around the affected joint. Your doctor may refer you to a physiotherapist who can treat you at your home. Severe cartilage damages need to be treated with surgery.
Surgery for joint preservation is used to repair damaged articular cartilage because of osteoarthritis and malalignment. High Tibial Osteotomy is a medical or surgical method to realign the knee joint. This surgery especially helps people with knee arthritis to avoid knee replacement surgery, either partial or total, by maintaining injured joint tissues.
People suffering from degenerative arthritis or osteoarthritis encounter a high crushing of the articular cartilage and menisci that can result in their tearing. Unbalanced forces lead to unwarranted pressure on the knee resulting in mal-alignment.
High Tibial Osteotomy as an Alternative to Knee Replacement:
High Tibial Osteotomy is usually performed on younger people suffering from mal-alignment or arthritis. The plastic and metal parts used in the total knee transplant surgery have a life expectancy of 15-20 years that might result in another knee transplant surgery for a younger patient. That is why high Tibial Osteotomy is referred to the younger patients until knee replacement becomes unavoidable.
Through High Tibial Osteotomy, the knee is re-aligned to take the pressure off the injured side of the knee. One will have to go through some medical tests before the surgery to know the actual condition of the injury. If the mal-alignment of the knee is not treated, it can make difficult for the patients to perform their daily tasks even walking.
Who Are Eligible for High Tibial Osteotomy?
HTO or High Tibial Osteotomy of the knee is more appropriate for young, active people. Patients who do not feel pain under their knee cap and only on a single part of the knee are permitted for knee osteotomy. They should be able to bend and straighten their knees completely. One should consult their doctor before confirming the type of surgery they will be going for as not everyone is suitable for High Tibial Osteotomy depending upon the severity and overall health of the patient.
Types of Osteotomy Surgeries:
Closed Osteotomy Surgery: The most commonly osteotomy procedure used is a closed wedge osteotomy where the wedge bone is replaced through guide wires. The bones are then closed to fill the gap with the removal of the wedge.
Open Osteotomy Surgery: In this type of osteotomy surgery, the bone wedge is opened to add a bone graft to block up the space with the removal of the wedge.
An effective osteotomy postpones the need for knee replacement surgery.
No physical restrictions have been posted for the surgery.
Unpredictable pain post surgery
Longer healing time than partial or total knee replacement surgery
Difficulty in bearing weight on the operated knee
Physical joint exercises
Protective weight bearing exercises
Use of crutches or walkers as assistive devices
Radiography to correct maintenance of bone
High Tibial Osteotomy Surgery is performed to avoid Total or Partial Knee Replacement Surgery. This type of surgery is mostly performed on young patients. For most sufferers, this alternative has proven to be working to relieve pain. However, it is always advisable to consult a doctor before opting for this surgery.
Cartilage is a fine, rubbery elastic tissue that acts as cushion between the bones in the joint spaces. It is a connective tissue and enables the joints to move freely and smoothly. It acts as a shock absorber and reduces the friction between the joints. This cartilage could either be damaged as a result of injury or degeneration as part of normal ageing process. Either of this causes friction during joint movement, causing painful, stiff movements and in some cases, even swelling of the joint spaces.
There is also a covering around the joints known as synovium. When there is a cartilage damage, this synovium is irritated, leading to increased secretion of synovial fluid, which can cause swelling in joints. There is also reduction in the range of motion of the affected joint.
Most commonly affected joints include knees, hips, shoulders, elbows and ankles. Other than degeneration that happens with ageing, cartilage damage is mainly caused by injury or trauma including fall/impact, joint dislocation, infection, ligament tear, meniscus tear, and inflammation (gout, arthritis, etc.)
Read on to know some of the most common causes for cartilage damage and ways to manage it.
Age and trauma are the main reasons for cartilage damage.
Direct blow: A heavy blow directly to any joint leads to damage (accident, sports injury, etc.).
Ageing: With constant wear and tear, joints that are under constant stress are prone for damage.
Obesity: This is also a common cause leading to chronic inflammation and breakdown of the joints.
Limited mobility: For whatever reasons (including sedentary lifestyle), lack of movement can cause cartilage damage.
The presenting symptoms of a person with any affected joint would be pain, discomfort and stiffness with movement. In addition to history and physical examination, MRI and arthroscopy can be used to confirm the diagnosis.
Start with a conservative approach and gradually switch to more advanced treatments. Conservative approach includes a combination of pain killers, steroid injections, and exercise (at a clinic or at home). If these do not work, the following surgical options are available:
Debridement: The affected cartilage is smoothened and the loose edges are removed to prevent rubbing and irritation. It is done using a shaver.
Marrow Stimulation: Using the marrow cells, more cartilage production is stimulated. Using tiny drills, holes are drilled to form a blood clot, which triggers formation of new cartilage.
Mosaicplasty: In areas of localized damage, healthy cartilage from an unaffected area is placed.
Autologous Chondrocyte Implantation: Cartilage that is grown in a lab for one to three months are placed into the knee or affected joint to allow for healthy tissue growth.
When it comes to contact sports like football or basketball, orthopaedic injuries are unavoidable. Given the high risk of falling and accidents and wear and tear of muscles, injuries like stress fractures, torn ligaments, ACL tears and chronic pain are common complaints a sports doctor comes across. Sports medicine is a specialisation of this field that deals exclusively with the prevention, diagnosis and treatment of injuries sustained while playing sports. A sports doctor must not only treat an injury but must also speed up the healing process so as to allow their patients to return to the field as quickly as possible.
When it comes to surgeries for sports injuries, the smaller the incision made, the faster an injury will heal. This has led to the popularisation of minimally invasive surgeries. Arthroscopy is one such type of minimally invasive surgery that is used by doctors to diagnose and treat joint injuries and musculoskeletal conditions.
This procedure is typically performed on a patient under general or spinal anaesthesia. When being used to diagnose a condition, it involves the insertion of a thin fibre optic tube with a light, magnifying lens and camera into the body through a small incision no bigger than a button hole. This allows the doctors to examine the bone and joint in detail. In cases where this type of surgery is being used to treat a patient, specially designed instruments may also be inserted through an additional small incision to repair the injury.
Arthroscopic surgeries for sports injuries are often used in combination with other approaches or open surgery. One of the most common conditions, this type of surgery is used to treat are ligaments in the knee. Other conditions that can also be treated with arthroscopic surgeries are torn cartilage, inflammation of the joint lining, carpal tunnel syndrome, tears in the rotator cuffs and loosening of bones and cartilage.
After the surgery, the incision will be stitched shut and a dressing will be placed over it. In most cases, patients require almost no pain medication as compared to the medication needed to recover from open surgery.
However, it can take several days for the joint to recover and for the incision to heal. Some of the benefits of this kind of surgery are:
Cartilage is an important structural component of human body. It is found in various parts of body like joints, end of ribs, nose, ears, and airway tube.
Knee joint contains 2 types of cartilage. 1st is the type which lines the surface of bones. 2nd type lies between the two joint forming bones and is called Meniscus. This article is about 1st type which is also called as articular cartilage.
Cartilage can get damaged by injury, ageing, infection and rheumatological disorders. Injury is a common culprit in young age especially in a sports person. Cartilage injury can manifest itself with pain swelling, locking of joint and inability to put load on affected leg.