WHAT IS CARTILAGE DAMAGE?
Articular chondral and osteochondral injuries of the knee are common in people aged under 35 years, but a second peak occurs in patients older than 60 years.
MECHANISM OF INJURY
Articular cartilage has little capacity to repair itself or regenerate. Therefore, cartilage defects repair by forming scar tissue. This scar tissue is deficient collagen and has lower load-bearing capacity. This later surface deterioration may progress to give chronic pain and poor function.
The knee may give way if a longstanding injury results in substantial muscle wasting or there is associated ligamentous instability.
Locking is reported if a loose fragment impedes articular movement.
The joint may be swollen.
Tenderness is found on palpation of the joint line, with pain induced by both passive and active movements.
Crepitus is palpable on passive joint movement in a usually stable knee.
Injuries that are new are given time to settle to see if the chondral lesion will become symptomatic or not. If pain fails to resolve after the initial acute phase, and after resting, applying ice, compression bandaging and elevation, surgical intervention is considered.
Several factors have been associated with improved postoperative recovery.
DEFECT SIZE OF LESS THAN 2 CM.
PREOPERATIVE DURATION OF SYMPTOMS OF LESS THAN 18 MONTHS.
NO PREVIOUS SURGICAL TREATMENT.
YOUNGER PATIENT AGE.
HIGHER PRE-INJURY LEVEL OF SPORTS.
DEVELOPMENT OF RECURRENT LOCKING, POPPING, OR EFFUSIONS AFTER AN ADEQUATE TRIAL OF CONSERVATIVE THERAPY MAY SUGGEST THE NEED FOR SURGICAL INTERVENTION.