Articular Cartilage Injury

Articular cartilage defect1

Articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint.  Cartilage helps the bones move smoothly against each other and can withstand the weight of the body during activities such as running and jumping. Articular cartilage does not have a direct blood supply to it so has little capacity to repair itself. Once the cartilage is torn it will not heal easily and can lead to degeneration of the articular surface, leading to development of osteoarthritis.

The damage in articular cartilage can affect people of all ages. It can be damaged by trauma such as accidents, mechanical injury such as a fall, or from degenerative joint disease (osteoarthritis) occurring in older people.

What are the treatment options for articular cartilage injury?

Patients with articular cartilage damage experience symptoms such as joint pain, swelling, stiffness, and a decrease in range of motion of the knee.  Some patients may benefit from cartilage restoration procedures.  Patients with diffuse or advance arthritis are usually not candidates for this.  These procedures include:

  • Microfracture
  • Drilling
  • Abrasion Arthroplasty / Chondroplasty
  • Autologous chondrocyte implantation (ACI)
  • Osteochondral Autograft Transplantation (OATs)
  • Osteochondral Allograft Transplantation

Microfracture: In this method, numerous holes are created in bone beneath the injured cartilage using a sharp awl tool. This procedure stimulates healing response by allowing blood and bone marrow elements to penetrate to the joint surface.. This blood supply results in the formation of a fibrocartilage (scar cartilage) that is not exactly like the native hyaline cartilage, but does have some of its qualities.

Abrasion Arthroplasty / Chondroplasty: A high speed burr is used to remove the damaged cartilage and abrade the underlying bone.  This procedure is performed using an arthroscope.

Osteochondral Autograft Transplantation: Healthy cartilage tissue (graft) is taken from the bone that bears less weight and is transferred to the place of the injured joint. This method is used for smaller cartilage defects.

Osteochondral Allograft Transplantation: A cartilage tissue (graft) is taken from a donor and transplanted to the site of the injury. Allograft technique is recommended if larger part of cartilage is damaged.

Autologous Chondrocyte Implantation: In this method, a piece of healthy cartilage from another site is removed using arthroscopic technique and is cultured in a laboratory. Cultured cells form a larger patch which is then implanted in the damaged part by open surgery.

Following the surgery, rehabilitation procedures are advised to improve healing and to restore normal functioning of the joint.

  • American Orthopaedic Society for Sports Medicine
  • The Arthroscopy Association of North America
  •  American Academy of Orthopaedic Surgeons
  • International Society for Hip Arthroscopy