Cartilage
Beside the ligamentous system the hyaline
cartilage, which covers the articulating bony surfaces of the
joint, is the most important component of any joint. Cartilage
has no blood supply and its nutrition is given by synovial fluid.
Intact cartilage surfaces are essential for a normal function
of every joint. There are various causes for damages to the cartilage
like fractures, joint instabilities, meniscal lesions or overuse
injuries. Symptoms depend on the diameter and depth as well as
the location of the lesion. Initially symptoms appear only while
using the joint whereas later on permanent pain may develop. Over
the years cartilage damage increases and may lead to complete
deterioration of the joint. There may be chronic swelling and
limited range of movement. This means, the joint has developed
osteoarthritis. Treatment depends on the dimension and localization
of the lesions and of the age of the patient as well. The potential
for regeneration of the cartilage is rather high in juvenile patients
but decreases with time. There are different therapeutical approaches
for every individual situation.
An exact anamnesis and the clinical examination usually lead to
a precise diagnosis already. X-rays are always needed to evaluate
the joint space and the mechanical axis (x-rays in monopodal stance).
In difficult cases magnetic resonance imaging (MRI) may be needed.
The main goal of every treatment is pain release and improvement
of joint function. At early stages of joint diseases the therapy
of choice is conservative, i.e. physiotherapy, physical treatment
like cryo-therapy or heat (fango e.g.) and local medication (Voltaren,
Celebrex or similar non steroidal anti-inflammatory drugs) Foot
support and modification of shoes are also part of the treatment.
Some patients may benefit from injections of hyaluronic acid which
may have a positive influence on the cartilage metabolism. Activities
like bicycling and swimming are always recommendable. For obese
patients diet is essential. Unfortunately for the majority of
patients conservative treatment alone is not sufficient and operative
arthroscopy is needed. This is enabling the physician to put a
precise diagnosis of the joint surfaces, both menisci and cruciate
ligaments. Pathological lesion like torn menisci, ruptures of
the cartilage and changes of the synovium can be treated at the
same occasion. Unstable parts of damaged cartilage can be resected
and smoothened whereas areas with naked subchondral bone can be
abraded or treated by multiple perforations (see microfracturing).
The choice of the procedure depends on the individual situation
of the patient and the pathological findings.
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