Articular Cartilage Repair

Articular cartilage is located on the surface of the bone endings. In a healthy state, it is smooth and slippery. Its purpose is to decrease the friction between the bone ends, to balance load, and to protect the bones during movement and loads. If the cartilage surface is damaged, it can interfere with the normal functioning of the joint. Thus, the joint functioning is accompanied by pain or disturbances in the joint during movement. Damage can irritate the joint capsule, which can lead to joint edema. Apparently, this is the background of the possible irritation of capsule, as the cartilage itself has no nerve endings. Maintaining joint health is particularly important, and it is essential to retain motion in the joint, if possible. Pain in the knee joint causes discomfort in walking, doing physical exercise, or even rest. This study aims to observe the causes of articular cartilage damage and the methods of its treatment.

The Causes of Articular Cartilage Damage

The study asserts that many factors can affect articular cartilage, and all of them have specific features (Cole & Malek, 2013). In young people, cartilage damage may be linked to the disease, softening the cartilage (chondromalacia); in growing children, this damage can lead to the disease of the joints, called osteochondritis dissecans. Adults can experience this discomfort because of rheumatoid arthritis. Furthermore, cartilage damage occurs in injuries, for example, cartilaginous surfaces during knee flexion can strike each other. It can also be a cause of a direct hit after the fall to the floor. According to the mechanisms of injury, it is possible to determine the possibility of damage to the cartilage. For example, during the patella dislocation, when the cup hits the edge of the cartilage surface, the tibial cartilage lesions are formed at the inner edge of the cup and the outer edge of the tibia. The second most frequently occurring damage is associated with the rupture of anterior cross ligament damage to the articular cartilage of the outer lip. Cartilage damage can also be the result of other damage to the knee.

Many findings reveal that cartilage lesions are rather diverse (Athanasiou, Darling, DuRaine, Hu, & Reddi, 2013). When the cartilage injuries occur, its surface remains flat. Cracks can be formed on the surface of the cartilage, damaging this surface, or they can capture the entire cartilage layer to the underlying bone. During this, single or multiple fragments can be separated completely or partially. The same symptoms can vary from asymptomatic to severe pain when walking. The examination takes into account the nature of the injury and its symptoms. If the sector knee movement is complete and the knee is stable, there is no particular hurry to get specialized treatment. Athanasiou et al. (2013) report that in general, cartilage damage does not require surgical intervention; the injury occurring simultaneously such as spiral damage may require it. Figuring out other injuries can sometimes give rise to magnetic resonance imaging, which is the only study that can be used to obtain an image of the cartilage damage.

Most of the articular cartilage damage should be observed in the application of the method of the rapid spectroscopy. In many cases, the separated fragment can be removed during the operative procedure and spectroscopy. Additionally, it can be required when cartilage damage extends through the cartilage to the underlying bone. Symptoms, causing the damage of articular cartilage may last for several months, but after a long time, the knee calms down. In the initial stage, training in the gym and the pool as well as cycling are the most suitable forms of training.

Methods of Treatment

Damage to articular cartilage remains a big problem. Cartilage defects are caused by injury or due to cartilage deterioration. Cole and Malek (2013) assume that the main problem is that being once damaged, cartilage regenerates tissue incompletely, for example, in the form of so-called fibrocartilage. For a long time, it has been believed that cartilage does not regenerate, but recently, this knowledge was expended. Nowadays, two main techniques for the treatment exist such as the transplantation of chondrocytes and the transplantation of cartilage with bone structures (Makris, Gomoll, Malizos, Hu, & Athanasiou, 2014). In comparison with the transplantation of foreign tissues and synthetic materials, the transplantation of the patient’s own cellular material has the advantage because the rejection reaction is not expected. The transplantation of autologous cartilage was developed in the late 1980s by doctors Brittberg Mats and Lars Peterson in Sweden that allowed a person to get a good hyaline cartilage with a perfect load capacity. Thus, a newly grown and later transplanted cartilage has almost the same properties as a natural hyaline cartilage, including the load capacity.

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As with any other injuries and diseases, there are conservative and operative treatment methods. The range of conservative measures includes regular training mobility, weight loss, gymnastic exercises in water, the correction of shoes, devices for assistance in walking, injections of steroidal and non-steroidal antiphlogistica, and tapping (Athanasiou et al., 2013). It is important to conduct a thorough examination of each patient, and based on the results of examination to decide on the further individual therapy. Operational therapy (surgery) can also be used to restore damaged articular cartilage. Operational activities include microfracturing, OATS transplantation, and transplants chondrocytes.

For example, OATS transplantation requires removing the damaged area of cartilage. The same fragment of healthy, not damaged cartilage is taken from the joint region and then installed in a place of a remote, ruined land (Cole & Malek, 2013). Cylinder damaged cartilage is installed in the place of a healthy portion of the fence, thus closing it. The advantage of this technique is that the reconstructed surface is identical to the biological and biomechanical terms of hyaline cartilage. Transplantation is possible for the patients of up to 60 years of age and the defects of up to 3 cm (Makris et al., 2014).  Osteochondral transplantation is the best alternative for sports active patients. It is important that the reconstruction of cartilage transplantation has achieved structures similar to the natural one. Through the minimally invasive intervention, surgeons manage to reconstruct the cartilage in accordance with its anatomy.

Recommendations

Articular cartilage repair is possible for not all defects of the cartilage layer. The best results are achieved while eliminating the local damage; however, thanks to the variety of techniques, the application area has expanded. The new method for transplantation allows patients to recover fully and have joint flexibility. Essentially, cartilage transplantation can be performed in the patients of up to 50 years of age with various defects in the early stages of cartilage wear surfaces. At the same time, some local areas of damage can be quite serious, but the surrounding surface defect must be in order. Admittedly, the patients who suffer from extensive osteoarthritis, older age, the legs axis, and other common diseases do not fit the cartilage transplantation criteria.

A patient in search for the most suitable method of transplantation should undergo a thorough clinical examination that includes general inspection, analysis of the history of damage to cartilage, gait analysis, determination of the degree of professional sports, and the load of the damaged joint (Makris et al., 2014). Then, the X-ray examination in two planes runs a complete snapshot of the legs to measure axis angles and MRI examination if necessary. The patient should bear in mind that the postoperative period consists of 6-8 weeks of immobilization and the further physiotherapy course. In the first weeks, flexion is limited and the patient uses crutches. As a rule, in 8 weeks after the surgery, the patient can fully load the leg. He or she can ride a bike, and run after three months. In general, after the completion of the regeneration phase and the complete healing after the cartilage injury, a person can return to the sports activity.

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Patients should know that the damage to articular cartilage is not always clinically manifested and the way of choosing the best method of treatment is rather complicated. Before surgery, the surgeon should consider many factors such as the age of the patient, his way of life, the severity of cartilage damage, collateral damage, and the knee joint disease (Cole & Malek, 2013). Sometimes, a patient needs to have additional tests done such as MRI of the knee joint. If cartilage damage is accompanied by pain, the patient is usually recommended to have a surgery. However, even if a patient experiences pain, surgery is not always displayed. A doctor may recommend a treatment to decrease pain in the form of drug therapy, physical therapy, and physical therapy sessions. The use of the special brace and orthopedic footwear can help reduce pain.

Conclusion

The damage of articular cartilage decreases the friction between the bone ends, load balancing, and it cannot protect the bones during movement and loads. In this state, the normal functioning of the joint is accompanied by pain or disturbances in the joint during movement. Maintaining joint health is of particularly importance, and it is essential to retain motion in the joint, if possible. Pain in the knee joint causes discomfort in walking, doing physical exercise, or even rest. There are numerous causes of cartilage damage, and they should be determined during the treatment. New methods of treatment offer various choices coping with this damage. The main goal of all operations is to restore the configuration of the damaged cartilage and decrease pain. Choosing the best type of treatment is determined by such factors as the location and extent of the cartilage damage, age, and co-morbidities.

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