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What To Do For Cartilage Damage In Knee

How Is A Meniscal Tear Diagnosed

Do you need surgery for cartilage damage in your knee?
  • How you injured your knee and the symptoms you are getting may be enough to tell a doctor that you have a meniscal tear.
  • A doctor or therapist will need to examine your knee. Certain features of the examination may point towards a meniscal tear. They will also want to examine the rest of your leg, including your hip, to check for other injuries or other causes of your symptoms.
  • Cartilage doesn’t show up well on an X-ray so an X-ray of your knee is not usually necessary. The one time you might need to have an X-ray would be if your doctor is concerned that you might have damaged your bone when you injured your knee.
  • The diagnosis of a meniscal tear can be confirmed by a magnetic resonance imaging scan.
  • Computerised tomography scanning is not as good as an MRI for diagnosing a meniscal tear.

Knee Cartilage Damage Causes

The most common cause of knee cartilage wear is osteoarthritis. Knee cartilage loss can be due to an injury to the knee such as a ligament tear, patellar dislocation, or meniscal tear. In addition, loss of cartilage can be triggered by lifestyle factors such as weight gain, diabetes, and high cholesterol. Also, inflammatory arthritis conditions such as rheumatoid arthritis can lead to further damage.

What Are The Symptoms Of A Knee Cartilage Injury

If a fragment of cartilage is damaged or breaks away, it can cause:

  • Pain, swelling and stiffness in the knee
  • A sensation of grinding or clicking in the joint when it moves
  • Difficulty carrying out everyday activities such as walking, climbing stairs, bending, squatting and kneeling
  • Knee instability
  • The joint catching or locking when you bend or straighten your knee

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What Are The Risks And Complications

In addition to the risks associated with any surgery and the anaesthetic, there are some risks specific to this surgery :

  • Joint stiffness can develop if the post-operative rehabilitation is not carried out properly.
  • Exacerbated inflammatory reactions which sometimes correspond to algodystrophy. However, new treatments exist that can help manage this rare complication more easily.
  • A haematoma may appear around the area operated on due to bleeding. According to the extent of the bleeding, drainage may be necessary.
  • The occurrence of an infection, although rare , is a serious complication and may require surgical revision and a course of antibiotics.
  • Small blood clots can form and block the veins in the legs resulting in phlebitis, which will require an anti-coagulant treatment for several weeks.
  • The mobilisation of a graft or the displacement of a fixed cartilage fragment can occur and require revision surgery.

This list of risks is not exhaustive. Your surgeon can provide you with any additional explanations and will be available to discuss the advantages, disadvantages and risks of each specific case with you.

Surgery For No Cartilage In Knee: What Are The Options

Torn Knee Cartilage

Surgical options for no cartilage in the knee are limited.

Firstly, keyhole surgery for knee osteoarthritis is not effective and, in fact, could accelerate knee damage.

High tibial knee osteotomy can reduce pressure on the knee joint if there is a malalignment problem. However, evidence for effectiveness is not strong and risks are real.

Finally, knee replacement surgery is effective at reducing pain and improving function compared to physiotherapy, but the sting in the tail is that 16% of people have problems after this surgery some of these are serious. Bottom line is that surgery should only be done once your pain and activity levels become unacceptable.

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Types Of Knee Cartilage Tears

What part of your knee cartilage have you injured? The two most common types of knee cartilage injury are:

  • Articular cartilage tears, affecting the cartilage covering the ends of your bones at the knee joint. An injury to this cartilage is called a chondral injury. Chondral injury is commonly seen in cyclists, runners, skiers, and soccer players.
  • Meniscus tears, affecting the c-shaped shock absorbers located on either side of your knee joint. Meniscus tears can happen to anyone at any age, but are particularly common in athletes who play contact sports like hockey or football.

Ligament injuries of the knee, such as ACL tears and PCL tears, are frequently confused with cartilage injuries. Though these are also components of the knee and share similar symptoms to cartilage tears, they’re different and may be treated differently.

Symptoms Of Knee Cartilage Damage

The symptoms of knee cartilage damage are similar to other common knee injuries:

  • joint pain this may continue even when resting and worsen when you put weight on the joint. J oint pain this may continue even when resting and worsen when you put weight on the joint
  • swelling this may not develop for a few hours or days
  • stiffness

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About Knee Cartilage Damage

The bones of your knee joint are coated with a layer of slippery tissue called cartilage, which reduces friction as the bones move over each other. Cartilage can be damaged or torn as a result of an accident or conditions such as arthritis.

Knee cartilage damage can be caused by a sudden twisting movement or a direct impact to the knee both of which happen in sports such as rugby, squash, football or skiing.

Arthritis is a common cause of knee cartilage damage. There are two main types of arthritis:

  • osteoarthritis a degenerative condition that wears away bone and cartilage.
  • rheumatoid arthritis an inflammatory disease causing swelling and stiffness in your joints, which can damage the bones and cartilage.

Minor cartilage damage can get better on its own after a few days, although more serious injuries or conditions will need treatment.

Cartilage has very little blood supply, meaning it is hard for it to repair itself. Surgery is usually the only option for more serious damage.

How Are Articular Cartilage Injuries Treated

Should you have surgery for a small area of cartilage damage?

Several treatments and therapies are available, including nonsurgical and surgical options. The choice of treatment depends on several factors, including age and overall health, physical activity level, desired post-treatment activities, and the type and severity of the articular cartilage injury.

Nonsurgical Treatment. Nonsurgical treatments are used to relieve symptoms and to prevent or slow further degeneration of cartilage. Nonsurgical treatments can improve quality of life by reducing pain and enhancing strength and mobility, but they cannot repair damaged articular cartilage. They are often used in the initial period following an injury, or when cartilage loss is extensive, as in the case of arthritis.

  • Resting
  • Applying ice to the affected joint for 15 minutes every one or two hours to reduce swelling
  • Elevating the joint to reduce swelling
  • Taking over-the-counter anti-inflammatory medications, such as acetaminophen, to reduce pain and swelling
  • Avoiding sports and activities that cause pain or involve heavy use of the affected joint
  • Using an unloader brace to unload the cartilage injury
  • Corticosteroid injections, to reduce inflammation and pain
  • Viscosupplementation, a treatment in which a physician injects the affected joint with hyaluronic acid. This lubricates the affected joint, reducing friction between bones in the joint and decreasing pain.

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What Is Cartilage Repair

On this website, we focus only on articular cartilage repair treatments, which means the restoration of damaged hyaline cartilage in the joints. Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy. Typically, these procedures are recommended for cartilage damage or deterioration caused by:

Injury or trauma, including sports injuries or repetitive use of the joint Congenital abnormalities abnormalities a person is born with that affect normal joint structure Hormonal or idiopathic disorders that affect bone and joint development, such as osteochondritis dissecans . There are several types of new and modern procedures for cartilage repair and regeneration techniques that are designed to heal the cartilage by filling the cartilage defect with repair tissue.

Traumatic Osteochondral Damage To The Articular Surface Of The Knee

These lesions occur associated with traumatic injuries to the knee. They can occur in any part of the knee joint, but most commonly are found on either the femoral condyles or in the patellofemoral articulation.

They can happen as a result of direction compaction injuries, such as can occur in the patellofemoral joint, if for example, the knee is struck against a car dashboard in a road traffic accident. Compaction injuries occur when two areas of the joint hit each other causing bleeding in the bone, as can be seen in the MRI scan below.

The more common mechanism for traumatic osteochondral defects is usually a rotational injury to the knee. The mechanism to cause an osteochondral lesion is usually a shearing force across the articular cartilage. For adequate shearing forces to occur, tearing of a major ligament must occur to the knee, the most common of which is an anterior cruciate ligament tear. The other common site of significant shearing forces developing, is at the patellofemoral joint, when a patella dislocation occurs.

Osteochondral/chondral injuries are commonly associated with major ligament injuries to the knee and also with meniscal injuries.

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How Do You Injure The Articular Cartilage

Damage to the cartilage covering the end of the bones at the knee joint is called a chondral injury. If the underlying bone itself is also damaged, this is called an osteochondral injury.

Injuries to the articular cartilage usually happen in combination with other injuries to the knee, either to the meniscus or the knee ligaments or bones.

What Are The Most Common Symptoms Of Cartilage Damage In The Knee

Torn Knee Cartilage

Cartilage damage can affect your knee in different ways.

Torn cartilage can get caught between the structures of your knee, resulting in pain, swelling and sometimes a locking or catching sensation.

You may also experience a feeling of instability and weakness.

Knee pain can cause you to alter your gait, which can, in turn, lead to misalignment and pain in your knees, ankles or hips.

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What Options Exist For Repairing Or Replacing Damaged Cartilage

When we evaluate patients for surgical treatment, the first thing we do is determine into which of two categories the injury falls. The first is surface damage only the cartilage is damaged but the bone beneath it is healthy. The second involves damage to both the cartilage and underlying bone.

When only the cartilage needs repair, its something like fixing a pothole, and there are a number of techniques to consider.

According to the FDA, the current gold standard of care is a procedure called microfracture. During microfracture, a surgeon cleans up the area of injury, removing the damaged cartilage and exposing healthy edges of the surrounding cartilage. The surgeon then drills small holes in the bone at the base of the defect. Over time, bone marrow cells will rise up through the holes and form a clot. After surgery, the patient must participate in a course of specific exercises and therapy. This specific rehabilitation program helps to ensure that the clotted cells will turn into cartilage, rather than becoming stiff like bone or scar tissue.

Patients with small areas of damage who commit to the necessary rehabilitation have good success with microfracture, although the benefits tend to decrease over time, with symptoms returning after a few years.

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A similar approach, called , is currently being evaluated in a clinical trial. Michigan Medicine is the only site in the state participating in the trial.

Symptoms Of Torn Knee Cartilage

How do you know if you’ve sustained a cartilage tear?

You may experience acute symptoms like pain and buckling of the knee right after an injury, but not necessarily sometimes, cartilage damage can happen gradually over time, resulting in intermittent symptoms. Some people with meniscus tears have no pain and don’t even realize they have an injury.

However, even if you’re pain-free, you will likely note one or more of the following symptoms:

  • pain or tenderness in the knee
  • buckling or locking of the knee joint
  • crunching or popping noises when walking
  • dull pain under the kneecap when exercising
  • difficulty bearing weight
  • inability to bend or straighten the knee
  • swelling or “water on the knee,” a buildup of fluid inside the knee joint
  • tightness of the knee joint

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Do You Need Surgery For Cartilage Damage In Your Knee

It is common for an active person to want to delay surgery for an injury in order to play sports or exercise. Is there a risk, though, of doing more damage? In this Ask Dr. Geier video, I answer that question for one of the most common injuries throughout the body articular cartilage damage.

Maureen in Stony Point, New York asks: Hello Dr. Geier: My son is 16 years old and had been recently diagnosed with an injury to his articular cartilage in his right knee. He plays soccer and basketball for his high school. Its been recommended that he has surgery to repair it if he wants to continue to play sports. He does not have any pain, but he just refers to the feeling in his knee as weird. He has rested it for more than six weeks. Of course, now feels great, but the doctor recommends he has surgery. Is there any sense in just trying physical therapy and continue to play as long as he has no pain? Of course I only want to do whats best for my son. Thank you for any help and advice you can give him. Your information on your blog is very informative and helpful.

The articular cartilage is the cartilage lining the ends of the bones within a joint. It helps the joint move smoothly. The articular cartilage serves as a shock absorber. If that cartilage breaks down, you can have pain, swelling and catching sensations. If the cartilage continues to break down within a joint like the knee, osteoarthritis can develop.

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Benefits Of Knee Cartilage Replacement

Cartilage injury: What does it mean for you?

Knee cartilage can cause daily pain and reduced mobility when it has been severely injured or worn down to the point where it no longer provides smooth bone movement within the joint or cushioning between the bones. It is not a condition that will improve on its own.

Repairing or replacing damaged knee cartilage can:

  • provide pain relief

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How Is A Knee Ligament Injury Diagnosed

Your healthcare provider will ask you to have your health history and do a physical exam. You may also need one or more of these tests:

  • X-ray. This imaging test can rule out an injury to bone instead of a ligament injury. It uses energy beams to make images of internal tissues, bones, and organs on film.
  • MRI. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. It can often find damage or disease in bones and a surrounding ligament, tendon, or muscle.
  • Arthroscopy. This procedure is used to diagnose and treat joint problems. The healthcare provider uses a small, lighted tube put into the joint through a small cut . Images of the inside of the joint can be seen a screen. The procedure can assess joint problems, find bone diseases and tumors, and find the cause of bone pain and inflammation.

How Do You Tear Your Meniscal Cartilage

The knee is commonly injured in sports, especially rugby, football and skiing. You may tear a meniscus by a forceful knee movement whilst you are weight bearing on the same leg. The typical injury is for a footballer to twist the knee whilst the foot is still on the ground – for example, whilst dribbling around a defender. Another example is a tennis player who twists to hit a ball hard but with the foot remaining in the same position. The meniscus may tear fully or partially. How serious the injury is depends on how much is torn and the exact site of the tear.

Meniscal tears may also occur without a sudden severe injury. In some cases a tear develops due to repeated small injuries to the cartilage or to wear and tear of the meniscal cartilage in older people. In severe injuries, other parts of the knee may also be damaged in addition to a meniscal tear. For example, you may also sprain or tear a ligament.

Meniscal cartilage does not heal very well once it is torn. This is mainly because it does not have a good blood supply. The outer edge of each meniscus has some blood vessels but the area in the centre has no direct blood supply. This means that although some small outer tears may heal in time, larger tears, or a tear in the middle, tend not to heal.

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What Is Cartilage And How Is It Injured

Cartilage is a smooth, slippery tissue that lines your joints so that your bones dont rub against each other when you move. Cartilage comes in a few types, including articular cartilage, which lines moving surfaces, and the meniscuses in your knees, which absorb impacts and support your full body weight.

Articular cartilage injury can happen in a number of ways. These include rips and tears, such as from sport, lifting or motion injuries, and basic wear injuries, either from impacts or long term erosion. While any kind of cartilage can be injured, those most commonly injured are those in important weight bearing joints, such as your hips and knees.

What Is Cartilage Damage

Articular Cartilage Injury

The slippery articular cartilage that coats your bones helps with smooth movement.

If its torn or worn, it can leave the rough bone surfaces exposed resulting in friction in the joint. Damaged cartilage can potentially lead to knee arthritis, with long-term effects on your knee function.

Damaged cartilage almost always has some sort of effect on your knees whether its pain, swelling or stiffness.

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