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Why does my Joint hurt?
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Why does my Joint hurt?

Joint pain often arises from injury to the ligaments or, in the knee, from injury to the meniscus, which can result from injuries or tears. Cartilage injury, which can be either sudden (acute) or long-term (chronic), can also cause joint pain.

Acute cartilage injury can occur during an accident or sport, or simply result from moving in the ‘wrong way’. This may have dramatic symptoms of pain.

After injury, movement can cause the cartilage to wear away. For example, the knee can mechanically ‘catch’ the cartilage defect, and fragments may break off into the synovial joint fluid. This may lead to inflammation, in which the joint becomes reddened and swollen. Further attempts by the body to dilute this chemical reaction may result in further swelling and pain.

Cartilage injury can also result from a gradual process of overload due to poor positioning of the bones, resulting in continued wear, breakdown and inflammation. This is known as chronic cartilage injury. In the knee for example, mechanical factors inside the joint may place excessive force on one surface only, which wears away the cartilage at that point. This may result from poor alignment after a ligament injury or be due to other factors.

One way of looking at this is to think of a car with steering that pulls to the side, resulting in uneven wear on the tyres. Until the steering is corrected, the problem will keep recurring. Similarly, in cartilage injury, the cartilage cannot be permanently repaired until the bone defect is corrected.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about joint pain, as well as anyone interested in cartilage problems.

What is knee pain?

Knee pain may result from injury, long-term wear and tear, or from inflammatory arthritis.

Sports injury, such as anterior cruciate ligament (ACL) tears, may cause meniscus and articular cartilage injury. These injuries may result in loss of joint shock absorption, resulting in the spread of forces across the knee. The force therefore becomes more concentrated, which can lead to a cycle of injury, wear and tear, meniscus loss, and poor alignment.

Joint (articular) cartilage protects the bone and spreads out the load around the knee. A cartilage (chondral) defect, results when the smooth cartilage has a tear that exposes the bone. Because the bone has nerves that can sense injury, the person will feel pain. Cartilage damage may also irritate the joint lining, which can also cause pain.

Pain from cartilage injury is not always dramatic. It may sometimes be a dull ache that worsens as the day goes on due to repetitive movement.

The knee ‘giving way’ is a self-protection mechanism in which the knee suddenly stops bearing weight, and suggests that the ligaments in the knee are unstable, or that there are problems with the quadriceps muscles. It may occur during the walking cycle, during sport, or even when getting up from a low chair. These actions expose the bone and, in response to the pain, the knee may give way to protect itself from more pain.

A more dramatic form of the knee giving way is ‘catching’ or ‘popping’, which is caused by, for example, the edge of the meniscus or the bone surfaces snagging during movement. This is more likely if a person has weakened muscles, which may result in limping and an altered stance. As the muscles slacken, imbalances are created that worsen poor alignment and magnify the problem.

How should cartilage injury be treated?

Cartilage injury should be treated when the patient complains of symptoms, such as pain. Ideally, this is when the lesion is still small, but this may not be the case in all patients.

Cartilage injury often occurs in young people, and so the aim is to repair cartilage in such a way that will prevent the development of arthritis further down the line.

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