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Articular cartilage injuries

Injuries to the articular cartilage (chondral) surfaces can affect the joint surfaces of the femur, the tibia, and the patella. Such injuries are often disregarded as they can be difficult to identify. They may result from direct impact against the knee joint, but can also occur in association with meniscal and ligament injuries. Indeed, any condition that leads to excessive repetitive forces can cause cartilage damage, in the form of small or large cracks and defects on the joint surfaces and continued degeneration. The result can be premature steoarthritis.

Symptoms and diagnosis
– Swelling occurs in the knee joint with recurrent effusions.
– Pain is felt during and after weightbearing activities.
– ‘Locking’ or ‘catching’ mimics meniscal injury.
– Crepitations are heard on weightbearing activities.
– Loose bodies may be felt.
– The injury can be diagnosed by arthroscopy and sometimes by MRI.

The athlete should:

– avoid symptomatic activity;
– train the thigh musculature;
– use a knee support or a heat retainer;

The doctor may:

– recommend a change to a sport that makes fewer demands on the knee joints;
– surgically remove the damaged cartilage, which is gradually replaced by less elastic fibrocartilage; where there is disabling knee pain or swelling from isolated articular cartilage injuries, the doctor may operate using one of the newer techniques described below.

Alternative surgical treatments
Several new techniques have been developed to treat small, isolated articular cartilage defects. Although they are still under evaluation, early results are promising.With abrasion, picking, or drilling of the defect, the defect is abraded to encourage cells to infiltrate the area from the underlying bone, forming new cartilage to fill the defect. No long-term results or comparative studies are available.
None of these methods has consistently been shown to form new normal cartilage, and isolated articular cartilage defects continue to be a difficult problem in orthopedics.

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