Articular cartilage injury: treatment options and rehabilitation

Damage to articular cartilage can result from an injury or from a number of other disease processes, including genetic mutations. Damaged articular cartilage leads to osteoarthritis, which shows as reduced joint mobility, swelling and pain. Articular cartilage is a tissue that cannot renew or regenerate itself after an injury. A range of surgical procedures aim to repair it, or to create the conditions for the joint to work normally. If treatment is not successful, the damage progresses to osteoarthritis, which in its final stage is treated with a total joint replacement.

Treatment options for damaged cartilage

A number of procedures are available to treat damaged cartilage, all aiming to restore normal joint function:

1. Lavage (joint washout) removes small loose bodies, cartilage fragments and inflammatory factors from the synovial membrane. Washout alone, however, is not enough to restore normal function in active, healthy people and athletes.
2. Drilling of the subchondral bone causes bleeding. The blood brings pluripotent mesenchymal cells that can partly regenerate the damaged cartilage. The tissue formed is not the same as the joint's hyaline cartilage but fibrocartilage, which in the long run leads to further degeneration and osteoarthritis.
3. Osteotomy offloads the overloaded, damaged part of the joint and creates conditions for partial regeneration of the cartilage.
4. Perichondral and periosteal grafts taken from the rib area give good results in forming hyaline cartilage.
5. Autologous chondrocyte implantation has given the best results in forming hyaline cartilage.
6. In mosaicplasty, plugs of healthy cartilage are transferred into the defect in the joint.
7. Studies using mesenchymal stem cells are the most promising.

Rehabilitation after cartilage repair

Arthroscopic cartilage surgery is a minor procedure, often done under local anaesthesia. Early mobilisation is not a problem. At first the operated knee is treated with ice packs, which reduce pain, bleeding and swelling. The leg rests fully straight on pillows, slightly raised. The patient does foot exercises to protect against deep vein thrombosis.

On the first day, cryotherapy continues together with isometric quadriceps exercises. Knee-straightening exercises are important: every hour the patient does 10 to 15 exercises to strengthen the muscles in extension. The drain is removed on the first day after surgery, and bending exercises start by sliding the heel along the surface of the bed.

Patients are discharged from hospital on the first or second day, once they reach full extension and 90 degrees of flexion. They must continue the exercises they have learned at home. If rehabilitation goes without complications, normal activities are possible after three weeks.