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uk sports medicine
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Health in Sports Report - February/March 2006
Articular Cartilage Injuries
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Along with fibrocartilage and elastic cartilage, articular cartilage is one of three different types
of cartilage found in the body. These different cartilages are distinguished by their structure,
elasticity and strength. In some joints, such as the knee, both articular cartilage and fibrocartilage
are found functioning side-by-side as distinctly different structures with different functions.
Articular cartilage is a complex, living tissue that lines the bony surface of joints. Its function is
to provide a low friction surface, enabling the joint to withstand weight bearing through the range
of motion needed to perform athletic endeavors and daily activities such as walking and stair climbing.
Articular cartilage injuries can occur as a result of traumatic mechanical destruction or progressive
mechanical degeneration (wear and tear.) Mechanical destruction is the result of a direct blow, or other trauma, leaving the articular cartilage with no direct blood supply and little or no capacity to repair itself. If the injury penetrates the bone beneath the cartilage, the underlying bone provides some blood to the area, improving the chance of healing. Occasionally an articular cartilage fragment
completely breaks loose from the underlying bone. This fragment may float in the joint interfering with normal joint motion.
In many cases of an articular cartilage knee injury, a patient will experience knee swelling and vague pain. At this point continued activity may not be possible. If a loose fragment is present, the patient may use words such as “locking” or “catching” to describe the problem. The physician examines the knee looking for decreased range of motion, pain along the joint line, swelling, abnormal alignment of the bones making-up the joint and ligament or meniscal injury. Injuries to the articular cartilage are difficult to diagnose, and additional evaluation with MRI or arthroscopy may be necessary.
Injuries to the cartilage that do not extend to the bone will generally not heal on their own. Injuries
that penetrate to the bone may heal, but the type of cartilage that is laid down is structurally
disorganized and does not function as well as the original articular cartilage. Defects smaller than two centimeters have the best prognosis and treatment options. These options include arthroscopic surgery using techniques to remove damaged cartilage and increase blood flow from the underlying bone.
Nonsurgical treatment consists of physical therapy, lifestyle modification (e.g. reducing activity), bracing, supportive devices, oral and injection drugs (i.e. nonsteroidal anti-inflammatory drugs, cartilage protective drugs) and medical management.
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