What is Management of Chondral Injuries?
Chondral is a medical term that means cartilage. Articular or hyaline cartilage is a tough, shiny, smooth white tissue covering the ends of the bones in a joint. Cartilage acts as a cushion and a shock absorber and helps the bones move smoothly against each other. A chondral injury refers to an injury of the articular cartilage, covering the joint. It often involves the knees, although joints such as the elbows, hips, and ankles can also be affected.
Articular cartilage does not have a direct blood supply to it, so has less capacity to repair itself. As cartilage does not heal on its own effectively, physicians have developed surgical and non-surgical techniques to stimulate the growth of new cartilage and promote healing. This is referred to as management of chondral injuries.
Causes of Chondral Injuries
The cartilage can be damaged by trauma such as accidents, mechanical injuries such as a fall, or gradual wear and tear (osteoarthritis) occurring in older people. The damage can occur from even a minor injury such as a small tear in the top layer of the joint or due to a major injury such as an extensive tear to the bone from severe trauma.
Symptoms of Chondral Injuries
Patients with articular cartilage damage may experience joint symptoms such as:
- Joint pain
- Grinding or clicking sensation
- Decrease in range of motion
- Locking, catching, or giving way
- A noticeable limp
Diagnosis of Chondral Injuries
Diagnosis of chondral injuries involves a thorough medical history and physical examination by your doctor. In addition to this, X-rays and MRI scans are also useful in diagnosing these types of injuries. However, arthroscopy is the most accurate way of diagnosing, evaluating, and managing chondral injuries.
Management of Chondral Injuries
The management of chondral injuries depends on the severity of the injury and includes non-surgical and surgical modalities of treatment.
Non-surgical treatment includes resting the affected joint; protecting the affected region from further damage by utilizing support such as a knee brace; physical therapy; elevating the affected limb and applying an ice pack to the joint regularly; eating a healthy diet, avoidance of aggravating activities, taking ordinary pain medicines and NSAIDs (non-steroidal anti-inflammatory drugs), and use of steroid injections in some cases.
When non-surgical options are ineffective and pain persists, arthroscopic surgery is commonly performed to treat chondral injuries. Arthroscopy, also referred to as keyhole surgery or minimally invasive surgery, is a surgical procedure employing an arthroscope, a narrow tube with a tiny camera attached to the end, to assess the damage to the joint. Your surgeon makes 2 to 3 small incisions around the joint. The arthroscope is inserted through one of the incisions and the camera attached to the arthroscope helps visualize the joint, on a monitor. A sterile solution is pumped into the joint to clear the view and increase the space for surgery. Specially designed instruments are inserted through the other incisions to the area of defect in the joint, and a procedure called arthroscopic debridement is performed. This procedure removes cartilage fragments, smooths the edges of the defect, and reduces friction and irritation. After the completion of the procedure, the arthroscope is removed and incisions are closed.
Other arthroscopic surgeries that may be recommended to manage chondral injuries include:
- Microfracture surgery/drilling/marrow stimulation: This technique to treat chondral injuries involves stimulating the formation of new articular cartilage by drilling numerous tiny holes in the bone underneath the damaged cartilage. This results in the formation of blood clots within the damaged cartilage, which stimulates the growth of new cartilage known as fibrocartilage. Although, the fibrocartilage formed is different from the normal hyaline cartilage, it can provide significant improvement in the symptoms
- Autologous Cartilage Implantation (ACI): In this procedure, the healthy cartilage cells are harvested from the non-weight-bearing area of the bone. The healthy cartilage cells are then sent to the laboratory where the cells are cultured and multiplied over a 3- to 5-week period. Once enough cells have grown, the new cartilage cells are implanted into the area of defect where they grow into healthy tissue.
- Matrix-induced Autologous Chondrocyte Implantation (MACI): This technique employs cultured chondrocytes (the cells which produce the cartilage) to repair the articular cartilage damage. These chondrocytes are inserted onto a layer of collagen (a type of protein). The embedded chondrocytes regenerate within the collagen matrix to form implant tissue that can be used to fill the cartilage defect. The matrix-induced autologous chondrocyte implant is then implanted over the damaged area of the joint to repair cartilage defects.
- Mosaicplasty: This is a surgical technique to repair the cartilage defect by transplanting healthy bone and cartilage (osteochondral tissue graft) from a non-weight bearing part of the joint into the area of defect. This allows the body to grow fresh cartilage from the underlying bone and fill in the area of the defect naturally. It is indicated to treat small cartilage defects of less than 2 cm in young active adults less than 45 years of age.