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Are all cartilage problems the same?
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Are all cartilage problems the same?

Joints, such as the knee, are formed of two types of cartilage. The first, articular cartilage, forms a smooth, lubricating layer that prevents wear between the bones. The second type is the meniscus cartilage, tasked with shock absorption, as opposed to preventing wear and tear. This latter type of cartilage is not connected to the bone; it merely rests between them.

The lubricating tissue that lines the joints, known as cartilage, can be damaged or degraded via a number of different ways, including:

  • Injury (including sports accidents)
  • Repetitive use
  • Congenital abnormalities
  • Cartilage disease

Most often, a ‘tear’ refers to an injury of the meniscus cartilage, which is usually much less severe than injury to the articular cartilage. This is permanent, and has long-term complications.

While many of the root causes of cartilage problems may result in similar overall outcomes (pain, physical disability, etc.) it is important to know that cartilage problems are a diverse group of conditions, with different individual symptoms and treatments.

This section will explore the differences – where applicable – between various aspects of cartilage conditions, as well as outlining the treatment options and considerations that might be important to know for your own circumstances.

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 the different types of cartilage problems, as well as anyone interested in cartilage problems.

What are common types of cartilage problems?

Cartilage can degenerate over time for a number of reasons including:

  • Aging
  • Obesity
  • Unbalanced forces across a joint
  • Disease

There can also be ‘focal’ injuries to cartilage, whereby an accident or blunt force causes trauma in a joint that in turn leads to damaged or dead pockets of cartilage.

Degenerative cartilage problems

Conditions such as osteoarthritis cause cartilage to degrade over time. This leads to rubbing between the bones, causing pain and reduced mobility. This type of cartilage damage may develop over many years.

Treatment for degenerative cartilage problems may include:

  • The injection of gel-like compounds (e.g., hyaluronic acid)
  • Pain and inflammation relief using non-steroidal anti-inflammatory drugs (NSAIDS)
  • Dietary supplements that are thought to help rebuild cartilage (e.g. glucosamine/chondroitin)
  • More conservative methods such as strength training and physiotherapy

The severity and long-term prospects for degenerative cartilage problems vary. However, slowing or halting the progress of degeneration (with adequate pain relief) can extend a person’s quality of life until, ultimately, a replacement joint or other surgical procedure may be required.

Treatments depend on the type of joint

While many different treatment therapies can be used in a variety of joints and cartilage areas, a number of treatments have become established in certain joints, with data lacking elsewhere.

For instance, autologous chondrocyte implantation (ACI) – in which cartilage cells from the joint are harvested, multiplied in a laboratory and then replanted in the joint at much higher concentrations – is established for the knee and ankle, but is less appropriate for the hip and shoulder joints.

Successful cartilage grafting from other parts of the body will also depend on individual factors, including the thickness of the natural cartilage at both the donor and recipient sites.

Age, size and other factors

A crucial factor that makes every cartilage problem relatively unique is the individual characteristics and circumstances of each patient.

Many treatment options that focus specifically on the repair of cartilage (by implanting cells or grafting cartilage from other areas of the body, for example) are approved for patients aged approximately 15–55 years.

Nevertheless, individual circumstances may suggest that a total joint replacement with a synthetic implant will give a better outcome (as this is a more established technique). This is particularly the case in older patients, who may have limited cartilage regeneration abilities, and are at a stage in their lives where the decision to take on a synthetic joint is a better choice, given their level of pain and physical lifestyle.

Conversely, it may be in some cases that patients are considered too risky for surgical approaches, and more conservative management of cartilage problems can be pursued, such as physiotherapy.

The size of the cartilage damage is also an issue. While current guidelines are not set in stone, the repair of small focal, localised pockets of damaged cartilage is often limited to a size roughly no more than 2 cm in diameter. Damaged areas larger than this may need to be treated as part of the whole surface of the joint using more aggressive strategies.

Nevertheless, a 2 cm lesion on a large male is clearly relatively smaller than one of a similar size in a petite female, so individual cartilage problems need to be assessed by a physician to gauge the risks and benefits for that patient, and tailor treatment accordingly.

Managing expectations, and quality of life

There is currently no perfect cartilage repair treatment. Patients therefore need to manage their expectations to their individual circumstances. The level of pain and immobility present in cartilage problems varies widely, and while some people may have mild discomfort during athletic pursuits, others may be in severe pain almost continuously.

In these situations, quality of life improvements following cartilage repair or surgery will be much more significant in patients who had crippling pain and immobility beforehand. Patients with only minor symptoms may see relatively little benefit, especially when factoring in the disruption surgery can have in their lives.

In essence, each patient will be on a sliding scale that will ultimately mean those who stand to benefit the most from a procedure may feel more ready to take on the risks and discomforts of surgery.

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