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CARTILAGE
TISSUE |
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CHONDROTISSUE |
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ARTICULAR CARTILAGE INJURIES
What is an articular cartilage injury?
An articular cartilage injury
occurs when there is damage to the joint surface. Injuries
to the cartilage can be partial thickness (part of the
way down to bone) or full-thickness (all the way down
to bone). The problem with articular cartilage injuries
is that they have very limited ability to heal.
Cartilage injuries can occur from trauma, such a football
tackle or twisting injury, or gradually over time. In
addition, there are certain diseases, such as osteochondritis
dessicans, which causes damage to an area of cartilage
and bone in the knee without a definite cause. When there
is significant loss of the articular cartilage, the knee
is considered to have “arthritis”.
Injuries to the articular cartilage most typically cause
pain in the knee in the area of the damage. In addition,
patients can get swelling, locking, or buckling of the
knee. In some cases, it can be difficult to know for sure
if cartilage damage is the reason for knee pain.
A set of x-rays is usually ordered to evaluate the bones
and cartilage around the knee. The x-rays are primarily
used to evaluate for arthritis and severity of the articular
cartilage injury of the knee joint. If the damage is small,
the x-rays may appear normal. A MRI may be ordered to
look for damage to the articular cartilage and rule out
any other injuries to the knee. In some cases, the damage
cannot be seen on the MRI, even though it is present
The surgery for articular cartilage injuries depends on
the extent of the problem. There are several surgical
options, and which procedure is best depends on several
factors. These factors include the patient’s age
and activity level, the size of the lesion, and the chronicity
(age) of the lesion.
The first step in evaluating the lesion is usually arthroscopy.
The arthroscope is a fiber optic instrument (narrower
than a pen), which is put into the knee joint through
small incisions. A camera is attached to the arthroscope
and the image is viewed on a TV monitor. The arthroscope
allows the surgeons to fully evaluate the entire knee
joint, including the knee cap (patella), the cartilage
surfaces, the meniscus, the ligaments (ACL & PCL),
and the joint lining. Small instruments ranging from 3-5
millimeters in size are inserted through additional incisions
so that I can feel the joint structures for any damage,
diagnose the injury, and then repair, reconstruct, or
remove the damaged tissue.
Once the lesion is evaluated, there are several options
for treatment. These include:
• Smoothing of the lesion and removing loose edges
only (debridement).
• Technique to stimulate scar cartilage to grow
into the lesion (microfracture).
Debridement is performed to smooth the cartilage edges
by using different small arthroscopic instruments, such
as a mechanical shaver. This is performed so that there
are no loose edges to irritate the joint, and to prevent
the area of damage from expanding. Debridement is primarily
used for small lesions, or when severe arthritis is found
that involves the entire knee joint.
Microfracture is a technique to attempt to repair damaged
articular cartilage. Small holes are poked into the bone
in order to allow blood and marrow healing elements into
the area of missing cartilage. This technique allows scar
cartilage (fibrocartilage) to fill the area where the
cartilage is missing. This technique is easy to perform
and can create good results in a lot of patients.
However, since the cartilage is scar cartilage, it may
not be as durable as other techniques to restore cartilage
defects. Microfracture can be performed during an arthroscopy,
and no other incision or surgery is needed. |
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