In this article, you will find out everything you need to know about cartilage damage and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Many surgical and non-surgical treatment options are available for conditions affecting the knee, such as osteoarthritis. These may include weight loss, arthroscopy, physical therapy, injection therapy, and Prolotherapy; whether surgical or non-surgical, physiotherapy with low-impact exercises is often recommended. However, some individuals also require the help of drug therapy to improve their pain, inflammation, and quality of life.
The medications which are most commonly prescribed for knee osteoarthritis include non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, and corticosteroids, which may be given as pills or intra-articular injections. Individuals with refractory pain may also be advised opioids and heavy analgesics. (1) But it’s important to keep in mind that most of these medications can lead to adverse effects when used in the long term.
Table of Contents
- Key Takeaways
- Understanding Cartilage Damage
- Causes of Cartilage Damage
- Identifying Symptoms and Risk Factors
- Non-Surgical Treatment Options
- Physical Therapy and Exercises
- Medical Interventions for Cartilage Damage
- Surgical Solutions for Chronic Cases
- Preventive Measures to Avoid Cartilage Damage Recurrence
- When to Seek Professional Help
- Prolotherapy
- Summary
- Frequently Asked Questions
Key Takeaways
- Cartilage damage can lead to knee pain, instability, and reduced mobility, often requiring a combination of treatments for effective management.
- Non-surgical treatment options typically involve rest, ice, compression, elevation (RICE), medication, and physical therapy with exercises to improve flexibility and muscle strength.
- In cases where non-surgical treatments are insufficient, medical interventions may include corticosteroid injections, bursal aspiration, and potentially surgery for chronic cases, along with preventive measures to avoid recurrence.
Understanding Cartilage Damage
The knee’s cartilage consists of an extracellular matrix and an intracellular matrix. The extracellular matrix of articular cartilage is mainly made up of a collagen framework and water. The collagenous framework consists of glycosaminoglycans, proteoglycans, and hyaluronic acid. A proteoglycan of clinical importance is known as aggrecan, which is a cartilage-specific proteoglycan core protein. This binds to the hyaluronic acid found in the cartilage and promotes properties like increased compressibility and elasticity in the cartilage.
In a healthy individual, the molecular size, shape, and volume of hyaluronic acid in the synovial fluid may remain the same throughout life. However, certain conditions can accelerate the drop in concentration of hyaluronic acid as an individual ages. This may affect the elastic and viscous properties of the synovial fluid, which makes it less effective as a lubricant.
One of the first changes seen in osteoarthritis of the knee is the destruction of aggrecan by the enzyme known as aggrecanases. This leads to erosion of the cartilage. These changes in the extracellular matrix may also lead to a reduced concentration of hyaluronic acid molecules in the knee cartilage. (2)
Causes of Cartilage Damage
Cartilage damage can result from various factors, including:
- Osteoarthritis: A degenerative joint disease that leads to the breakdown of cartilage over time.
- Injuries: Acute injuries, such as tears in the meniscus or ligaments, can damage the cartilage.
- Repetitive Stress: Overuse from repetitive activities can lead to wear and tear on the cartilage.
- Genetic Factors: Some individuals may have a genetic predisposition to cartilage degeneration.
Identifying Symptoms and Risk Factors
Symptoms of cartilage damage may include:
- Pain during movement or weight-bearing activities
- Swelling and inflammation around the knee joint
- Stiffness, especially after periods of inactivity
- Reduced range of motion and difficulty in bending or straightening the knee
- Audible sounds such as clicking or popping during movement
Certain risk factors increase the likelihood of developing cartilage damage, including:
- Age: The risk of cartilage degeneration increases with age.
- Obesity: Excess weight places additional stress on the knee joints.
- Previous Injuries: A history of knee injuries can predispose individuals to cartilage damage.
- Genetic Factors: Family history of joint problems may increase risk.
Non-Surgical Treatment Options
Rest is crucial for those suffering from cartilage damage, as it allows the inflamed area to heal and reduces the risk of further injury. Additional non-surgical treatment options include:
- Ice Therapy: Applying ice packs to the knee can help reduce pain and swelling.
- Compression: Using compression wraps or sleeves can provide support and minimize swelling.
- Elevation: Keeping the knee elevated can help reduce swelling.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate pain and inflammation.
Physical Therapy and Exercises
Under the guidance of a professional, physical therapy can improve flexibility and strengthen the knee muscles to relieve pain associated with cartilage damage. This treatment involves specific exercises like heel slides, straight-leg raises, and quad sets that help improve knee function and ease symptoms. Additionally, incorporating knee exercises into a regular routine can lead to enhanced mobility and reduced discomfort over time. It is important to progress gradually and listen to the body to avoid overexertion during these exercises. Consistent practice not only promotes healing but also helps prevent future flare-ups, ensuring long-term joint health.
Individuals suffering from cartilage damage are advised to follow their prescribed exercise routine six days a week with one day for rest until they experience less pain. A consistent regimen of targeted exercises is crucial in managing pain relief and preventing future occurrences of this condition.
Medical Interventions for Cartilage Damage
In some cases, non-invasive options may not effectively manage cartilage damage. In these situations, medical interventions like:
- Antibiotic Therapy: For infections associated with septic bursitis.
- Corticosteroid Injections: To reduce swelling and alleviate pain.
- Bursal Aspiration: To remove excess fluid from the joint.
- Surgery: For chronic cases where other treatments have failed.
Surgical Solutions for Chronic Cases
Surgery may be considered for long-term cartilage damage patients who have not responded to other treatments. One possible surgical option is bursectomy, a procedure in which the inflamed bursa (a type of soft tissue) is removed through either endoscopic or open surgery.
During an endoscopic bursectomy, minor cuts are made, and a tool called an arthroscope helps remove the bursa, while local anaesthesia allows it to be performed on an outpatient basis. Another possibility is arthroscopic surgery, which requires smaller incisions and results in faster recovery compared to traditional surgery methods.
After undergoing a bursectomy, patients will need pain relief medication as well as physical therapy exercises. The length of time required for recovery can vary depending on factors such as infection and the location of the affected bursa.
Preventive Measures to Avoid Cartilage Damage Recurrence
To avoid the recurrence of cartilage damage, it is essential to take preventive measures such as:
- Maintaining a Healthy Weight: Reducing excess weight can decrease stress on the knee joints.
- Taking Breaks: During activities that put pressure on the knees, like kneeling, take frequent breaks to rest and stretch.
- Addressing Underlying Health Conditions: Effectively managing conditions like osteoarthritis or rheumatoid arthritis can help reduce the risk of cartilage damage.
When to Seek Professional Help
Knowing when to seek professional help is crucial in managing cartilage damage, as home remedies may not always be practical. If symptoms of cartilage damage appear suddenly after a sharp impact or recent injury, it is essential to consult a medical expert immediately.
Persistent pain and swelling that worsen over time or with certain activities indicate that you should see a doctor. When at-home treatments do not provide relief, seeking medical advice from an orthopedic surgeon or rheumatologist for accurate diagnosis and treatment options becomes necessary.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat cartilage damage. Published research has proven its pain-relieving, anti-inflammatory, and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help with cartilage health. As prolotherapy is helping to treat the root cause of cartilage damage, it is deemed to be a permanent fix, preventing the symptoms from returning.
Summary
Cartilage damage is a prevalent condition that can be effectively managed with a proper understanding of its causes, symptoms, and treatments. Whether utilizing non-surgical methods or medical interventions such as physical therapy, there are various ways to successfully handle the effects of this condition and prevent it from reoccurring. In chronic cases where other solutions have not been effective, surgery may also be an option for addressing cartilage damage. It’s crucial to address any signs early on and seek professional help to better manage this ailment.
Frequently Asked Questions
How long do cartilage injections last?
Cartilage injections usually last between 5 to 13 weeks. However, this period may be extended by using a multiple injection regimen compared to a single injection. When additional injections are administered under the supervision of an orthopedic surgeon or other health professionals, the individual may be able to have pain relief for as long as three years.
Can you inject cartilage into the knee?
Hyaluronic acid can be injected into the knee, which helps boost the cartilage’s health and functioning. This is most commonly required in conditions like osteoarthritis of the knee, where the cartilage begins to thin, and the synovial fluid begins to disappear.
Can you rebuild knee cartilage?
The cartilage in the knees has a limited capacity to rebuild or repair itself due to the insufficient blood supply. However, hyaluronic acid injections can help induce the growth of new cartilage and bone tissue in the joint. This may help the individual delay joint replacement surgery for joint damage.
What is the newest knee injection?
The FDA has approved new single injections and extended-release formulations for the knee joint, which are effective for conditions like knee arthritis. The single injection hyaluronic acid-based injection includes Durolane and Bioventus, while the extended-release formulations include synthetic steroids like Acetonide.
Which knee injection is best?
Among all the knee injections proposed to treat joint disorders in the past, hyaluronic acid injections are the most successful. These injections are also known as gel injections and effectively reduce joint pain and improve its overall functioning. Sometimes hyaluronic acid injection may also be guided by ultrasound.
Are knee injections worth it?
Individuals who have been experiencing persistent pain in their joints with an increased level of inflammation may be recommended for knee injections. However, it is important to remember that most of these injections are effective for the short term and may need to be re-administered after a time recommended by the healthcare professional.
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Author Bio
Having performed over 10,000 procedures, Mr. Eaton is one of the UK’s leading practitioners in the field of treating cartilage damage, with patients travelling to see him from across the UK, Europe, and the Middle East. With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with cartilage damage and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany. Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
Linkedin profile: Oliver Eaton
References
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- Mora, J. C., Przkora, R., & Cruz-Almeida, Y. (2018). Knee osteoarthritis: pathophysiology and current treatment modalities. Journal of Pain Research, 11, 2189–2196. https://doi.org/10.2147/JPR.S154002