CARTILAGE LESION- THE PROBLEM
- The cartilage injuries usually involve patients aged 15-65 years (not ideal age for total joint replacement)
- Often the lesion is unifocal and concerns only one compartment of the knee.
- Patients wish to return in the same level of daily activities, post operatively
- Patients with abnormal body weight index.
- The frequency of revision is statistically high in patients undergone joint arthroplasty in a younger age, energetic and active people (about 30% need revision operation within first 5-10 years postoperatively)
- Total joint replacement is a very expensive surgical method.
- A long rehabilitation program is needed after total joint arthroplasty.
- The hospitalization time is prolonged.
- A blood transfusion is needed
KNEE CARTILAGE INJURY. THE REALITY
About 4 million people worldwide suffer a knee cartilage injury every year. Without treatment, the cartilage damage will result in a painful joint as a consequence of degenerative arthritis, the treatment of which is painful and very expensive for the patient.
Early and effective treatment that can lead to the regeneration of cartilage is a primary concern in modern orthopedic communities
WHAT IS CARTILAGE?
Cartilage is a thin, flexible film, a few millimeters thick, which overlaps the bony surfaces of a joint, or assist in the formation of the nose, ear and part of the throat and bronchi, as well as in the formation of intervertebral discs. Their basic function is the vibration absorption, ie operate as shock absorbers.
Cartilage is composed of chondrocytes and intermediate matrix. Three types of cartilage are present in the human body:
The HYALINE CARTILAGE found primarily in the bronchi and pivoted bone surfaces. The intermediate matrix composed of polysaccharide chains, called proteoglycans and help to retain water, which is responsible for the mechanical properties of cartilage. Also contains type II collagen which is very strong as substrate and chondrocytes.
The FIBROUS CARTILAGE is less powerful than hyaline cartilage. It is found mainly in the intervertebral discs and consiss of type I collagen.
The ELASTIC CARTILAGE contains elastic fibers in the matrix and is found in the ears and the epiglottis.
WHY CARTILAGE IS SUBJECTED TO INJURIES?
Although it is very subtle, it helps to polish the modular surfaces and lasts for many years. But it has two major disadvantages:
- No nerve endings, and thus the damage may not be diagnosed at an early stage, and
- Not own vasculature, thus lacking the ability to heal of the lesions by himself.
Cartilage Injuries occur primarily in the knee joint as this is the joint that is loaded more in each cycle of gait. Acute or repetitive trauma to the cartilage as a result of sports injuries or direct trauma, especially in the younger age patients may, if not diagnosed and treated promptly, result in permanent damage. The destruction of collagen fibrils leads to degradation of proteoglycans, escape of water and loss of cohesion of cartilage and therefore the mechanical properties. Progressive damage leads to exposure of subchondral bone, severe pain and reduce joint mobility. Without treatment, these lesions lead to degenerative arthritis and permanent disability, which often leads to total knee arthroplasty (artificial joint).
Even if that operation is highly successful in older people, it has serious disadvantages when is recommended in younger patients with increased demands and daily activities. international statistics suggest that 30% of relatively young patients who have undergone total knee replacement will need at least one revisional surgery in the first 10 years after surgery.