Minor cartilage damage may improve on its own within a few weeks, but more severe damage will often require surgery. Severe cartilage damage doesn’t tend to heal very well on its own, so surgery is often necessary in these cases.
Surgery is usually performed using arthroscopy – a type of keyhole surgery where special instruments are inserted into the joint through small cuts (incisions) – although sometimes larger incisions need to be made.
It’s normally carried out under general anaesthetic.
Some of the main procedures are:
- lavage and debridement – the joint is cleaned out to remove any loose tissue, and the edges of the damaged area are trimmed to make them smooth; it may sometimes be possible to repair the damage at the same time
- marrow stimulation (microfracture) – tiny holes are made in the bone beneath the damaged cartilage, which releases bone marrow into it; the marrow cells then begin to stimulate the production of new cartilage
- mosaicplasty – small plugs of healthy cartilage from non-weightbearing areas of a joint, such as the side of the knee, are removed and used to replace small areas of damaged cartilage
- osteotomy – the alignment of the leg is altered slightly to reduce pressure on the damaged area and improve pain; this usually involves adding or removing a wedge of bone from the shin or thigh bone, and the bone is fixed with a plate until it heals
- joint replacement – replacing the whole joint with an artificial one, such as a knee replacement or hip replacement, is occasionally necessary if the damage is particularly severe
Talk to your surgeon about which type of surgery they think is best for you, what the possible risks are, and how long they expect it will take you to recover.
You’ll usually need to take things easy for at least a few weeks after surgery, and you may not be able to return to strenuous activities and sports for several months.
Treatments for Cartilage Damage
Mr Sood’s article in Vantage Magazine (Standing Firm) explains the available options to deal with articular cartilage damage and early arthritis. Such damage is often related to sporting injuries. The treatments aim to restore the damaged cartilage where possible and this is knee joint preservation. Such treatment also helps to relieve pain and to prevent further deterioration of the joint.
Every year, many people are diagnosed with cartilage damage, often as a result of injury. Articular cartilage is located at the ends of the bones that make joints in the body. When damaged, the cartilage does not heal and, in the knee, can progress to arthritis which can lead ultimately to the need for a knee replacement. More than 90,000 knee-replacement operations are performed every year in the UK.
As a result of this, there is a growing interest in joint-preserving options in a bid to repair damaged articular cartilage, relieve pain and delay the need for knee-replacement surgery.
What causes damaged cartilage?
When healthy, articular cartilage allows smooth movement of the joint. When damaged through injury, a cartilage defect occurs which may involve either part or the whole thickness of the cartilage with the underlying bone becoming exposed. These cartilage defects cause the surface to become rough, damaging the joint further which may progress to painful arthritis. A number of techniques to repair cartilage are available, with this area of medicine developing rapidly as the focus shifts to prevent or delay the need for knee replacement.
If you suspect that you may have sustained cartilage damage or any problems with your joints, you should arrange an appointment with your GP or specialist, as soon as possible. Ignoring the problem could result in the injury becoming much worse and more difficult to treat.
What is joint preservation?
Joint preservation is a fairly new concept involving highly specialised treatments for preventing knee pain. It aims to restore normal and pain-free joint function involving treatments that aim to prevent cartilage injuries progressing to arthritis, as well as non-replacement treatments for established arthritis. There are a variety of ways in which joint preservation can be performed including lifestyle changes, medication and surgery.
Which treatment options are available to me if I have damaged cartilage?
Prior to any treatment options being offered, your specialist will perform some diagnostic tests to determine the best care plan for you. Some surgical options you may be offered include:
Although not a cartilage repair technique, this can help relieve pain and also allow you to start exercising and strengthening the knee in preparation for future surgery. This procedure is carried out through key-hole surgery (arthroscopy) and any loose cartilage that is irritating the joint is removed.
By creating small holes in the exposed bone in the base of a full-thickness defect, this allows marrow stem cells into the defect which then form fibrocartilage. This method is most suitable for smaller cartilage defects and can be very effective.
Autologous matrix induced chondrogenesis (AMIC)
MF is performed and then a gel or membrane matrix is placed in the defect as a ‘scaffold’ to help the stem cells to form cartilage. This technique is showing great promise.
Osteochondral autograft transfer / Mosaicplasty
Cylindrical plugs of healthy bone with its overlying cartilage are transferred from a non-load bearing area of the same knee into a cartilage defect in the load-bearing area, recreating a smooth surface. It is an effective technique, but is limited by the number of cylinders that can be taken from the ‘donor’ site.
Autologous chondrocyte implantation (ACI)
This involves two stages and can be used to treat larger cartilage defects, especially in younger patients. The first stage involves an arthroscopy to harvest a small piece of cartilage from a non-load bearing part of the knee. This is sent to a tissue lab where cartilage cells are grown and then implanted into the defect during an open, second-stage operation, around six weeks later.
This is a new technique currently being used in patients with large defects, as part of a trial. It involves using a metal implant with an overlying artificial plastic cartilage that is placed into the defect; restoring the smooth joint surface. It has the advantage of not requiring any biological repair to occur, and represents a mini-replacement of only the damaged cartilage area.
Stem cell-based treatments have already appeared and will be refined. Tissue-engineered articular cartilage, rather than fibro-cartilage that can be grown in the knee is the ‘Holy Grail’. Much research is underway to try to find the best way to repair and, hopefully, regenerate articular cartilage. In parallel with this, cartilage substitutes are being tested.