Articular cartilage damage is a very common sports injury and is often a result of wear and tear among active people. As a common orthopedic condition, Dr. Leon E. Popovitz, MD, who is considered one of the best arthroscopic orthopedic surgeons in the New York City and New Jersey area as well as internationally, along with his team of top-rated orthopedic surgeons, treat articular cartilage damage in varying degrees regularly.
As orthopedists with expertise in Sports Medicine, the NY Bone and Joint team is a leading provider of both conservative as well as surgical treatment for articular cartilage damage. Conservative treatment for articular cartilage damage includes a range of options, such as steroid and/or lubricating injection therapy, braces, physical therapy, and sports medicine rehabilitation. Our doctors are top-rated in their field for their knowledge and their ability to discuss treatment options with patients until they feel comfortable and are well informed about how to best care for their injury.
Dr. Leon E. Popovitz, MD, is known as a top orthopedic surgeon in the field of arthroscopic surgery. Years of experience and involvement in the progress of his field has won him international recognition. Dr. Popovitz routinely uses arthroscopic methods, as well as other surgical techniques when necessary, to treat articular cartilage damage in the shoulder and knee. His top-rated orthopedic team is also renowned for their skill in correcting cartilage damage in all joints.
WHAT IS ARTICULAR CARTILAGE?
Articular cartilage is a dynamic tissue composed of cells called chondrocytes, which make and maintain the cartilage matrix. This type of cartilage is hyaline (transparent) in its general appearance and is considered avascular (without a blood supply).
Articular cartilage is found at the final segment of bones in the area where they meet to form a joint. It is essential in the ability for our joints to move smoothly and without hesitation or restriction. Articular cartilage allows our joints to move smoothly by reducing the amount of friction that occurs when the bones interact with each other within the joint. As our bodies and joints move, this cartilage can begin to wear down. As the damage to the cartilage continues to progress, symptoms such as pain, impaired movement and loss of function can occur.
TYPES AND CAUSES OF ARTICULAR CARTILAGE DAMAGE
The articular cartilage in our joints can be damaged by an overburdened load to the structure. This can occur from an acute traumatic event or a repetitive load upon the joint. Acute damage to the articular cartilage can occur as a result of a sports injury, twist and fall directly on the knee, car accident or any other direct trauma to the knee. When this type of acute injury occurs to the articular cartilage, the damage can vary in severity.
In lesser injuries, articular cartilage can have localized, superficial damage. In more severe injuries the depth of the damage increases and the cartilage may fragment, tear, or completely detach from the underlying bone. In this instance, bare bone will be uncovered and create very severe pain. Many times, patients who have other joint related injuries, including ligament or meniscal tears, also have an underlying damage to their articular cartilage.
Unfortunately, articular cartilage has very limited ability to heal and often progresses over time.
While symptoms of articular cartilage damage can vary between patients, the symptoms experienced are often related to the degree of damage. Undamaged articular cartilage is a pristine, smooth, white and durable tissue that allows fluidity of joint movement.
As articular cartilage becomes damaged, this smooth surface becomes softened and rough. When extensive damage occurs, the cartilage can become fragmented and inconsistent. The most common complaints associated with this injury include:
- Pain (A tenderness within the joint or in the surrounding tissue during motion)
- Edema (Swelling at the joint)
- Locking (A loss in the fluidity of the motion of the joint)
- Instability (A feeling that the joint is not stable enough to support you)
- Grinding (A feeling that the bones of the joint are rubbing on one another)
DIAGNOSIS OF ARTICULAR CARTILAGE DAMAGE
A proper physical examination is the primary step on the road to the diagnosis of articular cartilage damage. Your doctor will assess your symptoms, range of motion and the overall quality of the joint. Although cartilage itself is not visible on X-ray, it still is performed to evaluate the bony structures. Other imaging techniques, such as an MRI or an arthroscopy, may also be needed to evaluate the articular cartilage directly.
Treatment options for articular cartilage damage are usually predicated on the size and depth of damage. Small areas of damage, where the damage does not extend to the bone, often respond well to conservative care. Larger lesions, joint disruption or deep fragmentation of the articular cartilage may require surgical intervention.
Conservative: Conservative care of articular cartilage damage may include modification of lifestyle and activities, supportive devices and accompanied braces, physical therapy, and the use of non-steroidal anti-inflammatories (NSAIDS) medications. Steroid or lubricating injections can also provide some relief of pain.
Surgical: If surgical intervention is required, your doctor will map out your specific treatment plan. Dr. Leon Popovitz is the best orthopedic surgeon in NYC for arthroscopic correction of articular cartilage damage.
Common surgical procedures for articular cartilage damage include knee arthroscopy (a minimally-invasive procedure that uses a camera to visualize your cartilage) with possible debridement (cleaning out of the damaged tissue) and chondroplasty (smoothing out the remaining surrounding healthy tissue). If the damage is down to bare bone, then typically a subchondral drilling or microfracture procedure is done via the arthroscopy. This procedure stimulates blood from the bare bone to promote regenerative cells to create a cartilage scab over the bare bone.
If this does not fully cover the bare area of bone, then a cartilage transplant procedure can be done. This would transplant cartilage from a lesser important part of the joint to the damaged sight. Another option is taking a small amount of cartilage from the knee via an arthroscopy and have it grow in a laboratory. Subsequently, the patient returns to the operating room for an implantation of the grown new cartilage.
EXPERIENCING PAIN? DO YOU HAVE AN INJURY?
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