About 900,000 people develop cartilage damage every year just in the USA.
Chondral (cartilage) injuries are very commonly seen today, and occur following injury, associated with degeneration, or injury superimposed on a degenerative knee.
Cartilage injuries may occur at any age, but become increasingly common with increasing age. They mainly affect the weight bearing joints, particularly the knee, but also frequently the ankle and hip.
About 70,000 arthroscopic procedures are carried out in Australia every year and it is estimated that 60% are associated with chondral defects, with up to 10% being full thickness cartilage loss. There is an increased incidence with high performance sport.
There are three types of cartilage, with cartilage lining joints being HYALINE cartilage.
Cartilage loss is graded simply into four:
Grade 1 – softening and superficial fissures
Grade 2 – fragmentation and fissuring down to 50% of the cartilage depth
Grade 3 – Fragmentation and fissuring greater than 50% of cartilage depth
Grade 4 – Exposure of the underling subchondral bone
Adult cartilage cells have a very poor regenerative capacity and grade 3 and 4 lesions will never heal, with eventual progression to Osteoarthritis of the joint.
If there is some healthy cartilage remaining, then treatments are available to “replace “the cartilage.
The symptoms of cartilage “disease” are pain, swelling and stiffness, so that initial treatments are conservative (physical therapy), and involve ice, heat and stretching. Assist devices such as crutches are often helpful, with the use of analgesics and anti-inflammatories. Cortisone and hyaluronic acid injections may have a role. PRP injections have no major benefit over the latter and are much more expensive. Stem cell injections are very expensive and there is no evidence at this time that they lead to any significant regeneration of cartilage cells.
MRI scan is useful in assessing chondral lesions, however arthroscopic surgery is frequently needed for accurate assessment and initial surgical treatment, involving chondroplasty (removing debris, loose pieces of cartilage and “smoothing” the defects. Other procedures such as microfracture and cartilage implantation are available, the latter replacing the absent cartilage with your own cartilage cells which are grown in the laboratory.
Many advances have been made in recent years in the science and treatment of cartilage lesions, with many treatments having moved from experimental to become the standard of care.
Cartilage loss is one of the most common conditions that we deal with in weight bearing joints, particularly the knee and ankle. It is responsible for very significant potential morbidity with loss of function and lifestyle and a significant potential impact on work. It may also lead to the development of osteoarthritis and the possibility of joint replacement.