What Is a Cartilage Lesion?
Healthy cartilage is a central component of a normal healthy joint. Cartilage lesions are damage to the joint’s cartilage tissue when constant stress causes the cartilage to become worn down, much like sandpaper would wear down a wood surface. Although this process can usually be slowed by addressing some causes, it cannot be reversed.
Causes
Cartilage lesions can be caused by many injuries, many of which are minor and require partial recovery over a few weeks. The usual causes are falling onto the knee, rapid deceleration injuries that occur when someone jumps or falls off a low stool, and quick changes in direction that are attempted on the athletic field or court.
Symptoms
Typical symptoms include:
- Aching pain
- Minimal swelling
- Partial functional ability
- Pain worsens with activity
Treatment
Though cartilage lesions can cause significant functional problems, this is not normal. When these injuries occur, you should follow the RICE guidelines (Rest, Ice, Compression, Elevation) until symptoms improve enough to allow a gradual return to play. The most challenging problem in treating these injuries is knowing how hard to “push” the knee and when to stop.
Alternative treatments include glucosamine, hyaluronic acid, and non-steroidal anti-inflammatory medications (NSAIDs).
Surgical intervention is suggested for individuals with cartilage lesions when the symptoms are severe enough to limit functional activities—either normal day-to-day activities or athletic activities. Most physicians recommend a period of conservative care first, but if this fails, arthroscopic intervention is appropriate.
The procedures developed to treat these lesions are generically called cartilage-preserving procedures. For smaller isolated lesions of <1 cm square, a one-step technique that removes bone and cartilage plugs from relatively non-utilized areas around the knee and plugs into the more stressed or injured areas can be effective.
The second procedure, consisting of two steps, is that of autologous cartilage implantation (ACI), or the Carticel procedure. First, cartilage cells are harvested from the knee via an arthroscopic procedure. Then, through an open procedure, a watertight pouch at the site of the defect is created, and cells are implanted underneath the pouch.
The decision as to which procedure, if any, is appropriate, is made on an individual basis.