Cartilage Tear or Cartilage Defect

Cartilage is the smooth lining of the joint which protects the ends of the bones from rubbing against each other and causing pain. The smooth surface of the cartilage with the lubrication in the joint has lower friction coefficient in comparison with any man made joint couples. When the cartilage loss is wide spread all over the joint it is called arthritis. However, specific localized areas of cartilage loss can still cause pain and friction.

Causes

Localized areas of cartilage loss can happen due to various conditions

  • Chondromalacia patella (Loss of cartilage behind the knee cap)

  • Osteochondritis dessicans (cartilage and underlying bone loss in a specific area of the joint)

  • Trauma

  • Iatrogenic (previous surgeries)

 

Where does cartilage loss affect?

The most common joint where we see these injuries is the knee. Ankle cartilage loss in the talar dome (the upper dome portion of the ankle bone) is another common area of problem. This is usually secondary to injury. In the knee we commonly see this behind the knee cap, in the adjacent area of the thigh bone, lower end of the thigh bone and also in the upper portion of the leg bone.

 

Classification

 

International Cartilage Repair Society (ICRS) Grading system

  • Grade 1. Nearly normal (superficial lesions)

  • Grade 2. Abnormal (lesions with < 50% of cartilage depth)

  • Grade 3. Severely abnormal (loss of >50% of cartilage depth)

  • Grade 4 Severely abnormal (Exposure of the subchondral bone)

 

What happens if cartilage injury is not treated?

 

Cartilage has poor blood supply and has got very limited capacity to regenerate and repair itself. Without treatment, at best it can remain the same, and at worse the cartilage loss can gradually increase in depth and also become widespread in the whole joint.

 

Management

Early grades (Grade 1 and 2) of cartilage can often be managed either with physiotherapy, activity modification, collagen supplements or PRP (Platelet Rich plasma) injection.

 

Advanced grades (Grade 3 and 4) of cartilage damage needs chondroplasty (cartilage regeneration technology).