The injury to the knee cartilage is the rupture of a part of the articular cartilage. 
This tissue is composed of cells (chondrocytes) coated with a thick, whitish and shiny substance.
The defect of cartilage is that the cells are not vascularized, the arteries irrigate the outer membrane of the tissue, and biochemical exchanges occur by osmosis through the extracellular substance.

The cartilage of the joints is called hyaline, covers the joint surfaces and acts as a lubricant to reduce friction during movement.
The erosion of this tissue is a chondromalacia, ie a disease of the cartilaginous tissue that does not heal over time, because the cartilage can not regenerate , in fact can evolve into an ulceration with a part of the bone completely devoid of a cartilaginous coating .
Today, the treatment for cartilage lesions is the subject of several scientific researches, is one of the most discussed topics in national and international congresses.
In the injured area develops a tissue called fibrocartilage that does not have the elasticity of the hyaline cartilage and is not as smooth, with the passage of time tends to degenerate.
The risk is that the bones slide over each other like an oil-free gear, so too much friction develops that can cause inflammation of the joint .

 

What are the causes and risk factors for knee cartilage injury?

This condition may result from injury or degeneration due to wear.
Cartilage injuries can affect people of all ages, and young people who suffer from it usually have a sports trauma.
Athletes can suffer damage due to a sprain , in addition the worn cartilage may be the consequence of excessive tension.

The predisposing factors for chondromalacia of the knee can be:

Heavy work and sedentary work are the activities that make the process of cartilage degeneration faster.
Those who lift a lot of weight during a large part of the day tend to consume the cartilage by excessive loading, while those who sit a long time have less vascularization of the tissue, also develop atrophy due to lack of stimulation provided by the load.
Athletes who practice athletics (runners, marathon runners and sprinters) after many years of racing may have a worn cartilage area.

 

What are the symptoms of knee cartilage injury?

The symptoms of a cartilage injury are not proportional to the size of the damage, a small injury can cause a lot of pain or vice versa.
The pain occurs during movement, especially in bending movements such as crouching, while at rest should disappear.

The symptoms are not as obvious as those of a meniscal injury or a ligament injury .

  • Often the only symptom is intermittent swelling .
    Broken cartilage fragments are floating in the knee and can cause edema.
  • The knee may swell in the front or back, in this case, the baker’s cyst increases in volume.
  • The pain occurs on the inside and back of the knee , and feels after an effort like a long walk or climb stairs.
  • Occasionally, the leg can not support body weight.
  • Cartilage fragments or foreign bodies can prevent joint movement when we bend the knee, causing knee blockage.
  • The knee can make noises (crackling) during movement, especially if the cartilage is damaged in the back of the knee.

In symptomatic patients, cartilage lesions do not allow sports activities.

 

How to get the diagnosis?

It is almost impossible to clinically diagnose a chondral lesion, in fact, there is no examination.
A  complete medical history , signs and symptoms can lead to a suspected chondromalacia, but confirmation can only be made through an MRI that shows if the tissue has thinned or is completely eroded, exposing the bone.
We do not recommend  knee ultrasonography because it can not show any deep lesions.
The radiograph may show a thinning of the joint rhyme (ie, the worn cartilage) but does not show a small crack.

 

How to heal knee cartilage injury?

In the past, it has rarely been seen in such a short time, for a succession and evolution of many surgical, biotechnology and pharmaceutical techniques with numerous rehabilitation protocols.
The problem with cartilaginous tissue is that it does not repair itself, for example bone.

The purpose of the therapy is to stop the evolution of the pathology that causes the disappearance of the articular cartilage (fourth degree), so the consequence is the friction of bone against bone during movement.
The drugs NSAIDs may help temporarily reduce pain, for example, ibuprofen(Alivium) or ketoprofen (Profenid).
We can try a drug treatment with intra-articular infiltrations with hyaluronic acid  that is a component of the cartilage, in this way it is possible to postpone surgery, which is the definitive therapy only in these cases.
The orthopedic surgeon may decide to aspirate the fluid from the inflamed knee prior to the injection.

 

Surgery for knee cartilage injury

Without considering techniques such as chondroplasty because the studies do not show good results, microfractures, mosaicplasty and autologous chondrocyte transplantation are currently used.

The technique of microfractures was invented by Steadman who performed micro perforations on the articular surface of the bone where there is no cartilage.
This type of damage stimulates the mesenchymal cells that gave rise to these tissues instead of the eroded cartilage.
This new tissue is not elastic like that of cartilage, so it does not lubricate the knee joint.

The mosaicplasty was invented by the Uruguayan Hangody, consists of the removal of a  part of the bone with the cartilage of an area of ​​the knee without load and in the transplant in the affected area.

The results are good, but the patient must undergo a lengthy process of physiotherapy to fully protect the transplanted tissue.

One of the treatment options in these patients is the autologous chondrocyte transplantation , the Swedish Peterson and his team developed this technique where an arthroscopic knee surgery is performed by collecting a fragment of healthy cartilage to be sent to specialized laboratories where it is treated for isolate chondrocytes and culture in the laboratory so that the chondrocytes proliferate.
Successfully, 1-2 months after the first surgery, the surgeon makes an incision and implants the chondrocytes where the cartilage is damaged to regenerate.

This transplant is only possible in some patients with certain characteristics.
Five years after surgery, studies show good results, can be considered a reliable technique.

This technique has been perfected several times, for example, the material to be used to maintain chondrocyte transplantation in place, but the principle remains the same.

Patients candidates for chondrocyte transplantation should meet the following requirements:

  • Age below 40 years.
  • The injured cartilage should be the one that covers the femoral condyles.
  • The event that caused the injury should be trauma or osteochondritisdissecans.
  • The patient’s menisci should be intact.
  • There can be no knee defects.
  • Overweight patients with arthritis or rheumatic, metabolic, and infectious diseases are excluded

 

What to do? Rehabilitation for knee cartilage injury

Rehabilitation is very long, for the first 30-40 days it is not possible to support body weight on the operated limb, return to sports is not predicted before 10 months after surgery.
The goal is muscle strengthening and recovery of the entire lower limb joint.

In the first stage, it is necessary to carry out active mobilization exercises without load for the knee joint, such as the ergometric bicycle without resistance, in case where it is necessary we can perform physical treatments for pain and swelling.
The hip and ankle should start strengthening muscles early.
As soon as the surgeon allows, it is necessary to begin muscle strengthening work on the quadriceps in the gym and in the water.

At this stage we can ride a bike.
The first two months of muscle strengthening should be done in closed kinetic chain exercises (such as Leg press or squatting) and then we can begin working in open kinetic chain ( leg extension ).
The magnetic therapy  is helpful in reducing swelling and pain in the knee.

 

Natural Remedies for Knee Cartilage Injury

Among the natural remedies there are the shark cartilage supplements in tablets, the treatment provides for the administration of a pill daily for at least 2 months.

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