Cartilage lesions

Articular cartilage is a complex tissue that is able to withstand tremendous forces over many cycles but does not have the ability to heal even after a minor injury. More than 250 years ago, Hunter observed, “Ulcerated cartilage is a troublesome thing, once destroyed is not repaired.” If untreated the cartilage lesions can lead to early knee arthritis.

Etiology-

In young athletic individuals, articular cartilage changes usually are caused by trauma, whereas these changes are degenerative in older individuals.

Clinical feature-

Patients with articular cartilage injuries usually complain of pain, effusion, and mechanical symptoms. In patients with femoral lesions, pain generally is localized to the medial or lateral tibiofemoral compartment and is worse with weight bearing or high-impact activity. Patients with patellar lesions report pain with kneeling, stair climbing, and prolonged sitting.

Evaluation

Evaluation of a patient suspected of having a chondral or osteochondral lesion of the knee should include weight bearing radiographs. Clinical suspicion of an articular cartilage lesion should prompt evaluation with cartilage-sensitive MRI to determine lesion location, size, and grade.

Treatment

Treatment recommendations for articular cartilage injuries and resulting arthritis include nonoperative and operative management.

Nonoperative-

Nonoperative treatment involves decreasing the load on the joint. Having the patient lose weight, alter activities, and strengthen the muscles across the joint may help absorb some of the load. Orthoses or braces also are beneficial, as are analgesics and antiinflammatory medications.

Operative-

Operative treatment generally is indicated if nonoperative methods fail to relieve pain and mechanical symptoms. Treatment options include débridement, marrow stimulation, transplantation to fill the defect, cell-based therapy, and the use of growth factors or pharmacological agents  and injections like Platelet Rich Plasma (PRP). The choice of procedure is based primarily on the size of the lesion and the activity demands of the patient.

Treatment Options for Articular Cartilage Lesions

Treatment of articular cartilage lesions depends on the size, severity of symptoms, location, age and activity levels of the individual. The various options available are –

 

 

Procedure Indications Outcome
Arthroscopic débridement and lavage {cross link to “arthroscopic surgery”} Minimal symptoms Palliative
Marrow stimulation {cross link to “arthroscopic surgery”} Smaller lesions, low-demand patient Reparative
Osteochondral autograft Smaller lesions, low- or high-demand patients Restorative
Osteochondral allograft Larger lesions with bone loss, low- or high-demand patients Restorative
Autologous chondrocyte implantation Small and large lesions with and without bone loss, high-demand patients Restorative
Genetic engineering Investigational Restorative