Knee Cartilage Rupture: Symptoms and Treatment

Articular cartilage protects the ends of bones from friction. Damage to cartilage can exist for several years and be completely asymptomatic, but from time to time symptoms suddenly begin to appear. If a sharp exacerbation does not occur, the result of many years of wear and damage to the cartilage and constant friction of the ends of the bones against each other can become arthrosis or osteoarthritis, which will be accompanied by a lot of unpleasant symptoms. Articular cartilage is a specific tissue that covers the surface of a joint. To the naked eye, it has a shiny, smooth white surface. When viewed through a microscope, it is composed of water, collagen, and an extensive network of proteins and lipids.

Articular cartilage does not have nerve endings and for this reason does not feel pain or other sensations during minor or minor injuries. It also cannot repair itself if damaged. Damage to articular cartilage is quite common, although symptoms may not appear at the onset of the disease.

Many factors play a role in knee cartilage injuries, such as the patient's age at which tissue destruction began, his level of physical activity (including how intensely he exercises), his weight, the condition of the ligamentous apparatus of the knee joint, and the presence or absence of meniscus damage.

Damage to the cartilage of the knee can occur as a result of injury or age-related wear and tear of the cartilage tissue.

Damage to articular cartilage can be classified according to severity and damage to the body, and all stages may have characteristics of osteoarthritis:

Stage 0: healthy articular cartilage

Stage 1: At this early stage, the articular cartilage begins to become soft and tissue swelling is observed.

Stage 2: This stage is accompanied by partial thinning with fibrous appearance (split appearance) or cracks on the surface that are no more than 1.5 cm in diameter and do not reach the bone.

Stage 3: At this stage, the transformation of the smooth surface into a fibrous one continues, the cracks increase to more than 1.5 cm in diameter and reach the subchondral bone. Patients usually complain of a crunching sound when bending the knee and pain and difficulty getting up from a sitting position.

Stage 4: the subchondrial bone comes to the surface, and we can say that the cartilage is completely worn out and erased. When such areas become larger, the pain intensifies, severely limiting the patient's activity.

Diagnosis of knee cartilage rupture

On the surface of the joint is the so-called hyaline cartilage. When it becomes damaged and begins to tear, its surface becomes uneven. This is why the symptoms appear: pain and difficulty in movement.

Damage to articular cartilage is difficult to detect because the tissue contains virtually no calcium and is not visible on x-rays. Diagnosis of cartilage rupture is a rather problematic task.

The best option would be to use the arthroscopy method to accurately identify all pathologies in the knee joint. Diagnosis by arthroscopy proceeds as follows: a specialist makes several incisions on the knee, into which an arthroscope is inserted, at the end of which a camera is placed. This way, a picture is displayed on the screen and you can clearly see all the problems in the knee joint.

Knee cartilage damage symptoms

Symptoms of a cartilage injury may not appear immediately like they do with an ACL tear or meniscus tear. Similar to the initial stages of arthrosis, the first symptoms are weak and unnoticeable, progressing over time and developing into much more serious and noticeable ones for the patient.

Symptoms of knee cartilage damage—if they have begun to appear—include:

• periodic swelling of the joint (sometimes this is just a symptom without a disease)

• pain after prolonged walking or climbing stairs

• when the body is fully loaded on the knee, its deformation, the patient may also fall due to the fact that the knee could not bear the weight

• clicks or blockages

• the knee may creak when moving

Diagnosing knee cartilage damage can be quite challenging. Knee swelling does not always indicate cartilage damage. Using X-rays, MRI or arthroscopy, you can more accurately determine whether the cartilage is fine or whether it has already worn out (as abrasion reduces the space between the surfaces of the bones).

Damage to the knee cartilage occurs in several stages and can reach complete abrasion and exposure of the end of the bone

Treatment methods and repair of cartilage tears

There are 2 types of treatment for cartilage tears: conservative and surgical.

Conservative treatment

If you go to the clinic in a timely manner and the disease is at an early stage, the specialist will prescribe conservative treatment.

First of all, it is necessary to stop putting stress on the knee joint. The doctor may also prescribe vitamins for joints, anti-inflammatory and painkillers, and pinpoint injections with hyaluronic acid. The treatment package may include a course of physical exercise and wearing orthopedic devices.

Another method is plasma lifting. This method is based on the use of platelets taken from the patient's blood. The specialist takes blood, uses centrifugation to isolate platelets, and injects the resulting material into the joint.

Plasmolifting is based on the principle of self-healing of the body.

Knee cartilage damage treatment

Conservative

The degenerative condition of the knee cartilage is usually treated without surgery. To achieve the effect, I recommend removing weight from the injured knee, strengthening the muscles around the joint with the help of certain exercises, and taking vitamins for joints (chondroprotectors). In certain cases, injections of hyaluronic acid are excellent for increasing joint hydration and reducing friction. Certain medications may also be recommended to help relieve symptoms associated with knee cartilage damage. However, since cartilage tissue does not grow back, medications will not cure it completely, but will help the patient live without pain and return to active physical activities. Further treatment will require surgery.

Surgical

Over the past decade, significant advances and improvements have been made in the surgical treatment of knee cartilage defects. The most commonly used techniques today are shaving and microfracture.

Shaving is an arthroscopy technique that uses special arthroscopic instruments to smoothly treat the cracked or worn surface of the knee joint. Ideally, this treatment reduces friction in the joint and reduces inflammation, reducing swelling, noise when moving, and pain.

Microfracture is an arthroscopic technique for microfracture of the subchondral bone that stimulates the growth of new cartilage tissue in the defect area. This method is well accepted by the body and is recommended for patients with deep damage to the knee cartilage (up to complete disappearance).

What is cartilage wasting

Arthrosis goes through several stages. At the initial stage, subtle changes appear in the joint. On the last one, they talk about complete wear of the cartilage and the impossibility of its restoration. His fate directly depends on the stage at which a person consults a doctor.

Normally, articular cartilage is elastic and dense, so in a healthy state it easily performs a shock-absorbing function during movement. As a result of degenerative processes, the height of the cartilage decreases, it loses moisture and ceases to be elastic, begins to crack and delaminate.

As cartilage depletes, the negative impact on surrounding tissue increases. Bone surfaces, tendons, muscles, and joint capsules suffer. Morning stiffness and pain after physical activity appear. The thinner and stiffer the cartilage tissue, the worse the joint functions.

Joint destruction begins with cartilage depletion

Is cartilage capable of restoration? What does science say?

Most common cartilage injuries

Most often, patients need treatment for arthrosis, osteoarthritis and its deforming form after such injuries:

prolonged mechanical load on the joint, which exceeds the permissible limit, for example due to banal excess weight;
chronic microtraumas of joints received during professional activities, for example among loaders, blacksmiths;
sports injuries - while running, playing football, weightlifting, jumping.

For one reason or another, the amount of proteoglycans in the body rapidly decreases, and the collagen fibers of hyaline cartilage are damaged. This leads to the death of chondrocytes - the cartilage gradually becomes thinner.

Deforming osteoarthritis of the hand joints - an occupational disease of loaders and riggers

What happens to the donor site?

Control arthroscopy showed that the donor site remains empty, only after a sufficiently long time does it slightly lower and fibrous tissue forms in the depths.

Experiments have been conducted with filling the defect with an osteoperiosteal plug from the tibia, but this still does not provide bone filling.

Briefly summarizing all of the above, we can draw the following conclusions:

osteochondral grafts from the lateral and medial surfaces of the condyles, as well as from the area of the intercondylar groove, can successfully correct cartilaginous defects;
the diameter of the graft should be slightly larger than the landing hole;
the length of the graft should be equal to the depth of the hole;
Press-fit method is preferred;
The osteochondral implant remains viable for a long time and ensures normal functioning of the joint.

Degenerative changes in cartilage

With age, degenerative changes occur in cartilage tissues. As a result of wear and tear of the cartilage, the surfaces of the bones begin to rub against each other, creating discomfort during movement and causing pain. This causes the development of joint diseases, which have dangerous consequences.

What are degenerative changes in cartilage?

Degenerative processes in cartilage are processes that occur in tissue structures and lead to disintegration, thinning and cracking with the subsequent development of erosions.

Cartilage, which has lost fluid during wear, dries out and its surface becomes rough. Hyaline tissue is completely replaced by fibrous tissue, which has significantly increased in volume. Negative changes also affect the subchondral bone plate, which is subjected to heavy loads due to the destruction of cartilage. On nearby structures the ongoing process is reflected as follows:

The articular ends of the bones partially dissolve due to insufficient blood circulation. Their defective functioning causes the occurrence of foci of osteonecrosis.
The joint capsule becomes sclerotic and empties.
The volume of fatty and fibrous tissue in the synovium increases.
Liquid exudate accumulates inside the inflamed joint.

Kinds

There are two types of processes occurring in cartilage:

lesions are a pathological condition that occurs regardless of age and provokes the development of arthrosis;
changes are processes caused by natural aging and do not have a significant impact on the functionality of cartilage.

The process of degenerative damage occurs in several stages:

a decrease in the amount of moisture in the cartilage, leading to loss of functionality;
partial death of chondrocytes in cartilage tissue without subsequent restoration;
reduction in the amount of protein glycons (in particular chondroitin);
disruption of blood flow in the articular ends of bones;
changes in the biological composition of synovial fluid;
loss of moisture from cartilage, leading to loss of elasticity and stability;
slower recovery of the damaged joint;
development of degenerative processes – the onset of arthrosis.

Important! The gradual process of degenerative joint damage occurs over several years.

Causes

The mechanisms of degeneration of cartilage tissue are absolutely the same, regardless of their causes. The following factors contribute to the emergence of these processes:

Age-related changes that reduce the elasticity of cartilage tissue and its ability to produce important components of cartilage.
Increased stress on joints. As a rule, cartilage tissues that experience maximum mechanical stress are most often susceptible to degenerative changes. These include the joints of the spine, hip and knee joints.
Excess body weight.
Injuries, surgical interventions.
Congenital disorders.
Genetic predisposition.
Weakening of the muscular system, which increases the load on the joints.
Pathologies that provoke changes in the structure and function of articular cartilage, for example, gout.

Symptoms and signs

Due to the absence of blood vessels and nerve endings in cartilage, symptoms of degeneration appear only when similar processes begin in other tissues. Main features:

limited mobility due to stiffness in the joint;
the occurrence of a pronounced crunch when flexing/extending the joint;
fast fatiguability;
pain that appears after prolonged periods of rest;
aching joints, worse in bad weather;
joint deformation.

Which doctor treats

When degeneration of cartilage tissue begins, the patient should consult an orthopedist or rheumatologist.

Important! At the Health Clinic on Kurskaya, the patient will be able to undergo diagnostic tests (CT, MRI, ultrasound, radiography), and based on the results, immediately receive competent advice from the necessary doctor.

Diagnostic methods

Diagnostics includes the following activities:

laboratory research
general blood analysis;
erythrocyte sedimentation rate (ESR);
C-reactive protein;
serum uric acid;

other studies

CT scan;
Magnetic resonance imaging;
radiography.

Treatment methods

The goal of conservative therapy is to reduce the severity of symptoms and slow down degenerative processes. For this, the patient is prescribed:

non-steroidal anti-inflammatory drugs – reduce pain and inflammation;
corticosteroids – have an anti-inflammatory effect;
drugs that help strengthen cartilage tissue.

results

Timely diagnosis and an effective treatment package make it possible to partially restore cartilage tissue and completely eliminate pain.

Rehabilitation and lifestyle restoration

During the rehabilitation period, the patient is prescribed a set of exercises aimed at strengthening the muscular-ligamentous system, as well as diet, massage and physiotherapy.

Lifestyle with degenerative changes in cartilage

When cartilage tissue degenerates, it is important to adhere to a number of rules:

Exercise regularly, avoiding high stress on the affected joints.
Maintain normal body weight.
Avoid prolonged stays in stationary positions.

Is it possible to prevent cartilage destruction?

In the case of deforming osteoarthritis, prevention is possible only if we are talking about the primary form of the disease. If you have not yet been prescribed treatment for arthrosis, you can pay special attention to the load on your joints and prevent a possible problem. If, due to your line of work or as part of a hobby, you regularly expose your joints to microtrauma, it is not too late to stop this and thus protect the cartilage from damage.

It is almost impossible to prevent the development of so-called symptomatic osteoarthritis, caused by inferior cartilage due to abnormalities in other organs. If the cause of the destruction of cartilage tissue is congenital diseases, metabolic disorders, pathological conditions of the endocrine system or peripheral nerves, all that remains is to alleviate the symptoms of deforming osteoarthritis by turning to modern therapeutic methods.

In most cases, intra-articular injections of Noltrex can help relieve pain and restore joint mobility. The drug restores the viscosity of the synovial fluid, stops friction of cartilage and relieves pain, no matter what it is caused by - regular excessive stress on the knee, genetic predisposition or unfavorable environment.

Advantages and disadvantages of using osteochondral grafts

A short list of advantages:

the osteochondral graft used for mosaic chondroplasty is a completely viable functional unit that allows the restoration of destroyed hyaline cartilage;
the size of the graft can be easily adjusted to the size of the planting area;
the procedure is one-stage in nature - no intermediate steps are required in the form of growing cells in the laboratory;
low risk of complications.

Flaws:

difficulty in choosing areas with the necessary curvature to ensure better congruence;
When taking a large number of donor grafts, the risk of postoperative joint pain is high.

Mosaic chondroplasty technique

The patient's position is on the back with the leg bent at 120°. An x-ray with a reference mark helps ensure that the knee is flexed enough to access the bone donor site.

Next, arthroscopic access is made to the femoral condyle with the damaged area of cartilage. The area is cleaned with a curette and the edges are excised to obtain a smooth, healthy contour. Then a probe with marks is inserted - it is used to measure the exact size of the defect. If the defect is too large or located very far away, the operation is performed using arthrotomy (open approach).

The next step is to make a tissue incision and gain access to the area of the bone from which the graft will be taken. The cross principle is used: if a defect is restored on the medial condyle, then the graft is taken from the lateral surface of the lateral one and vice versa. The tissue is taken with a tubular chisel. It is very important to maintain exact perpendicularity with respect to the surface of the cartilage at the moment of “driving in” the chisel.

The number of cylindrical osteochondral fragments harvested varies from three to five and depends on their size: the larger the graft, the fewer are required. Usually 3 grafts with a diameter of 10-11 mm or 5-6 with a diameter of 5-7 mm are taken.

After obtaining the required number of osteochondral fragments, the first “landing socket” is drilled on the defective area of the cartilage. This is also done with a tubular chisel, but its diameter is 1 mm smaller than that used to extract grafts. The length of the landing hole is measured, the length of the graft is adjusted to it, which is carefully fixed to the place intended for it using the press-fit method. The procedure is repeated the required number of times. In this case, the holes are drilled in such a way that they are not parallel and fan out from the hypothetical center of curvature of the condyle, this allows the curvature of the articular surface to be restored as accurately as possible.