Cartilage structure and function can be damaged. Such damage can be caused by a variety of causes, such as a bad fall or a traumatic sport accident, previous knee injury or damage that occurs over time. Immobilization for a long time can also cause cartilage damage.
Articular cartilage damage to the knee can be found on its own but will be more commonly found along with ligament and meniscus injuries. People with previous surgical interventions face more possibility of damage to articular cartilage because the mechanics are changed joints. Articular cartilage damage can also be found on the shoulder causing pain, discomfort and limited movement.
Articular cartilage usually does not regenerate (the process of repair with the formation of the same type of tissue) after an injury or disease that causes tissue loss and formation of a defect. This fact was first described by William Hunter in 1743. Several surgical techniques have been developed in an attempt to repair articular cartilage defects.
Video Articular cartilage damage
Diagnosis
There are no non-invasive tests that can currently diagnose articular cartilage damage. In addition, the symptoms vary from person to person. Or as Dr. Karen Hambly:
"You may or may not have pain and you can not experience swelling, or are limited.Yes, you may experience locking if a piece of articular cartilage has been broken and is a loose body in the joint or you may be catching or giving way. has some muscle wasting and difficulties in activities such as up and down stairs, walking or running but then people with moderate knee injuries may also.This is why articular cartilage damage is a 'cinderella' knee problem.This tends to be diagnosed only after other structures have been ruled out - well if not your meniscus or ligament, what else can, maybe we should see articular cartilage? "
MRI-scan becomes more valuable in articular cartilage analysis but its use is still expensive and time-consuming. X-rays show only bone injuries and are therefore not very helpful in diagnosing cartilage damage, especially in the early stages. The best tool for diagnosing articular damage is the use of arthroscopy.
Measuring cartilage damage
The International Cartilage Repair Society has established an arthroscopic assessment system with which cartilage defects can be classified:
- level 0: (normal) healthy cartilage
- class 1: cartilage has soft spots, abrasions, or shallow clothing
- class 2: small tears less than half the thickness of the cartilage layer
- grade 3: the lesion has a deep gap more than half the thickness of the cartilage layer
- grade 4: cartilage rips full thickness and expose the underlying bone (subchondral)
Doctors will also often measure the size of each defect. Defects smaller than 2 cm, for example, are considered small. It is also important to remember that although the amount of damage is an important factor, the location of the defect can also affect the symptoms you get in terms of pain and function and repair options available.
In contrast to popular perception, pain is not a good indicator to determine the extent of damage to the articular cartilage. One person can have severe pain with one minor flaw while others can have a bit of pain with some big full thick flaws.
Because articular cartilage has no blood supply and chondrocytes (cells in articular cartilage) have limited mobility, articular cartilage has a very limited ability to heal itself. If left untreated, the cartilage lesions will get worse and the level of lesions or defects will increase.
Maps Articular cartilage damage
Consequences
Articular cartilage has a very limited capacity to improve. Small damage does not improve itself and can often get worse over time. Because of aneural and avascular cartilage (lack of nerves and blood supply, respectively), superficial damage often does not trigger pain.
As damage increases and chondral damage reaches the subchondral bone, the blood supply in the bone begins the healing process in the defect. A tissue scar that consists of a type of cartilage called fibrocartilage is then formed. Although fibrocartilage is capable of filling articular cartilage defects, the structure is significantly different from that of hyaline cartilage; it's much denser and can not stand the demands of everyday activity as much as hyaline cartilage. Therefore, it is higher risk to be damaged.
Wang et al. (2006) found that small articular cartilage defects may develop into osteoarthritis over time if left untreated. An initially small articular cartilage defect still has the potential to have a physical and chemical "domino effect" on normal "normal" articular cartilage.
Treatment
Although the damage to articular cartilage is not life-threatening, it greatly affects the quality of one's life. Articular cartilage damage is often a cause of severe pain, knee swelling, major decreases in mobility and severe restriction for one's activity. Over the last few decades, however, research has focused on the regeneration of damaged joints.
This regenerative procedure is believed to delay osteoarthritis injury to knee articular cartilage, by retarding joint degeneration compared with untreated damage. According to Mithoefer et al. (2006), this articular cartilage repair procedure offers the best results when the intervention takes place in the early stages of cartilage damage.
References
Source of the article : Wikipedia
0 Comments