Knee injuries, how to treat them?

Knee injuries have become a headache for athletes, especially for runners. It is the largest of our joints, and has a very complex movement, in addition to withstand large forces of compression and tension.

The menisci, tendons, muscles, ligaments and hyaline cartilage contribute to the loads that the knee supports; all of them help in the distribution and absorption of loads, as well as to facilitate the movement of the joint, in which the patella is included. It is necessary to bear in mind that the cartilage of this last one is very thick and delicate, reason why its thinning or deterioration, the chondromalacia or patellar chondropathy, is a cause of pain and incapacity of complex solution. This poses a threat to any athlete, such as the runner.

In fact, chondromalacia represents between 10% and 25% of consultations to specialists in Traumatology and Sports Medicine and Physiotherapy for knee problems, affecting young adults and somewhat more women. On the other hand, many knee cartilage injuries occur in the area of greatest load and in athletes it is relatively common for injuries of the internal condyle to be related to other injuries such as those of the meniscus or anterior cruciate ligament.

Cartilage injuries in athletes

Cartilage injuries pose a threat to the athlete since they involve a difficult recovery and, in the worst case, can cause, in the long term, a degenerative process, osteoarthritis. This pathology is one of the most prevalent chronic diseases in developed societies, affecting the elderly, sportsmen, elite athletes and people suffering from obesity or other predisposing factors.

Since the repair of cartilage lesions involves great difficulty, their prevention has become a very important line of research, as much or more than the treatment of established lesions.

Cartilage injury prevention options

There are different options for the prevention of cartilage lesions, distinguished between surgical and non-surgical:

Most commonly used non-surgical therapies:

  • Cartilage protectants. The combination of Chondroitin Sulfate and Glucosamine Sulfate, two active ingredients, has the highest degree of scientific evidence to delay or slow down osteoarthritis, improve pain, inflammation and stiffness. Its long-term effects on pain and function are comparable to those of the latest generation anti-inflammatory drugs, such as Celebrex.
  • Intra-articular hyaluronic acid infiltrations, with autologous serum (orthokine) or plasma rich in growth factors. These infiltrations can achieve micro-repairs of the cartilage, induce the synthesis of endogenous hyaluronic acid and, therefore, clinical improvements and improvements in function and stiffness.
  • There are different types of hyaluronic acid, such as low and high molecular weight hyaluronic acid. In addition, new types of hyaluronic acid, with improved mechanical and superior biological properties, have recently come on the market and are already supported by publications.
  • Plasma rich in growth factors, which offers a good clinical response. Even so, in cases of cartilage wear this therapy is more inconsistent.
  • Orthokine. It is an evolution of the more potent platelet-rich plasma. It maintains many of the effects of PRFC but adds an enormous analgesic and anti-inflammatory capacity by providing antibodies against the molecule that causes pain and inflammation in the arthritic joint. Moreover, its effects seem to last longer (about 2-3 years).
  • True stem cells, which can be uncultured and cultured. These treatments still have little scientific evidence. Although they fulfill the anti-inflammatory and clinical improvement and micro-repair function, they are very expensive therapies that, at the present time, cannot offer either joint regeneration or rejuvenation.
  • With all of them the patient can achieve clinical improvements, allowing the patient to exercise more, lose weight, lose muscle and improve his pain threshold.
Read Now ๐Ÿ‘‰  The future of biological repair of intervertebral discs

Most commonly used surgical therapies:

  • Symptomatic treatment. It is the washing of synovial fluid and meniscus lesions, free bodies, etc., by arthroscopy.
  • Stem cells or bone marrow fibroblasts. It is based on stimulating the subchondral bone to allow the stem cells in the bone bed, on which the cartilage rests, to remodel and form a repair fibrocartilage film or plug to cover and regenerate the lesion.
  • Cellular induction of chondrogenesis. The intention of this technique is to use other tissues with greater differentiation potential, whose cells can be transformed into chondrocytes that form cartilage. Chondrocyte transplantation techniques such as autologous chondrocyte implantation (ACI) or autologous chondrocyte implantation induced in extracellular matrix (MACI ยฎ) are indicated when the damage is in a specific area, a defect or a patch (a crater in the cartilage). The success rate is around 90% in lesions of the femoral condyles. 84% in osteochondritis dissecans and 70% in patellar cartilage lesions.
  • Osteochondral transplantation for knee cartilage lesions. This transplant can be from the patient himself โ€“ osteochondral autograft โ€“ or from a donor โ€“ allograft. The disadvantages of the latter are poor cell viability (between 10-30%), surgical difficulty and the risk of infection, immunological reactions or transmission of viral diseases, although these are exceptional.

The factors that will make us lean towards one technique or another are, among others, the size and location of the lesion, the level of sports and work activity, the expectations in relation to the result or the economic cost of the procedure.