Knee Cartilage Injuries: Types, Symptoms, and Management
Cartilage is located at the lower part of the femur; it is a thin, white, and smooth layer that minimizes friction. Having low cellularity means it cannot regenerate naturally, which is why it is exposed to tears or wear that can be divided into:
Chondropathy and chondromalacia: This is the most incipient degree of tearing or wear; intervention is not necessary, but constant monitoring of the injury is important.
Chondral lesion: As the lesion enlarges, it becomes a chondral lesion, where treatment will be defined depending on its extent.
Pre-arthritic lesion: This is when the lesion is already too diffuse and it is necessary to implement a more aggressive treatment. Over time, it turns into Osteoarthritis.
The causes of tears are varied; one of them is Osteochondritis dissecans, which mainly affects adolescents and young adults. It is a joint disease in which the bone (femur) beneath the cartilage does not have enough blood flow and dies, causing both to potentially detach.
Another reason why this injury occurs is the misalignment of the knees, which produces excess friction and asymmetrical wear of the knee. The menisci and their wear are another cause of cartilage tearing. And finally, trauma such as a blow or a fall.
Symptoms:
Patients who come to the consultation say they feel internal, deep, and very intense pain that worsens with movement. Effusions may occur, although it is not a common symptom among those who suffer from it. They also feel crepitus or clicking and lose range of motion over time as the injury worsens.
Management:
It is important to state that regarding cartilage, there is no regeneration treatment; they are rather repair options. Depending on the location, size, depth, patient's age, previous injuries, and lifestyle, it is possible to propose the best option for rehabilitation.
Initially, a conservative treatment focused on physical therapy, muscle strengthening, corticosteroid or hyaluronic acid injections, and analgesics is chosen. When this is not enough, and the patient continues to present a lot of pain and limited movement, and the lesion is considered recoverable, the surgical option of smoothing and microfractures is presented, where the damaged area is smoothed and small perforations are made so that the blood creates a kind of fibrocartilage. Another surgical option is cartilage transplantation, which is a more complex open surgery, and finally, when the cartilage is totally torn or has suffered major damage, Total Knee Replacement is considered.
Recovery times differ from patient to patient, but as a general rule, when a Replacement is performed, it is necessary to get the patient moving as soon as possible to decrease the risk of complications. When it is a cartilage transplant or smoothing and microfracture, the rest time is longer as the tissue must heal correctly.
There is no regeneration, there is repair.
