Knee cartilage can be divided into femoral cartilage, tibial cartilage and kneecap (patellar) cartilage. Cartilage damage is one of the most common knee injuries. Damage often occurs during a direct blow to the knee or during activities that indirectly overload the knee.

Due to the extremely low capacity of the cartilage to regenerate, damage often requires treatment with an operative approach. The goal of all surgical procedures is to stimulate the growth of the new cartilage or to replace an existing cartilage defect.

Knee anatomy

• Femur – thigh bone
• Patella – kneecap
• Tibia – shin bone (larger leg bone)
• Fibula – smaller bone of the lower leg
• Collateral ligaments – tough, elastic connective tissue that surrounds a joint to provide stability
• Cruciate ligaments - the anterior and posterior cruciate ligaments in the knee form the shape of the letter X, and ensure rotational stability and prevent excessive movements of the lower leg in relation to the upper leg.
• Menisci – curved cartilaginous parts in the joint that serve as shock absorbers that absorb the load, increase the contact of joint surfaces, etc.
• Muscles – serve dynamic joint stability

Symptoms

If your cartilage is damaged, you may experience following symptoms:

• swelling or stiffness
• pain
• difficulty extending the knee
• limited movements in the knee
• cracking of the knee when extending or bending

If you feel any of these symptoms, make an appointment for an examination and leave yourself in the hands of our experts.

When to see a doctor?

See your doctor if your knee is painful or swollen, and if your knee's range of motion is limited after an injury, i.e., after an event that preceded your symptoms.

Causes

Cartilage damage is often caused by sports injuries or other activities that cause damage due to excessive load or disturbed mechanical relationships in the knee. Also, long-term and repetitive loading of the knee can lead to wear and tear of the articular cartilage.

Some of the activities that can lead to cartilage damage are:

• climbing stairs
• excessive knee bending
• contact sports (e.g. football)
• squats (an additional risk is the use of loads)
• sports such as basketball and handball that require rotations (pivoting) in the knee



Complications

In addition to symptoms such as pain, swelling and reduced range of motion that occur immediately after injury, there are also long-term consequences of cartilage damage. Considering that cartilage is a tissue that does not have its own blood supply but is nourished by the synovial fluid that fills the joint, it is very difficult to heal once damage has occurred. The goal of operative treatment is to replace the existing cartilage defect so that the damage does not progress further and to restore the possibility of performing all previous activities.

Diagnostics

Orthopedic specialist examination

In order to make a decision on the type of treatment, an orthopedic specialist will determine the range of motion, the stability of your knee and the persistence of associated injuries (e.g. the existence of a meniscus or ligament injury that may be associated with a cartilage injury) through a detailed clinical examination using specific clinical tests.

Imaging tests

In order to prove the above-mentioned injury with certainty, a radiological diagnosis is also necessary. Magnetic resonance (MR) imaging of the knee joint provides detailed information regarding the structures inside and outside of the knee joint. It is also the best radiological method for showing cartilage damage.

Treatment

There are many options for the treatment of damaged cartilage. These options range from symptomatic pharmacological treatment, physical therapy and rehabilitation, innovative treatment methods and also surgical treatment. The orthopedic specialist will discuss all options and recommend treatment based on the history, clinical examination, and the extent and localization of cartilage damage (visible on magnetic resonance imaging of the knee).

Conservative treatment

Treatment of cartilage injuries depends on the type, size and localization of the cartilage defect. It is often initiated by conservative methods. Nonoperative treatment with physical therapy will focus on reducing pain and maintaining full range of motion in the knee joint.

Your doctor may recommend:

• rest
• avoidance of activities that increase the pain in the knee. In case of severe pain, offloading with forearm crutches can help reduce pressure on the injured knee and promote healing.
• ice
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• hyaluronic acid
• plasma enriched with platelets
• mesenchymal stem cells

Surgical treatment of cartilage injuries

There are various surgical procedures to repair damaged cartilage, and your orthopedic specialist will choose the method that best suits your condition. In St. Catherine Specialty Hospital, numerous procedures are performed, from the most commonly indicated microfractures to newer methods such as implantation of autologous minced cartilage.

Microfractures are a therapeutic option for patients with minor cartilage damage (< 4 cm2). The procedure is performed arthroscopically (with the use of specialized cameras and instruments). Due to the minimal injury to soft tissues, such an approach enables accelerated post-operative recovery. If, in addition to cartilage damage, there are injuries to the ligaments or the meniscus, they also need to be treated in order for the treatment to have the best long-term effect. Microfractures are small holes drilled with specialized orthopedic instruments in the area of ​​the knee where the cartilage is damaged. The goal of the procedure is to reach the bone that is located below the cartilage damage (subchondral bone) and enable the blood vessels in that bone to create a blood clot at the site of the injury. Such a clot contains stem cells originating from the bone marrow that have the potential to create cartilage tissue. After some time, tissue with characteristics similar to cartilage (fibrocartilaginous tissue) begins to form at the site of the clot formation, which fills the area of the cartilage defect. After the procedure, the patient must limit the load on the knee for 4-6 weeks and undergo intensive and high-quality physical therapy and rehabilitation.

Autologous Minced Cartilage Implantation is an innovative method that uses the patient's own cartilage to replace the existing area of the cartilage defect. The surgeon arthroscopically approaches the area of the defect from which he collects the damaged cartilage and minces it with special instruments. In the next step, pieces of cartilage are mixed with platelet-rich plasma (PRP) obtained from the patient's blood, and such mixture is applied to the cartilage defect. Newly-formed environment allows for chondrocytes (cartilage building cells) to potentially create new cartilage that covers the defect.

Our excellent physicians with extensive international experience are experts in the treatment of complex medical conditions. They are the reason why we are a Center of excellence.