These injuries are generally as a result of direct blow to the knee or twisting/turning injuries. In some cases, it may be associated with ligament injuries of the knee such as anterior cruciate ligament (ACL) injuries.
In deciding what treatment will suit the injured patient best several factors need to be considered including: location, size and depth of the defect as well as presence or absence of any associated ligament and meniscal injuries.
Other factors such as age, activity level, sport, occupation, knee alignment and body weight may also need to be considered.
Once decision is made that an individual is in need of surgery based on evaluation and studies such as X-ray or MRI or the defect is detected at the time of an arthroscopy then there are varieties of surgical treatment are available:
Debridement: In this method of treatment the damaged articular cartilage is shaved off and joint is irrigated.
Abrasion Arthroplasty: In this method the damaged articular cartilage is shaved off and the bed is abraded with a special bur to create a bleeding surface which ultimately will turn into fibrous cartilage.
Microfracture: In this technique the defective cartilage is shaved off and several bony channels is created utilizing special awl to create bleeding surface and ultimately fibrous cartilage.
Osteochondral grafting: In this method a cylinder of cartilage and bone is removed from a remote site in the knee and the defect is grafted. This provide a normal articular cartilage once defect has healed.
Allograft: This technique is similar to (4) except instead of individuals own cartilage and bone tissue, banked cartilage and bone is used.
Autologous Chondrocyte Implantation (ACI): In this method a small biopsy of normal cartilage is taken from individuals’ knee and is sent to a special facility for culture. This process will lead to laboratory growth of human cartilage cells which can be implanted in the individual’s knee at a later date (usually 4-6 weeks after the biopsy is taken).
Articular cartilage also known as hyaline cartilage is the durable tissue that covers the ends of bones. It provides a smooth and impact resistant surface to help individuals during activities such as walking, kneeling, running, and jumping.
Articular cartilage undergoes substantial stress every day. A simple activity such as walking upstairs increases pressure on the knee several times body weight. During more vigorous activities, such as high impact sports that involve running and jumping, this pressure is intensified.
- Repetitive trauma as caused by sports or a very physical job can begin to wear down and weaken articular cartilage over time.
- A traumatic or severe incident can cause the cartilage to “shear off”, fully exposing the bone.
- Cartilage cannot heal on its own when damaged.
If untreated, articular cartilage damage may lead to osteoarthritis, a more serious, degenerative, and irreversible condition in which the surface of the bone becomes less protected, resulting in pain, inflammation, decreased mobility, and muscle atrophy. Since cartilage serves such an important role in the knee, even the slightest amount of damage can hurt. Therefore, it is important to see a specialist for evaluation as soon as possible.
Often , there are contributing conditions present in patients with knee cartilage injuries that could cause or worsen the damage. Some examples of these include:
- Valgus deformity (Knocked knees)
- Varus deformity (Bow legged)
- Meniscus tears
- Ligament tears
CARTICEL is a biologic product used to repair articular cartilage injuries in adults who have not responded to an arthroscopic or other surgical repair procedures. It uses your body’s own cultured cells to regenerate the articular cartilage in your knee during a surgical procedure called autologous chondrocyte implantation (ACI). Carticel is the name of the cells that are grown from the samples (Biopsy) taken from your knee. When implanted into a cartilage injury, these cells can form new hyaline-like cartilage.
Carticel poses little risk of disease transmission since it comes from your own tissue, and is not transplanted from an unrelated donor.
Carticel is not indicated for treatment of cartilage damage associated with generalized osteoarthritis.
As with any surgical procedure, there are important safety considerations to keep in mind and you need to discuss it with your surgeons.
Click Here to visit the Carticel Web site.
For viewing this procedure in animated format click on Surgical animation tab.
Small artificial plugs: Defect can be treated by placement of artificial material or biologically processed material
Osteochondritis Dissecans (OCD)
Osteochondritis Dissecans is a nonacute condition of the knee which involve necrosis and fragmentation of subchondral bone (bone under the knee surface cartilage).
This condition may be seen in other joints such as ankle, elbow and hip but is seen with more frequency in the knee joint. Most commonly OCD occurs in the second decade of life but also has been reported in younger and older age groups.
This condition may be present with much less frequency in both knees.
Symptoms:
Symptoms varies from vague activity related pain to sensation of catching, locking, giving way and occasionally feeling of a loose fragment floating in the knee joint.
Diagnosis:
Usually, diagnosis is made by radiographic evaluation, bone scan and more specific MRI.
Treatment:
These condition should be diagnosed and treated early prior to completion of the individual’s growth. Treatment of this condition after completion of growth generally lead to poor prognosis and possible development of degenerative arthritis.
Usually after 8-10 weeks of failed conservative treatment surgery is considered and there are varieties of surgical techniques which can be utilized to fix and stabilize the unstable and loose fragment. This however is in the case that fragment is viable and not necrotic. In case of non-viability of the OCD fragment then grafting techniques should be considered.
Osgood-Schlatter Disease/Osteochondritis (OSD)
The tibial tubercle (bump in front of the knee where patellar tendon attaches) forms as a result of secondary ossification. Repetitive microtrauma to this area will lead to development of Osgood-Schlatter Disease(OSD).
It is more common in males and usually is seen from ages 11 to 15. More commonly is seen at the onset of growth spurt.
Approximately 1/3 of cases are bilateral.
Symptoms:
Pain specially with running, jumping and contact and is more common in sports such as basketball, volleyball, soccer, gymnastics and ?rack.
Diagnosis:
Diagnosis is made by clinical examination, history of complaint and is confirmed by radiographic examination which in most cases will show a separate bony fragment from the proximal tibia.
Treatment:
Depending on the severity and stage of presentation treatment may require one or combination of the followings;
- Rest, at times this may be 3-4 months away from offending sport.
- Partial or total immobilization.
- Strengthening exercises.
- Flexibility and stretching exercises for quadriceps (thigh muscles).
- Simple over the counter analgesics.
- Protective braces and bands.
- Cross training.
- Surgery (as the last resort).