Above, left: intact knee articular cartilage; on the right, MRI image: the covering cartilage zone appears in light gray on the darker bone (arrow).
Degenerative diseases of the cartilage:
In certain diseases, mainly osteoarthritis, the articular cartilage wears out, degenerates and eventually disappears completely in places. There is no more lubrication, and as the surfaces become rough, the movement produces inflammation, which in turn causes pain.
Above: diffusely worn cartilage, seen in MRI: we see at the end of the arrow bone exposed by the disappearance of the cartilage.
The movements can then no longer be made without friction, which causes inflammation of the joint, then, gradually, stiffness. The pain becomes more and more severe, and further limits movement. In the case of the hip, it becomes increasingly difficult and painful to walk, sit or even lie down. The patient ends up being embarrassed even in the acts of daily living.
Trauma
In certain traumas, especially during the practice of sport, acute lesions of the articular cartilage can occur. In general, they are more circumscribed, more localized, and can be repaired better than degenerative lesions.
Medical treatments (non-surgical)
At the beginning of the evolution, a simple treatment with painkillers (eg dafalgan), or anti-inflammatories (eg Voltaren, Brufen, Celebrex) may be sufficient if the pain and discomfort are intermittent.
The sports practice called "soft" or "fluid", that is to say without impact, is always recommended: indoor or outdoor cycling, swimming, fitness, gentle gymnastics, yoga, pilates. These practices maintain good muscles and good mobility, which is essential to reduce symptoms.
In more severe cases, hyaluronic acid, a protective and lubricating gel, can be injected, which can improve joint function and reduce pain, and possibly prolong cartilage survival.
Treatments in tablets, which claim to "regenerate" cartilage (chondroitin surfactate, glycosamine, extracts of various fish and shellfish) have no objectively proven effect.
Sometimes cortisone injections may be beneficial, especially in the event of an acute crisis, or while awaiting surgery. The effects are often dramatic, but transient.
Surgical treatment
Articular "toilet" by arthroscopy , with or without drilling
In some cases, we can perform a joint "toilet", that is to say, remove pieces of meniscus, or partially detached degenerative cartilage, which can hinder the proper functioning of the joint. We can also remove troublesome bone spurs (osteophytes), regularize a surface that has become irregular.
When there are places where the cartilage has disappeared, a "drilling" can be done, that is to say, drill small holes in the bone of the bare surface, in order to bring repair cells from the underlying bone marrow, which can rebuild a semblance of cartilage tissue.
Osteochondral graft
When the lesion is well circumscribed, or well delimited, in a young person, it is sometimes worthwhile to make an osteochondral graft, which resembles a "coring" in geology.
localized lesion of the covering cartilage of the knee
with a hollow trephine, a cylinder is removed taking away the lesion and the underlying bone
we then take a "carrot" of healthy bone and cartilage in a block, and we will insert it where the lesion was; the sample is taken from a neutral zone of the knee, that is to say where the lack of cartilage does not interfere.
Autologous transplant with collagen matrix
For various reasons, but especially if the cartilaginous lesion is too large, we give up doing a "carrot" graft; we can then make an autograft with a collagen membrane.
as above, the starting situation is that of a localized lesion of the cartilage
the lesion is cleaned and then perforated to allow stem cells and growth factors to pass into the lesion from the underlying bone marrow and colonize it.
The collagen membrane is sewn and glued (with biological glue) in place. It prevents growth and regeneration factors from escaping. Gradually, these cells organize themselves and reform cartilage that resembles the original covering.
In both techniques, rehabilitation is relatively long: 6 weeks of removable splint in partial load, with 2 canes, and progressive mobilization.
CARTILAGE
Articular cartilage lesions and their treatment
What is articular cartilage?
It is a tissue that covers the surfaces that are in contact in a joint, and which ensures movement without friction, and therefore without pain. Natural lubrication by joint fluid, secreted by the inner membrane of the joint (synovium), allows movement without pain, and partly nourishes the cartilage.