What is cartilage?
Cartilage is a layer of tough tissue that covers the ends of your bones at the joints. It provides the smooth surface to allow smooth movements between bones.
How can cartilage defects and injuries occur?
Cartilage defects or injuries can occur due to various reasons. These can occur as part of the wear and tear of the joint over time ( resulting in osteoarthritis). These may also occur due to a specific trauma or injury. Repetitive micro injuries in sports persons could also be a cause.
What are the symptoms of cartilage defects?
These defects can cause pain and swelling. They can casue reduced joint mobility. The defects can progress over time. Fragments of cartilage and bone can become loose bodies inside the joint, which can cause pain, catching, giving way, and can further damage the remaining joint cartilage. These symptoms can significantly impact quality of life.
How are cartilage defects managed?
Conservative Treatments:
- Physiotherapy: It helps strengthen the muscles around the joint and improves stability and mobility. It can also reduce pain and improve function.
- Medications: Short course of anti-inflammatory medicines can help manage symptoms.
- Joint Injections: Specific joint injections in the joint can help reduce inflammation and improve function.
Surgery
Surgery is considered depending on the severity and location of the defect, presence of loose bodies, as well as the patient’s age, activity level, and overall health.
Refixing of fragment: In very few cases, it may be possible to refix the fragment.
Microfracture Surgery: Small holes are made in the bone beneath the cartilage, which releases cells that can build new cartilage.
Osteochondral Autograft Transplantation (OATS): Small plugs of healthy bone with intact cartilage covering are taken from one area of the joint and used to fill the defect.
Cell-based and cell-free bio-regenerative therapies:
Autologous Chondrocyte Implantation (ACI and MACI): New cartilage cells are grown in a lab and then implanted in the cartilage defect, with or without a scaffold. This requires two surgeries.
Chondrofiller: Other options are cell-free collagen matrix implant like Chondrofiller, which can be done in a single surgery. PRP injection inside the joint may also be used.
Autocart/ minced cartilage & PRP with fibrin coat: Very Small pieces of patient’s own cartilage are taken and mixed with bio-regenerative substances and used to fill up the cartilage defect. This gives very good results and needs only single surgery.
Joint Replacement: When the cartilage damage is extensive, joint replacement or arthroplasty is needed. Sometimes, only a part of the joint needs to be replaced, like the Unicondylar Knee Arthroplasty (UKA) or Unicondylar Knee replacement (UKR). Other times, the whole tibio-femoral joint needs to be replaced (Total knee replacement or TKR/ TKA)
How can we prevent cartilage damage?
There are some precautions that you can take to reduce the risk of cartilage damage.
- Maintain a healthy weight as recommended for your height (BMI) to reduce stress on joints.
- Do regular exercise to strengthen the muscles around your joints. For example, for the knee joint, maintaining a healthy quadriceps muscle.
- Avoid repetitive stress on joints.
- Wear appropriate protective gear when engaging in sports.
Early diagnosis and treatment are crucial for managing cartilage defects and preventing progression of damage. If you’re experiencing joint pain or other symptoms associated with cartilage damage, it’s important to see your Orthopaedic doctor specialised in Arthroscopy and Arthroplasty techniques to explore the most appropriate treatment options for you.
