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Articular Cartilage Injury

  • Overview

    Three different types of cartilage are found in the body:

    • Articular or hyaline cartilage -- covers joint surfaces
    • Fibrocartilage -- such as in the knee meniscus and vertebral disk
    • Elastic cartilage -- such as the outer ear.

    Articular cartilage is a complex, living tissue that lines the bony surface of joints. It provides a low friction surface, enabling the joint to withstand weight bearing movements, both for daily activities as well as athletics, including walking and stair climbing, and work-related activities. In other words, articular cartilage is a very thin shock absorber.

    Articular cartilage injuries can occur as a result of either traumatic mechanical destruction or progressive mechanical degeneration (wear and tear).

    How Boston Children's Hospital approaches articular cartilage injuries

    Depending on the severity of your child's articular cartilage injury, treatment may be surgical or non-surgical. At Children's, doctors are committed to repairing your child's knee in the least invasive manner possible, including physical therapy and tips on lifestyle changes. Surgery is only used in the most severe cases of articular cartilage injuries.

    »
    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

     617-355-6021
     fax: 617-738-1336

    +
    Boston Children's at Waltham
    9 Hope Avenue
    Waltham MA 02453

     617-355-6021
    Boston Children's at Lexington
    482 Bedford Street
    Lexington MA 02420

     617-355-6021
     fax: 617-738-1336
    Boston Children's North
    10 Centennial Drive
    Peabody MA 01960

     617-355-6021
     fax: 617-738-1336
    Stetson Medical Center
    541 Main Street
    Weymouth MA 02190

     617-355-6021
     fax: 781-335-5628
    Caritas Good Samaritan Medical Center
    830 Oak Street, Suite K
    Brockton MA 02301

     617-355-6021
     fax: 617-738-1336


  • In-Depth

    Mechanical destruction of articular cartilage

    With mechanical destruction, a direct blow or other trauma can injure the articular cartilage.

    • Because articular cartilage has no direct blood supply, it has little or no capacity to repair itself from mechanical destruction.
    • Depending on the extent of the damage and location of the injury, it is sometimes possible for the articular cartilage cells to heal.
    • If the injury penetrates the bone beneath the cartilage, the underlying bone provides some blood to the area, improving the rate of healing.

    Occasionally, an articular cartilage fragment completely breaks loose from the underlying bone. This chip, called a loose body, may float in the joint, interfering with normal joint motion.

    Mechanical degeneration of articular cartilage

    Mechanical degeneration (wear and tear) of articular cartilage occurs with the progressive loss of the normal cartilage structure and function.

    • This initial loss begins with cartilage softening, then proceeds to fragmentation.
    • As the loss of the articular cartilage lining continues, the underlying bone has no protection from the normal wear and tear of daily living and begins to breakdown, leading to osteoarthritis.

    Also known as degenerative joint disease, osteoarthritis is characterized by three processes:

    • a progressive loss of cartilage
    • the body's attempted to repair the cartilage
    • the destruction of the bone underneath the articular cartilage

    The cause of osteoarthritis is poorly understood, but lifelong moderate use of normal joints does not increase the risk. Factors such as high impact twisting injuries, abnormal joint anatomy, joint instability, inadequate muscle strength or endurance, and medical or genetic factors can contribute to osteoarthritis.

    What are the symptoms of an articular cartilage injury?

    • Knee swelling and vague pain. At this point continued activity may not be possible.
    • If a loose body is present, words such as "locking" or "catching" might be used to describe the problem.
    • With mechanical degeneration (wear and tear), the patient often experiences stiffness, decreased range of motion, joint pain, and/or swelling.
  • Tests

    How does a doctor know my child has an articular cartilage injury?

    The physician examines your child's joint, looking for

    • decreased range of motion
    • pain along the joint line
    • swelling
    • fluid on the knee
    • abnormal ailment of the bones making-up the joint
    • ligament or meniscal injury

    Because an articular cartilage injury is hard to diagnose, your child's doctor may also require

    • Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body
    • Arthroscopy – a minimally invasive outpatient procedure that inserts a small camera into the joint for the doctor to inspect.
  • When a joint is injured, the body releases enzymes that may further break down the already damaged articular cartilage.

    • Injuries to the cartilage that do not extend to the bone generally do not heal on their own.
    • Injuries that penetrate to the bone may heal, but the type of cartilage that is laid down is structurally unorganized and does not function as well as the original articular cartilage.

    Defects smaller than two centimeters have the best prognosis and treatment options. Those options include arthroscopic surgery, which can remove damaged cartilage and increase blood flow from the underlying bone (e.g. drilling, pick procedure.) For larger defects, it may be necessary to transplant cartilage from other areas of the knee (joint).

    For patients with osteoarthritis, non-surgical treatment consists of:

    • physical therapy
    • lifestyle modification (e.g. reducing activity)
    • bracing
    • supportive devices
    • oral and injection drugs (i.e. non-steroidal anti-inflammatory drugs, cartilage protective drugs)
    • medical management

    Surgical options often only provide short-term relief, and depend on the severity of the osteoarthritis:

    • Tibial or femoral osteotomics (cutting the bone to rebalance joint wear) may reduce symptoms, help to maintain an active lifestyle, and delay the need for total joint replacement.
    • Total joint replacement can provide relief for the symptom of advanced osteoarthritis, but generally requires changes in a patient's lifestyle and/or activity level.
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