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Cartilage Injuries

Injury to the knee can cause damage to the articular lining cartilage in the knee joint, or sometimes to both the cartilage and the bone.

If the injury is restricted to the cartilage, it will not show up in a plain X-ray; it may be noted on an MRI.  An arthroscopy (using a special instrument to look inside the joint) can thoroughly identify it.

Symptoms may include swelling and pain when bending the knee.

In some cases arthroscopy can be used to 'smooth' the cartilage. Although new cartilage cannot grow to take its place, scar tissue appears.

It is also possible to transplant some cartilage from an uninjured part of the knee. Another option is to remove some normal cartilage cells, reproduce them in a lab and then later reimplant them into the damaged area so that new cartilage will grow.

Detached Cartilage of Bone in the Knee Joint

If a piece of cartilage or bone has become detached in the knee and the injury is not treated immediately, the loose part can 'swim around' in the joint. This means that it may occasionally get stuck, causing pain and a feeling that the knee is locked. The knee may also click and swell up. Such a condition is called a loose body in the knee.

If the injury is fairly recent, it is possible to put the piece back in place. More commonly, the loose body may be removed by arthroscopy.

As cartilage does not show up on an X-ray, the loose body will only be visible if it consists of bone.

Chondromalacia Patella - Runner's Knee

Chondromalacia patella is a common cause of kneecap pain or anterior knee pain. Often called Runner's Knee, this condition often affects young, otherwise healthy athletes.

Chondromalacia is due to an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some individuals, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result.

What Happens to the Cartilage with Chondromalacia?

Chondromalacia is due to changes of the deepest layers of cartilage, causing blistering of the surface cartilage. The pattern of cartilage damage seen with chondromalacia is distinct from the degeneration seen in arthritis, and the damage from chondromalacia is thought to be capable of repair, unlike that seen with arthritis

Who Gets Chondromalacia?

Chondromalacia is interesting in that it often strikes young, otherwise healthy, athletic individuals. Women are more commonly affected with chondromalacia. Exactly why this is the case is unknown, but it is thought to have to do with anatomical differences between men and women, in which women experience increased lateral forces on the patella.

Treatment

The treatment of chondromalacia remains controversial, but most individuals can undergo effective treatment by resting the knee and adhering to a proper physical therapy program. Allowing the inflammation of chondromalacia to settle is the first step of treatment. Avoiding painful activities that irritate the knee for several weeks, followed by a gradual return to activity is important. In this time, cross-training activities, such as swimming, can allow an athlete to maintain their fitness while resting the knee. The next step in treatment is a physical therapy program that should emphasize strengthening and flexibility of the quadriceps and hamstring muscle groups. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the pain associated with chondromalacia.

Is Surgery Necessary for Chondromalacia?

Sometimes chondromalacia is not cured by conservative therapy, and it may be determined that surgery is needed. By looking into the knee with an arthroscope, the surgeon can assess the damage done to the cartilage. He or she can also assess the mechanics of the joint to ascertain if there is an anatomic misalignment that could be corrected.