Muscles In The Medial Compartment
There are several different muscles that attach above or below the medial compartment of the knee. They include:
- Adductor magnus muscle: This muscle runs along the side of the leg and inserts near a boney bump called the adductor tubercle on the medial femoral condyle.
- Medial gastrocnemius muscle: This calf muscle travels up the lower leg from the Achilles tendon to a boney prominence below and slightly behind the adductor tubercle.
- Vastus medialis oblique : One of the four quadriceps muscles, the VMO runs down the leg on the inner part of the thigh and eventually joins the quadriceps tendon to insert into the superomedial border of the kneecap.
- Pes anserine bursa: On the anteromedial portion of the tibia, three muscles insert one above the next and form the outer border of the pes anserine bursa. This fluid-filled sac separates the muscle tendons from the tibia bone and helps to reduce friction in the area.
- Semimembranosus: One of the three hamstring muscles, this structure originates from just below the buttocks and runs down the back of the leg. It inserts below the knee joint on the posterior and posteromedial portions of the tibia.
Final Word From Sportdoctorlondon About The Treatment Of No Cartilage In Knee
Loss of cartilage in the knee is common as we get older. Weight loss and exercise are the best medicines to reduce pain and improve activity. Only use injections sparingly to help with lifestyle factors with a preference for gel and PRP. Avoid any expensive treatments like stem cells that promise regeneration. Finally, consider a knee replacement if all other treatments fail and your ability to exercise drops.
What Is An Arthroscopy
This is a procedure that allows a surgeon to look inside a joint by using an arthroscope. An arthroscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside a joint. Two or three small cuts are made at the front of the knee. The knee joint is filled up with fluid and the arthroscope is introduced into the knee. Probes and specially designed tiny tools and instruments can then be introduced into the knee through the other small cuts. These instruments are used to cut, trim, take samples , grab, etc, inside the joint. Arthroscopy can be used to treat meniscal tears and damaged articular cartilage. There are some risks from arthroscopy. See separate leaflet called Arthroscopy and Arthroscopic Surgery for more details.
Following surgery, you will have physiotherapy to keep the knee joint active and to strengthen the surrounding muscles to give support and strength to the knee.
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Structure And Composition Of Articular Cartilage
Articular cartilage is hyaline cartilage and is 2 to 4 mm thick. Unlike most tissues, articular cartilage does not have blood vessels, nerves, or lymphatics. It is composed of a dense extracellular matrix with a sparse distribution of highly specialized cells called chondrocytes. The ECM is principally composed of water, collagen, and proteoglycans, with other noncollagenous proteins and glycoproteins present in lesser amounts., Together, these components help to retain water within the ECM, which is critical to maintain its unique mechanical properties.
Along with collagen fiber ultrastructure and ECM, chondrocytes contribute to the various zones of articular cartilagethe superficial zone, the middle zone, the deep zone, and the calcified zone . Within each zone, 3 regions can be identifiedthe pericellular region, the territorial region, and the interterritorial region.
Schematic, cross-sectional diagram of healthy articular cartilage: A, cellular organization in the zones of articular cartilage B, collagen fiber architecture.
How Is A Knee Cartilage Injury Diagnosed
Your consultant will discuss your symptoms with you and examine your knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, they will arrange for you to have an X-ray to confirm the diagnosis of arthritis. They may also arrange for you to have a magnetic resonance imaging scan to show any damage to the soft tissue in your knee.
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What Is The Expected Outcome Of The Operation
Whichever procedure is performed, the locking, swelling and instability will disappear rapidly after the operation.The healing of fixed osteochondral fragments varies from 75 % to 90 % post-traumatic lesions have a greater chance of healing.Regarding the microfracture technique, the improvement in cartilage function and condition is about 80 % in the case of an isolated cartilage lesion.Regarding mosaicplasty, moderate discomfort around the harvesting site is observed in about 15 % of cases. Nevertheless, the results remain very encouraging as good results are obtained in nearly 90 % of cases when located on the femur, 85 % of cases when located on the tibia and 80 % for the patella.
How Is A Meniscal Tear Diagnosed
- 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.
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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.
Who Is A Good Candidate For Cartilage Restoration
Anyone who leads an active lifestyle but feels limited by pain, swelling and dysfunction may be a candidate for cartilage restoration. The best way to determine if you are a candidate is to schedule a consultation with for Dr. Van Thiel. He will examine your knee joint, and possibly order a specialized MRI to determine the health of the cartilage surfaces, and whether you would be a good candidate for restoration.
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Articular Cartilage Paste Graft
At The Stone Clinic, we have a unique procedure for repairing articular cartilage: the Articular Cartilage Paste Graft, designed by Dr. Stone in 1991.
Articular cartilage paste grafting uses your own bone, cartilage, and marrow cells to regenerate your damaged cartilage. It is a minimally invasive, single arthroscopic procedure that stimulates regrowth of damaged articular cartilage surfaces.
The arthritic area of the knee, or the area where there is missing cartilage, is morselized by the surgeon to create a fresh blood supply and to bring marrow cells to the surface. The graft is harvested from the intercondylar notch , crushed into a paste, and packed into the fractured chondral defect. The result is a repair technique that can provide durable cartilage repair tissue with long-term improvement in function and diminishment of pain.
“Articular cartilage paste grafting has provided my patients with tremendous relief and permitted a return to sports for many arthritic joints that were thought to require joint replacement. Our published peer reviewed long-term outcome studies have matched or exceeded any other published work. Paste grafting has been a great tool for salvaging failed microfractures and other cartilage procedures.”
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.
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What Can Patients Expect Before And After Surgery
During an initial consult in our clinic, we review the patients symptoms, what treatments he or she has received to date including injections, braces, physical therapy, and previous surgeries and do a physical exam to assess joint swelling, instability, and alignment. We also review X-rays and MRIs to determine the location and size of damage. All of that helps determine which option is best.
The majority of cartilage surgeries are performed on an outpatient basis. Depending on the procedure, patients can expect to use crutches for six to eight weeks, and to begin physical therapy and home exercise right away, continuing for six months or longer. While each patients healing timeline and treatment goals are different, on average patients return to full activity in six to 18 months.
What Are The Symptoms Of Damaged Articular Cartilage
It is much less common to damage your articular cartilage than it is to damage your meniscal cartilage . If you do injure your articular cartilage, it is very likely that you have also injured another part of your knee at the same time, such as one of the ligaments or your meniscus. The symptoms that you get from any other injury may be more noticeable than the symptoms that are being caused by the injury to the articular cartilage.
- Articular cartilage does not contain any nerves or blood vessels but you may still feel pain from a damaged articular cartilage. If it is painful, the pain tends to be felt around the joint line and on movement.
- ‘Locking’ of the knee can occur if a piece of cartilage affects the smooth movement of the knee.
- The knee may swell and it may be painful to weight bear.
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Knee Cartilage Repair Regeneration And Replacement
There are two primary types of cartilage in the knee: articular cartilage and meniscus . SeeSoft Tissue of the Knee Joint
These surgeries can be performed on almost any joint, but they are most commonly performed on knees. They are generally appropriate for people who have specific cartilage injuries rather than widespread cartilage damage, like that found in moderate to severe knee arthritis.
Benefits Of Knee Cartilage Replacement
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
What Is A Meniscectomy
A meniscectomy is an outpatient, elective surgery to remove the torn meniscus in your knee. Its typically done as an arthroscopic procedure. This involves small incisions, about a centimeter long, that your surgeon used to insert an arthroscope and small instruments for the removal of part or all of the meniscus.
Types of meniscectomy surgeries include:
- Partial meniscectomy: Removes a small piece of the torn meniscus
- Total meniscectomy: Removes the entire meniscus
In most cases, a partial meniscectomy is done to try to preserve as much of the cartilage as possible. Removal of an entire meniscus may increase the risk of arthritis about 10 years later. Thats because the meniscus helps decrease stress on the knee and provides shock absorption, stability, and joint lubrication. Without the meniscus, the impact of stress on the knee with activities is three times higher.
Causes Of Torn Knee Cartilage
Torn knee cartilage is often a result of sudden, twisting, forceful movements of the knee joint. The cause of knee cartilage tear is often traumatic like injury while playing, due to fall or an accident. Forceful movements, sudden squatting, kneeling or similar activities too can damage the knee cartilage.
Sports injuries are the commonest cause of knee cartilage damage or meniscus tear. Those with a history of knee injury or a previously torn knee cartilage may be slightly at an increased risk for further cartilage damage. Certain sports that involve pivoting the knee and forceful jerking knee movements are at greater risk for the tear of knee cartilage.
Sometimes, repeated stress and strain on the knee joint can lead to damage or tear of the cartilage in certain areas. Osteoarthritis, a common degenerative joint condition, results from wear and tear of the knee joint. Older adults, those with previously injured or operated knee joint and overweight people are more likely to have torn knee cartilage.
Some other bone and joint conditions too can affect the knee cartilage or make the knee meniscus weak like certain infections affecting the joint or disorders of joint formation.
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Diagnosis Of Torn Knee Cartilage
Diagnosis of torn knee cartilage is based on the history of the person, background and the activities that were being performed in recent past. In case of injuries, X-rays may be taken to rule out any trauma to the bone or any other abnormality, but these do not help to identify a torn knee cartilage. MRI is required to detect bone and soft tissue injuries like cartilage or meniscal tears.
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What is the procedure like?
First, we take a small biopsy of the nasal septum, which is a few millimeters in diameter, under local anesthesia. Out of this little tissue we isolate the cells and we grow them in the lab. And once we have enough this takes about two weeks then we load them into a carrier. Its a sponge made of collagen and we let them colonize the sponge and mature and develop new tissue, which takes another two weeks. So after a total of four weeks, then we have this mature cartilage tissue which we implant into the patient.
How long do you think this new cartilage might last?
We have to be realistic. In these two patients, the implanted cartilage is preventing them from having to undergo total knee replacement. But we dont know long-term what will happen. What we envision is the possibility of a combination therapy. So where this engineered cartilage is implanted in the knee and is resistant and reducing inflammation, at the same time, we want to take care of a primary cause for the generation of the cartilage, by surgically correcting it in some patients. We may need to introduce a simultaneous pharmacological treatment or we may just need to be very careful with targeted physiotherapy, which we know is very important.
How long since their implants?
Its now over two years that they are being followed up.
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What Is Knee Osteoarthritis
Knee osteoarthritis is defined by degeneration of the knees articular cartilagethe flexible, slippery material that normally protects bones from joint friction and impact. The condition also involves changes to the bone underneath the cartilage and can affect nearby soft tissues.
Other types of knee arthritisKnee osteoarthritis is by far the most common type of arthritis to cause knee pain, and often referred to as simply knee arthritis. Many other less common types of arthritis can also cause knee pain, including rheumatoid arthritis, pseudogout, and reactive arthritis.
What Is Cartilage Surgery
Cartilage surgery concerns localised lesions. It aims to reattach or extract a partially or completely detached lesion. It also treats the zone of the defect by cartilage grafting or stimulating cartilage repair.
In the case of a deep, broad lesion in the form of an osteochondral flap or intra-articular fragment, reattachment can be considered to enable healing. After repositioning the fragment in its original site, it is fixed with a screw to enable the homogenous reconstruction of the cartilage surface . In the case of a shallow lesion, the chances of healing are minimal. The lesion is excised and the edges are rectified .If the cartilage defect is small and superficial, nothing else is done.
In the case of a more extensive cartilage defect, two procedures are possible to repair the defect according to its position and extent :
- The microfracture technique consists in stimulating the bare bone using a pointed tool to create a rough surface this causes local bleeding and stimulates cartilage regeneration and repair .
- The mosaicplasty technique consists in replacing the defective zone with osteochondral grafts taken from the less weight-bearing periphery of the same knee. For that, one or several osteochondral plugs are harvested, generally around the periphery of the femur, using a special instrument . The defective bone is prepared to receive the graft. The osteochondral grafts are then inserted side by side like a mosaic to recover a homogenous sliding surface .
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