Cartilage Ulcers
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
Joints in our bodies comprise ends of bones articulating with each other. The ends of the bones forming the joints are covered with an extremely smooth cartilage further lubricated with viscous joint fluid, making for friction-free movements. Holes in the smooth cartilage cap can occur at any joint resulting. These holes are known as cartilage ulcers.
What Is A Cartilage Ulcer?
Cartilage is the smooth, flexible tissue that covers the ends of bones within joints, allowing them to glide smoothly against each other during movement.
However, damage or wear and tear can result in the formation of holes in this cartilage layer, known as cartilage ulcers.
These ulcers can occur in any joint but are most commonly found in weight-bearing joints like the knees, hips, and ankles. They range in severity from minor surface irregularities to deep lesions that expose the underlying bone, leading to pain, stiffness, and reduced joint function.
What Causes Cartilage Ulcer?
Cartilage ulcers can develop due to various factors, including:
- Acute injuries: Cartilage ulcers can develop following sudden, traumatic events such as sports injuries or accidents where there is direct impact or force applied to the joint.
- Chronic wear and tear: Continuous stress and strain on the joints from activities like running, lifting heavy objects, or repetitive motions can gradually wear down the cartilage.
- Repetitive stress or overuse injuries: Activities that involve repetitive motions or prolonged stress on the joints, such as kneeling, squatting, or manual labour, can gradually wear down the cartilage. If the joint does not have enough time to recover between activities, this can eventually lead to the formation of ulcers.
What are the symptoms?
The symptoms of cartilage ulcers can vary depending on its severity and location, but commonly include:
- Pain in the affected joint, especially during movement or weight-bearing activities
- Swelling around the joint
- Stiffness and reduced range of motion
- Clicking or grinding sensations during joint movement
- Joint instability or the feeling of the joint “giving way”
- Locking of the joint, where it gets stuck in one position
- Tenderness when pressing on the joint
These symptoms can worsen with activity and may improve with rest, but they can persist or worsen over time if left untreated.
How Is Cartilage Ulcer Diagnosed?
Diagnosing cartilage ulcers typically involves a combination of physical examination, imaging studies, and arthroscopic evaluation.
During a physical examination, a healthcare professional will assess the affected joint for signs of swelling, tenderness, and range of motion limitations. Imaging studies such as X-rays, MRI scans, or CT scans may be ordered to visualise the cartilage and assess the extent of the ulceration.
In some cases, arthroscopy, a minimally invasive surgical procedure, may be performed to directly examine the cartilage as well as to confirm the presence and severity of the ulcers.
How Is Cartilage Ulcer Treated?
Treatment options for cartilage ulcers depend on the size, location, and severity of the lesion, as well as the patient’s overall health.
Non-surgical treatments are often recommended for milder ulcers, aimed at alleviating pain and inflammation, enhancing function, and fostering healing. These treatments include:
- Rest and activity modification: Reducing activities that aggravate the joint allows for healing and reduces pain.
- Medication: Pain relievers like ibuprofen or acetaminophen can help manage discomfort and inflammation.
- Physical therapy: Strengthening exercises and improving range of motion can enhance joint stability and function.
- Bracing: Using a brace can unload pressure on the joint, promoting healing.
Surgical interventions may be necessary if nonsurgical approaches fail to provide relief or if the tear is severe. These may include:
- Arthroscopic debridement: During this minimally invasive procedure, a surgeon removes damaged cartilage fragments through small incisions.
- Microfracture: Tiny holes are drilled in the underlying bone to stimulate new cartilage growth.
- Cartilage resurfacing techniques: These procedures aim to replace the damaged area with healthy cartilage-like tissue.
- Autologous chondrocyte implantation (ACI) or matrix-induced ACI (MACI): Cartilage cells are harvested from a healthy area of the joint, grown in a lab, and then implanted into the damaged area. MACI uses a collagen structure to support the implanted cells.
- Osteochondral autograft transplantation (OATS): A small healthy cartilage and bone plug is taken from a less-weight-bearing area of the joint and transplanted to the ulcer.
Anatomy/ Pathology
The collateral ligaments are found on either side of the knee, connecting the femur to the tibia. The knee is a hinged joint designed to flex and extend only in one plane. The collateral ligaments prevent the knee from opening up side to side. Forces causing the leg to deviate either outwards or inwards can cause the collateral ligaments to rupture.
Frequently Asked Questions
Can Cartilage Ulcers Heal?
How do cartilage ulcers impact daily activities and quality of life?
Can cartilage ulcers heal on their own?
What can I do to prevent cartilage ulcers from worsening?
Are there any long-term complications from cartilage ulcers?
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