The number one cause of musculoskeletal injuries and problems in the world is arthritis. Arthritis in its purest form is inflammation within a joint. Much more common, however, is the use of the word “arthritis” to describe wear and tear and loss of articular cartilage or the gliding surfaces of the joint. The constant stress on the cartilage within the knee especially causes the cartilage to become thin as it is worn down, much like sandpaper would wear down the surface of wood. Although this process can usually be slowed by addressing some of the causes, it cannot be reversed.
Over the last decade, the ability to treat traumatically caused arthritic damage has improved. It is now possible to surgically correct isolated, traumatically caused cartilage lesions. This is a positive step forward in the treatment of arthritis as we know that untreated, these types of lesions result in wear-and-tear arthritis that is not treatable.
The procedures developed to treat these lesions are generically referred to as cartilage-preserving procedures. One procedure is a one-step technique where bone and cartilage plugs similar to hair plugs are removed from relatively non-utilized areas around the knee and plugged into the more stressed or injured areas. Osteochondral autografting such as this is referred to by many names; mosaicplasty, OATS, and COR procedures. For smaller isolated lesions of <1 cm square, this can be effective.
The second procedure is that of autologous cartilage implantation (ACI) or the Carticel procedure. This is done in two separate steps. First, chondrocytes (cartilage cells) are harvested from the knee via an arthroscopic procedure. Second, through an open procedure, a watertight pouch at the site of the defect is created, and cells are implanted underneath the pouch. This procedure has resulted in significant positive effects and a return to highly functional knees.
The decision as to which procedure, if any is appropriate, is made on an individual basis.
Cartilage lesions can be caused by many different injuries. Often these injuries are somewhat minor and partial recovery over a period of a few weeks is common. Usual causes are falls onto the knee and rapid deceleration injuries as occur when someone jumps or falls down off a low stool or when perturbed rapid changes in direction are attempted on the athletic field or court.
- Aching pain
- Minimal swelling
- Partial functional ability
- Pain worsens with activity
Though major functional problems can be caused by cartilage lesions, this is not normal. When these injuries occur the athlete follows the guidelines of RICE (Rest, Ice, Compression, Elevation) until symptoms improve enough to allow a gradual return to play. The hardest problem in treating these injuries is knowing how hard to ‘push’ the knee and knowing when to stop.
Alternative Treatment Options
Surgical intervention is suggested to individuals with cartilage lesions when the symptoms are severe enough to limit functional activities – either normal day-to-day activities or athletic activities. Most physicians recommend a period of conservative care first but if this fails, arthroscopic intervention is appropriate. Surgical care depends on the extent of the injury seen at the time of arthroscopy. Minor problems can be treated with simple debridement procedures while more advanced problems are treated by methods as described above.