Treatment Options for Cartilage Injury
A 38 year old woman complains of intermittent knee pain and swelling after activities. Her MRI shows she does not have a meniscus tear, but does have an area of ‘full thickness chondral loss’.
What does this mean ?
What are the treatment options?
What will work best?
What is cartilage?
Cartilage is the smooth tissue covering the end of a bone that allows a joint to move smoothly. Cartilage is made up of mostly water, and sponge-like scaffolding to hold the water. Cartilage is alive with cells that repair and maintain the scaffolding material.
Why does it wear out?
Cartilage can be damaged by injury, or by wear and tear over time. Being overweight will cause it to wear prematurely. A bad injury and start the wear and tear process.
What does the MRI mean by full thickness chondral loss?
This is a medical way of saying there is an area of the joint surface that is worn away – like a pothole on a road. Sometimes this hole can be really deep – down to bone. Sometimes only part of the surface is worn away. The MRI will give some idea as to how severe this cartilage injury is.
What does it look like?
Here is an example of a cartilage injury in the knee. First, look at the picture of the normal cartilage. It appears white, smooth and shows no sign of injury. Next, look at the picture of damaged cartilage. It appears to be scraped away, not smooth and bone appears exposed below it.
What are the treatment options for a cartilage injury?
Let’s go over all the treatment options: From minimal intervention to the end-all of treatments.
Rest, ice, anti-inflammatories
Pain from cartilage injuries are activity-related. This also means that pain relief is activity-related. If you rest, you will feel better. Taking a few days off (minimize weight bearing) when your knee is painful will lead to less pain and resolution of swelling in most cases. Anti-inflammatory medications will also help reduce pain and swelling. Ice does the same thing, just on a local scale.
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What is a steroid? It is a strong anti-inflammatory. It does the same thing that ibuprofen does, but with an injection, we can put the medication right where we want it – in the joint where it is concentrated. It works to do what you might think – reduce inflammation. While it does not change the actual problem in the joint it does decrease the pain from it.
Platelet Rich Plasma Injections
I’ve written more about this elsewhere. It is a new option for cartilage injuries, however there is no data that tells us if it will work or not. It may be worth a try.
Stem Cell Injections
Also considered experimental, stem cells have the ability to transform into any cell. This involves a small liposuction procedure to remove fat from you. The cells are then processed, isolated, and injected into your joint. This treatment lies at the forefront of cutting edge evolving techniques for cartilage regeneration.
MicrofractureThis is an arthroscopic procedure that creates punctate passageways deep into the bone beneath the cartilage layer, allowing bone marrow cells to come to the surface and create a cartilage scar over the damaged area.
Cartilage Transplant from a Donor
Cartilage plugs can be taken from living donor cartilage and plugged into an area that is defective on your joint surface. This transplants normal living cartilage into the damaged area which then incorporates into your joint.
Cartilage cell implant from a donor
The damaged area can be filled with a juvenile cartilage cell tissue that may lead to cartilage healing . This is called a DeNovo graft.
Cartilage implant using your own Cells
Cartilage is harvested from another area of your knee, and your living cells are grown, multiplied, and then re-implanted back into the joint embedded in a matrix of tissue. This is possible through a Phase 3 FDA Clinical Trial.
Partial Joint Resurfacing
When the cartilage damage is too severe, the cartilage surface can be completely restored with an artificial joint. This procedure changes the bearing surfaces of the joint to eliminate pain completely. This is usually the last resort.
What will work best ?
This is the difficult question and one that needs to be answered by you and your doctor. I am happy to answer your questions about these techniques and methods. For specific questions about your knee, please plan on sending me your imaging studies, and seeing me in the office.