Cartilage is the connective tissue that covers the ends of the bones at a joint throughout the body to provide a smooth bearing surface. Healthy cartilage allows the bones to move and glide over each other with minimal friction and with no pain. Articular cartilage is very important for the preservation and normal function of the joints.
In the knee, cartilage is responsible for providing a smooth protective layer covering the femur, tibia and the patella undersurface, as well as serving as a shock absorber for the knee. When a knee cartilage injury occurs, such as torn cartilage in the knee, it is important to schedule an orthopedic consultation to examine the extent of injury. Our team of orthopaedic specialists at Wake Forest Baptist Health includes surgeons who specialize in treating knee cartilage injuries and disorders.
Cartilage does not have its own blood supply so it does not have the natural ability to heal itself after damage from a sports injury, work injury or a traumatic event. If left untreated, a knee cartilage injury can cause deterioration in the joint leading to osteoarthritis and other degenerative disorders.
A knee cartilage injury can occur through trauma, overuse, sports injuries and age related degeneration. An injury can range from softening of the cartilage to torn cartilage in the knee showing the underlying bone. “Loose bodies” can also occur within the knee joint. This term refers to the cartilage that has been separated from the bone and now floats within the joint, often causing mechanical symptoms such as locking and catching.
Symptoms of a Knee Cartilage Injury
The most common complaint from patients suffering from a knee cartilage injury is a constant, dull ache and swelling with activity. With more severe injuries, catching or locking of the joint with motion may occur due to a piece of broken cartilage that is lodged in the joint.
Diagnosis of a Knee Cartilage Injury
The symptoms of knee cartilage injuries may overlap with other injuries to the joint. In order to reach a diagnosis, our team will conduct a thorough physical examination, compare the injured knee to the other knee and conduct numerous tests to rule out other possible knee injuries. X-rays and an MRI may also be ordered to confirm the diagnosis.
Treatment of a Knee Cartilage Injury
Once a knee cartilage injury has been diagnosed, your surgeon will explain the injury and treatment options. Treatment recommendations are based on the location of the injury, the size and depth of the damage as well as any additional pathology such as ligament injury.
A knee cartilage injury is often treated without surgery. Rest, ice, compression and elevation of the knee will assist with the healing process. Your surgeon may also recommend a physical therapy recovery program and anti-inflammatory medications to build up strength and mobility and decrease inflammation. Often times injections of cortisone or other biologic agents may help to decrease swelling and improve pain and function.
If a non-surgical approach is not beneficial or if the injury is too severe, we may recommend surgery. Surgery depends on lesion size, injury severity, patient age and activity level of the patient. There are numerous knee surgery options our experts can utilize, many with an arthroscopic approach. The most commonly performed procedures are debridement and Microfracture.
- Debridement (shaving): Special arthroscopic instruments are used to smooth the shredded or frayed cartilage. Ideally, this treatment will decrease friction and irritation, reducing the symptoms of swelling and pain.
- Partial Menisectomy: If the meniscus is torn, it may cause pain, catching or other mechanical symptoms. Using special arthroscopic instruments, a portion of the torn meniscus may be repaired or removed to eliminate symptoms.
- Microfracture (marrow stimulation): A surgical technique used to treat damaged areas of articular cartilage in the knee. Small holes are prepared in the bone to allow for blood flow egress to stimulate healing and neocartilage formation
- Allograft transfer: A technique used to replace the damaged areas with a cartilage-bone unit that is procured from a donor. This is usually reserved for large areas of cartilage damage and can be ideal in situations where the underlying bone is damaged.
- Autologous Chondrocyte Implantation (ACI): A technique used to repair defects to the articular cartilage. The procedure involves removing a small piece of cartilage and sending to a laboratory where additional cartilage cells are fostered from the sample. After a waiting period, the new cartilage cells are implanted into the knee by injecting the cartilage cells into the defect. These cells eventually grow into new, healthy cartilage.