Before we learn about the diagnosis and treatment for articular cartilage injury, it is important to know the risk factors that can cause injury to the articular cartilage.
Risk Factors for Articular Cartilage Injury
There are many risk factors which influence the articular cartilage injury. Some of which are:
- Obesity or Excess Weight: This gives more strain over knees therefore more pressure on knee articular cartilage. When a person is involved, even in ordinary day to day activities like walking, climbing steps, he finds difficult to move than an ordinary weighted person. Also more pressure on knee cartilages over a period of time set off the cartilages thinner, then frictions starts off, then it leads to bone damage.
- Biomechanical Disorders: If a person is having biomechanical problems like uneven legs, flat feet, crooked knees and so on there is a high risk of experiencing articular cartilage injury.
- Having Poor Elasticity and Week Muscles: Due to birth effects or less exercises, ones muscles could be very week and less flexible. This problem leads to another serious problems of articular cartilage injury because weak muscles gives less support to knees as it absorbs less stress which apply on joint bones.
- Athletics: Some activities need extra rush on athletes knees. Regular practices and participating in tournaments more often creates a high risk on articular cartilage injury. Doctors' advice athletes in this nature of work to wear knee guards.
- Previous Experiences of Knee Injuries: If a person has already experienced a knee injury, need to be extra careful during his day to day activities like waking, taking steps, running, weight lifting etc. There's a high risk of causing the articular cartilage as the previous injury has made the knees unstable.
Tests to Diagnose Articular Cartilage Injury
It was not easy to diagnose articular cartilage injury earlier, but now with the modern technology and smart tools and machineries it has become so convenient and less challenging to diagnose this injury. Sometimes articular cartilage injury in a knee is difficult to identify as the signs overlap with the sprain injuries. After a physical exam of the patient, doctor may prescribe two more tests for further clarification.
- MRI or Magnetic resonance imaging exam of the knee joint: Through the use of magnetic field & radio waves this machine can result complete images of a human body. Even cartilage damages also could be detected, but there are instances where this injury could not be identified even if it exists.
- Arthroscopy of knee joint: This device could be used to diagnose the injury and even repair the damage. It is a tube type instrument and into a joint it can be inserted.
Grading Articular Cartilage Injury
The degree of cartilage damage is also possible to rank, the International Cartilage Repair Society has established an arthroscopic degree/ or grading system which ranks the severity of articular cartilage injury:
- Degree 0: A normal or a healthy knee articular cartilage.
- Degree 1: Blisters or soft spots started appearing on the knee articular cartilage.
- Degree 2: The knee articular cartilage has small tears seen on the cartilage.
- Degree 3: More than 50 percentage of the articular cartilage has lesions that have deep crevices.
- Degree 4: The underlying sub chronal knee bone is visible and the knee articular cartilage has damaged severely.
The size / width of each individual injury will also be calculated. An injury to the articular cartilage which is less than 2 square centimeters is marked as tiny. Where the injury is located can also influence severity of pain, function and the medical care. The pain experienced by an individual is not a good indicator to the severity of the articular cartilage injury. Some individuals may have very moderate pain and have more severe injury than others with serious pain.
Treatment for Articular Cartilage Injury
Conservative Treatment for Articular Cartilage Injury
Conservative treatment for articular cartilage injury is the traditional approach for treatments, through unique exercises and usage of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), and sometimes steroid injections as well. Conservative treatment for articular cartilage injury is very well suitable to majority of patients who are suffering from articular cartilage injury. Physical therapy (PT) is a special exercise course an individual can do being at home, once all the exercises are been taught by a physical therapist at the beginning. Conservative treatments try to cure the injury without the need for surgeries.
Surgical Intervention to Cure the Articular Cartilage Injury
Why Should I Consider Surgical Intervention to Treat My Injured Articular Cartilage?
There are no blood vessels in the articular cartilage; therefore damages cannot be repaired or regenerate by the cartilage by itself. Therefore loss of cartilage occurs rapidly and associated worsening symptoms too are generated.
No one should neglect any articular cartilage injury, knee injuries and knee pains, if you left the injury without proper treatment; damage may occur to chondral surfaces and will become increasingly painful. Due to that it may destruct his/ her lifestyle as they are unable to perform their regular exercises and day to day other activities.
New cartilage growth can be stimulated in a joint, or transfer a cartilage from another part of the body by a surgical technique. Before the surgery it is critical to get to know how much of damage has occurred to the articular cartilage to decide the type of the surgery. If the injury is left untreated patient may lose their cartilage permanently. Whenever surgeons come across a situation where a surgery is insufficient, a joint replacement could be done. Especially surgeries are required for those who are not responding to traditional treatments. Different categories of surgical options are there, doctors decide which surgery type is suitable for which patient depending on the age and the daily activity routine of the patient and also the time period that the patient is suffering from the injury.
Possible Surgeries for Articular Cartilage Injury
- Debridement: Debridement is a type of surgery for articular cartilage injury which is done by a small arthroscopic instrument which is also known as mechanical shaver. In this surgery loose edges are removed, smoothens the lesion and lessen the pain.
- Marrow Stimulation: Marrow stimulation for articular cartilage injury surgery makes provisions to form a blood clot in the required sections of the cartilage by revealing the blood vessels which are within the bone. For this to happen few tiny holes need to be drilled to make micro fractures in the bone beneath the damaged cartilage. Then a new cartilage forms up with the support from blood cells. But there is a main issue in this surgery type, that is, it constructs a different cartilage type which is called fibro cartilage. The fundamental cartilage is known as hyaline cartilage by name which is naturally more flexible than the artificially constructed cartilage (fibro cartilage) by the surgery. Fibro cartilage deteriorates faster than the natural one, therefore patient may have to undergo the same surgery many times in his life time.
- Mosaicplasty: Mosaicplasty surgery for articular cartilage injury is suitable only for cartilage damages in non-load bearing parts of the body joints and also this is insufficient to cure extensive damages as the level of osteoarthritis. If the harm is about 10-20mm this surgery is suitable. In this surgery an undamaged cartilage part is transferred to the damages area of the joint.
- ACI or Autologous Chondrocyte Implantation: ACI or autologous chondrocyte implantation for articular cartilage injury is a method which allows provisions the cartilages to grow artificially in a laboratory from a small cartilage piece taken from the patient by means of biopsy. Cultivated cartilage cells in the lab then are implanted to the knee after 1 month or so. From periosteum (lower leg) a small piece bone of exterior coating/tier is captured and replaced into the cartilage damaged area and then periosteum is shut.
Treatment Summary for Articular Cartilage Injury
- Rest, Ice, Compression, and Elevation (RICE) is a technique which can be useful in minimizing swelling.
- Nonsteroidal anti inflammatories are used to reduce pain and swelling.
- The affected individual is advised to see a sports Injury specialist.
- An X-ray or arthroscopic surgery is done for confirmatory diagnosis.
- As mentioned above, rest is imperative.
- The affected patient should be enrolled in a rehabilitation program.
- If a fracture is identified for example in osteochondritis dissecans, surgery becomes necessary to required repair the broken fragment.
- There is another surgical procedure which involves recruitment of marrow stem cells into the affected area by piercing the subchondral bone so as to accelerate recovery of the articular cartilage.
Complications in Articular Cartilage Injury
If a person does not give much attention to his knee pain caused by articular cartilage injury and if proper treatments are not given, he/ she is at a danger of losing their knee which is required for proper functioning of his legs. Gradually they will reach to a complication of osteoarthritis stage and he may have to suffer with unbearable pains. Strong pain killers gradually bring him to a dangerous situation like kidney failure or damage.