Knee Cartilage Damage FAQs
Can you regrow cartilage in your knees?
The cartilage in the form of meniscus usually does not regrow in the knee joint. Once it is excised it stays short and the body doesn’t have the power of regenerating it. The cartilage lining on the bone, once damaged, also does not regrow back to the normal quality, but the body tries to cover it up with a little inferior quality of the cartilage, which may still be helpful in preventing further damages and decreasing the pain and swelling on the knee.
What are the symptoms of cartilage damage in the knee?
Cartilage damage usually causes pain and swelling of the knee which happens specifically in the certain movements which lead to loading of those cartilage. If the cartilage damage is in the patellofemoral joint or on the kneecap, then there is more pain and swelling after moving up and down the stairs. If it is on the inner side of the knee, then there be more pain while doing deep knee bends. It may be associated with clicking and popping of the joint and occasional feeling of giving way.
What is an arthroscopic abrasion chondroplasty?
Patients with grade 4 cartilage loss leading to exposure of the underlying bone may be treated with a procedure called abrasion chondroplasty, in which the exposed bone is abraded. This is usually done arthroscopically with the use of camera, light source and arthroscopic instruments. It is done to enhance bleeding on the bony surface so that the underlying bone is stimulated to try to cover the raw surface with cartilage.
What is chondroplasty of the knee joint?
The knee joint is lined by cartilage over the bones on the lower end of the thigh bone, and upper end of the leg bone and behind the knee cap. Due to injury, or aging, the cartilage gets frayed, and damaged, and may cause pain, and swelling in the knee with or without clicking or popping.
Patients who have persistent pain, and swelling, which is not improved with medications, cortisone injection, and physical therapy, or if such damage is found in arthroscopic surgeries when done for other reasons, like meniscus injury or ligament repair, may need attention. The loose cartilage is cleaned and debrided to stable margins. This procedure, of removing the damaged flaps of the cartilage, as well as cleaning up is called chondroplasty.
What is Microfracture?
If the underlying bone is exposed, then it may be abraded using arthroscopic instruments, and this is called abrasion chondroplasty. Sometimes instruments are used to dig deeper into the underlying bone, and this process is called microfracture. Chondroplasty is done in order to stimulate the body to heal with better blood supply and forming fibro cartilage layer over the bone.
What can be done for a large cartilage damage in the knee of an old patient?
If the patient has a large cartilage damage or defect in the knee of a patient more than 60 to 70-year-old or with limited activity, then such patients are usually referred for a joint replacement surgery, which can be either full joint replacement or partial joint replacement surgery depending on the health of the other areas of the knee. If the cartilage damage is found during an arthroscopic procedure which is being done for other pathology like meniscus tear, then such cartilage is debrided and cleaned to a stable margin.
The patient is followed postoperatively and sent for physical therapy. Such patients are informed about the damage in the knee and are given the option of continuing with conservative means and using medications including cortisone injection versus going for a consultation with a joint replacement surgeon to look for options regarding joint replacement.
What can be done for a large cartilage damage in the knee of a young patient?
Occasionally younger age group patients, especially those involved in motor vehicle accidents or sports injuries, may present with large cartilage flap or damages. These patients are not ideal candidate for a joint replacement surgery due to their age. These patients are offered joint cartilage restoration, regenerative or replacement procedures. Occasionally the patients, who have loose cartilage flap as in patients of osteochondritis dissecans, can be treated with drilling and fixation of the flap to its native position.
If the defect is not large enough, then a biologic replacement can be put at the place of loss of cartilage to allow for regeneration of native cartilage. If the defect is large, then a substitute allograft replacement can be performed to provide smooth surface after healing. These patients must be put in rigorous rehabilitation protocol, which includes no weightbearing to protect the healing knee.
All these surgeries do carry risk of failure in which case they may also need repeat surgeries. Occasionally the patient may be found to have malalignment of the bones of the leg which leads to cartilage damage. Such patients may also be offered osteotomy or correction of the bone alignment by cutting the bone and fixing it into a straighter position.
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