How to treat cartilage lesions of the knee

What is articular cartilage?

Articular cartilage is a tissue located in the joints. It is found lining the joint surface where bones interact to move (e.g., in the knee, lining the femur and tibia).

Why is it so difficult to repair cartilage injuries?

Articular cartilage has no blood circulation, lymphatic circulation or nerve innervation, it is nourished by diffusion and also lacks progenitor cells, so self-repair is not possible and if it happens it does so in a very defective way.

It is easy to deduce that leaving a chondral lesion to its free evolution will trigger a degenerative arthritis that will diminish the patient too much, leading them to the placement of a total knee arthroplasty. In addition, it should be taken into account that a not inconsiderable percentage of patients suffering from these lesions are young, under 50 years of age.

In what areas are most cartilage lesions located? What are the warning signs of a cartilage lesion?

The joint most frequently affected is the knee, followed by the ankle and hip.

Joint pain is the most common symptom of chondral injury. Depending on the degree of involvement, the pain will be accompanied by more or less joint swelling, even joint effusion. If the injury consists of the detachment of a fragment of cartilage, these symptoms may be accompanied by joint blockage.

Who tends to suffer from these lesions?

Special attention should be paid to sports patients since activities that cause recurrent and medium/high intensity impact on the joints may trigger a subacute chondral injury. On the other hand, this type of patients may experience more frequently a high energy trauma and may suffer an acute injury even with cartilage detachment.

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Another group of patients to pay attention to are patients over 65 years of age. Patients suffering from osteoarthritis have cartilage that has already undergone subtle delaminations that can be accentuated at any slightest gesture and cause a functional disability that should alert us.

Which treatments are used and what factors should be taken into account when deciding on one treatment or another?

We could make a classification of the treatments that exist for chondral lesions:

  • Stimulation techniques: microfractures and nanofractures.
  • Replacement techniques: mosaicplasties and structural allografts.
  • Biological repair techniques: Autologous Chondrocyte Implantation with Membrane.

The choice of a specialist in Traumatology of one technique or another will depend on the type of injury we are facing, if the injury is less than 2 square centimeters in area we can use the stimulation techniques. If we are facing a lesion between 2 and 10 square centimeters without more than 2cm deep we can use mosaicplasty, in case the depth of the lesion is greater we can think of structural allografts in fresh.

Special mention is for the Autologous Chondrocyte Implantation with Membrane that can only be implanted in centers specialized in this technique. It may be used in focal chondral lesions between 2-10 square centimeters in area not exceeding 1.5-2 cm in depth.

For more information about cartilage lesions of the knee, please contact me for a consultation.