CARTILAGE INJURIES

CARTILAGE INJURIESPRESENTER- Dr. RAGHAVENDRA.

INTRODUCTIONMost common in knee joints.Occur in both young and elderly populations.ETIOLOGY- 1. traumatic. 2. degenerative.

COMPOSITION AND STRUCTURE

CHONDROCYTES- play role in synthesis, maintenance, degradation.Mechanical properties of cartilage is due to biphasic nature of cartilage.

ClassificationsBased on severity-

classificationICRS, International Cartilage Repair Society

Bauer and Jackson classification

RESPONSE TO INJURY

Symptoms and signsSymptoms- pain ( most common and increases with weight bearing).SwellingMechanical symptoms.

SIGNS-Tenderness. Effusion.Fat globules on aspiration may suggest chondral injury or osteochondral fracture.

Investigations

X rays MRI- cartilage sensitive MRI or fast spin echo sequence MRI.Most accurate- diagnostic arthroscopy.

TREATMENTConsider lesion location, size, and depth, associated instability, malalignment , age, and activity level of patient.Broadly divided in 1. partial thickness injury. 2. full thickness injury.

CONSERVATIVE-

Decreasing the load on the joint( lose weight).Alter activities.Strengthen the muscles across the joint . Orthoses or braces also are beneficial.Analgesics and antiinflammatory medications.

OPERATIVE TREATMENTOperative treatment generally is indicated if nonoperative methods fail to relieve pain and mechanical symptoms.

The choice of procedure is based primarily on thesize of the lesion and the activity demands of thepatient.

Partial thickness injuryRemain stable for long duration.It is important to distinguish symptomatic lesions from those that are incidental findings.Correlate symptoms and findings.Treat only those areas that have large articular flaps and impending loose bodies.

Arthroscopic debridementFor patients with minimal symptoms and small lesions (