What Are Chondral Defects?
Fast Facts On Chondral Defects:
- Age Group: Can affect all age groups
- Gender: Affects both genders
- Cause: Wear and tear with age; traumatic injury
- Primary Symptoms: Knee pain and swelling
- Prognosis: Depending on the size and severity of damage, chondral defects are repairable
What Are Chondral Defects?
Chondral defects are localized areas of articular cartilage damage that develop most commonly in the knee joints. Articular cartilage is the cartilage that covers the ends of bones and provides protection, cushioning and frictionless movement to the joints.
Chondral defects can be difficult to identify and diagnose early because the damage usually occurs gradually from wear, tear and repeated stress on the joint. The knee joints are prone to damage because they are weight-bearing joints in the body. Over time, articular cartilage damage can lead to osteoarthritis (OA).
Chondral defects are classified from Grades I-IV, depending on the severity of damage. In mild to moderate cases, cartilage becomes soft, shredded and thin. In significant Grade IV cases, cartilage wears down all the way to the bone. Increased pain is associated with Grade IV defects because the damage causes painful bone-on-bone friction in the joint.
Causes and Risk Factors
Articular cartilage injuries may happen suddenly or develop gradually over time. Cartilage damage can result from the following:
- Wear and tear over time
- A traumatic injury from a fall, car accident or direct blow to the knee
- Injury from bending or pivoting with a bent knee
- Repetitive movement injuries from high-impact activities like running or playing sports
- Joint instability caused by damage to a nearby ligament
- Structural abnormalities like bowed legs or knock knees
In many cases, there may not be a single traumatic incident that causes damage. Instead, damage may happen from multiple small injuries or from natural wear and tear with age.
Signs and Symptoms
Symptoms may appear gradually and worsen over time as the damage progresses. Common symptoms include:
- Knee pain with activity
- Swelling
- Stiffness
- Loss of range of motion
- Locking, catching or giving way of the knee with weight-bearing
- Noise from the knee during movement, due to loose cartilage floating in the joint
Diagnosis
Physical examinations and imaging studies like X-rays and MRIs are not reliable tools to make a diagnosis. In many cases, your doctor will perform a minimally invasive arthroscopy procedure to evaluate damage within the joint.
Treatment Options
Articular cartilage injuries almost always require surgical treatment to stop the progression of damage. Articular cartilage doesn’t contain vascular, lymphatic or nervous tissues and does not receive a blood supply to stimulate healing of the damaged area. Therefore, while conservative treatment methods can help reduce symptoms of pain and swelling, they can’t facilitate healing and regrowth. Factors for consideration of surgery are the size and location of the defect, the patient’s age and activity level and the patient’s future goals for activity and mobility.
Conservative Treatment
Conservative treatments can help reduce the symptoms of chondral defects, but they can’t repair damaged cartilage or prevent worsening degeneration. Your doctor may recommend conservative treatments as a first course of action and monitor your progress to determine if surgery would be beneficial.
Over-the-counter NSAIDs can ease pain, swelling and inflammation. Cortisone or hyaluronic acid injections can provide pain relief and greater mobility in the joint. Weight loss, activity modifications and assistive devices like braces can help reduce pressure on the knee joint. Exercises and stretches can improve joint range of motion and strengthen the surrounding muscles for better protection of the joint.
Arthroscopic Debridement
Debridement is an effective treatment when the damaged cartilage isn’t worn all the way down to the bone. Arthroscopy is a minimally invasive procedure with fewer risks than invasive surgeries. During the procedure, your surgeon will make a small incision in your knee and use arthroscopic tools to remove loose cartilage fragments and smooth rough, frayed cartilage edges. The goal is to reduce friction and irritation to relieve pain and swelling. The possible downside is that debridement may only slow or delay further cartilage degeneration, instead of treating it completely.
Arthroscopic Microfracture
Microfracture is an effective treatment when cartilage is worn down all the way to the bone. During the procedure, your surgeon will make a small incision in your knee and use arthroscopic tools to prick small holes in the bone under the damaged cartilage. This releases blood — which is necessary for healing — and bone marrow cells into the defect. The blood and bone marrow stimulate the growth of a hybrid cartilage called fibrocartilage. Fibrocartilage is not as strong as articular cartilage, but it can help reduce joint pain and facilitate joint mobility. The possible downside is that fibrocartilage is not as strong as real cartilage and it may not hold up long-term, especially in a weight-bearing joint like the knee. Microfracture may only be delaying the need for additional treatment down the road.
Cartilage Implantation
Cartilage implantation is an effective treatment for larger defects. During the procedure, your surgeon will harvest a small sample of healthy cartilage cells from a non weight-bearing area of your knee. The cells are cultured and grown in a lab for several weeks, then implanted into the defect. Ideally, the implanted cells will cover the defect with a new cartilage surface. The possible downside is that this treatment requires two procedures, with several weeks worth of waiting between them.
Osteochondral Transplantations
An osteochondral transplantation is an effective treatment for defects that are causing underlying bone loss. During the procedure, arthroscopic tools are used to remove a small plug of healthy articular cartilage and bone from a non weight-bearing joint. Next, the plug is transplanted into the chondral defect. Ideally, this procedure will be performed with your own cartilage and bone, but donor plugs can be used too. The possible downside is that this treatment requires two procedures.
Prevention and Lifestyle Changes
Joint cartilage wears down naturally with age and damage isn’t always preventable. However, there are steps you can take at home to protect your joints and live an active, pain-free lifestyle.
- Modify physical activities. Repeated stress and pressure on the knee joints from high-impact activities like running can lead to cartilage damage. If you have knee pain, knee damage or osteoarthritis, you may need to stop or modify high-impact exercises and sports to prevent further damage.
- Exercise. Exercise helps improve strength, flexibility and balance in the joints and surrounding muscles. And there are plenty of low-impact exercises that you can incorporate into your routine to replace or alternate with high-impact exercises. Walking, swimming, water aerobics and bicycling build strength while going easy on the joints.
- Lose weight. If you’re overweight, exercise and eat a balanced diet to find and maintain a healthy weight. Extra pounds place added stress and pressure on weight-bearing joints like the knees.
- Use proper joint support. Wear shoes that fit properly and have arch and heel support. Use insoles in your shoes to reduce pressure on your feet, knees, hips and back.
If you’ve been diagnosed with arthritis or joint damage and you suffer from pain, stiffness and difficulty walking, climbing stairs or performing daily activities, then the iO-Core™ procedure may be a viable treatment option for you. iO-Core™ combines orthopedics and biologics to treat degenerating cartilage and underlying bone and tissue damage caused by arthritis and other joint injuries. Treating the underlying damage and not just the surface layer of cartilage has shown better results in decreasing pain and improving mobility for many patients. Contact us today to see if you qualify for the iO-Core™ procedure.