The number one cause of musculoskeletal injuries is arthritis. In its purest form, arthritis 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.
Cartilage lesions can be caused by many different injuries, many of which are somewhat minor and consist of partial recovery over a period of a few weeks. Usual causes are falls onto the knee, rapid deceleration injuries that occur when someone jumps or falls down off a low stool, or quick changes in direction that are attempted on the athletic field or court.
Typical symptoms include:
- 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, you should follow 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 treatments can include glucosamine, hyaluronic acid, and non-steroidal anti-inflammatory medications (NSAIDs).
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.
The procedures developed to treat these lesions are generically referred to as cartilage-preserving procedures. For smaller isolated lesions of <1 cm square, a one-step technique where bone and cartilage plugs are removed from relatively non-utilized areas around the knee and plugged into the more stressed or injured areas can be effective.
The second procedure, consisting of two steps, is that of autologous cartilage implantation (ACI), or the Carticel procedure. First, cartilage cells are harvested from the knee via an arthroscopic procedure. Then, through an open procedure, a watertight pouch at the site of the defect is created, and cells are implanted underneath the pouch.
The decision as to which procedure, if any is appropriate, is made on an individual basis.