Knee cartilage injuries

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Cartilage

Knee cartilage is a specialized connective tissue that covers the joint surfaces of bones, allowing smooth joint movement and absorbing shock. There are two main types of cartilage in the knee:

Articular Cartilage
This smooth cartilage covers the ends of the bones that come into contact in the knee joint (femur, tibia, and patella).

Meniscal Cartilage
Located between the femur and tibia, the menisci are crescent-shaped and play a crucial role in load distribution, shock absorption, and stability of the knee joint.

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Treatments for Knee Cartilage Injuries

Treatments depend on the nature and severity of the cartilage injury. Common approaches include:

Conservative Treatment

Physiotherapy: Exercises to strengthen the muscles around the knee and improve stability.
Anti-inflammatory medications: To reduce pain and inflammation.
Intra-articular injections: For example, corticosteroid or hyaluronic acid injections to relieve pain and improve mobility.

Surgery

Cartilage Repair Surgery: Repair of cartilage injuries using techniques such as microfracture, mosaicplasty, or autologous chondrocyte grafting.

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Cartilage Repair Surgery

Cartilage repair surgery is a surgical procedure aimed at treating articular cartilage injuries, often performed arthroscopically.

Goal of Cartilage Repair Surgery
The main goal of cartilage repair surgery is to restore the surface of damaged or worn articular cartilage in the knee joint (or other joints). Articular cartilage is crucial for smooth, pain-free joint movement, and restoring it can help delay or prevent the development of osteoarthritis.

Common Cartilage Repair Techniques

Microfracture:

Description: This technique is used to stimulate the formation of new cartilage. The surgeon makes small perforations in the underlying bone at the site of the cartilage injury. This allows stem cells present in the bone marrow to enter the injured area and form new cartilage tissue.
Indications: It is often used to treat small cartilage lesions in well-vascularized areas where healing potential is higher.

Mosaicplasty (or Osteochondral Transplantation):

Description: This technique involves harvesting small healthy cartilage-and-bone (osteochondral) grafts from a non-weight-bearing area of the knee and transplanting them into the injured area. These grafts are generally taken from the same patient.
Indications: It is suitable for treating larger lesions or specific cartilage areas where other techniques may not be effective.

Autologous Chondrocyte Grafting

Description: This procedure involves harvesting healthy cartilage cells (chondrocytes) from the patient’s knee, culturing them in a laboratory to multiply them, and then reimplanting them into the injured area with a biological scaffold.
Indications: It is used for extensive or deep cartilage lesions where natural cartilage regeneration is insufficient.

Biological Restoration Techniques:

Description: This includes the use of biological products such as platelet-rich plasma (PRP) or collagen matrices to promote healing and cartilage regeneration.
Indications: They are often combined with other surgical techniques to optimize cartilage repair outcomes.

Cartilage Repair Surgery Process

Preparation and Anesthesia

The patient is prepared for surgery under general or regional anesthesia, depending on the surgeon’s recommendations.
Access to the Joint:

Small incisions are made around the knee to allow insertion of the arthroscope and surgical instruments.

Assessment and Treatment

Using the arthroscope, the surgeon assesses the extent and nature of the cartilage injury.
The specific cartilage repair technique is then chosen based on the size, location, and depth of the lesion.

Repair

The chosen technique is carried out to restore the cartilage surface.
Grafts are prepared and implanted into the injured area, or perforations are made to stimulate cartilage healing.

Closure

The incisions are closed and a dressing is applied.

Postoperative Rehabilitation
Rehabilitation is crucial to optimize the results of cartilage repair surgery.
It includes muscle-strengthening, flexibility, and proprioception exercises, tailored to protect the treated area while promoting cartilage healing.

Expected Results
The results of cartilage repair surgery vary depending on many factors, including the technique used, the size and location of the lesion, the patient’s age, and adherence to rehabilitation recommendations. Goals include reducing pain, improving joint function, and preventing progression of osteoarthritis.

Possible Complications
Complications may include infections, persistent pain, nerve or vascular injury, as well as unsatisfactory results in terms of cartilage healing. The risk of complications depends on the specific procedure and the patient’s overall health.

In conclusion, cartilage repair surgery is a promising option for treating knee cartilage injuries, aiming to restore joint function and improve the quality of life of patients affected by these problems.