Cartilage Damage

What cartilage damage is

Two tissues in the knee are called cartilage, and the distinction matters. The menisci are the wedge-shaped shock absorbers between the bones. Articular cartilage is the thin, glossy layer bonded to the bone ends, which lets the joint glide with almost no friction. When people speak of torn cartilage they usually mean the meniscus, but damage to the articular surface is a separate problem.

Articular cartilage can be injured by a single event, such as a twist, a direct blow or a kneecap dislocation, or it can wear down through arthritis or chronic overuse. Because the tissue has no blood supply and very limited capacity to repair itself, damage tends to persist. Surgeons describe what they see in several ways. Fissuring is a cleft or split within the layer, which may cause no symptoms or a catching sensation. Thinning can follow an injury or signal early arthritis, and thinned cartilage does not glide as smoothly. Flaps occur where a piece of the layer has lifted from its bed and can catch during movement. A defect is an area where cartilage has been lost altogether, sometimes leaving bone exposed; when a fragment of cartilage and bone separates, it is an osteochondral injury.

Symptoms that often bring people in

• Deep, poorly localized joint pain, often worse with loading or stairs
• Swelling that comes and goes, particularly after activity
• Catching, clicking or a sense of something moving inside the joint
• Episodes where the knee briefly locks or gives way
• Stiffness after sitting, or grinding

How it is evaluated

Cartilage injuries can be hard to identify from symptoms alone, since they overlap with meniscus and ligament problems. The history matters, particularly whether there was a specific injury. Examination looks at swelling, motion, tenderness, alignment, kneecap tracking and stability. Standing x-rays show how much space remains between the bones. MRI is the usual way to see the cartilage surface directly, and specialized sequences can show the depth of a defect and the bone beneath it. Alignment matters too, since an overloaded surface will not do well unless the overload is addressed.

Treatment options in general terms

Non-surgical management is often the starting point:

• Load management. Adjusting activity, addressing body weight, and bracing or offloading.
• Physical therapy. Building strength and control that spread load more evenly across the joint.
• Medication and injections. Anti-inflammatory options, and injection categories such as hyaluronic acid or biologic treatments including platelet-rich plasma.

Surgical options depend on the size and location of the damage, the patient's age and activity, and the rest of the joint:

• Arthroscopic debridement. Smoothing unstable flaps and removing loose fragments.
• Marrow stimulation. Small openings in the bone beneath a defect so marrow cells can form repair tissue.
• Grafting and cell-based restoration. Moving a plug of cartilage and bone into a defect, using the patient's own or donor tissue, or resurfacing it with cells or scaffolds.
• Correcting the underlying cause. Realigning the leg or stabilizing the kneecap so the treated surface is not overloaded again.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada and has a particular interest in joint preservation, the framework he brings to cartilage problems. A consultation covers what the imaging shows, whether the damage explains your symptoms, whether anything is overloading that part of the joint, and which treatments are reasonable.

This page provides general information about cartilage damage and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]