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A chondral injury is a medical term used to describe an injury to a joint surface.This surface tissue is made up from a type of cartilage called hyaline cartilage. However, these injuries are commonly referred to as a cartilage injury by the general public.
What is hyaline cartilage?
Hyaline cartilage is a smooth elastic tissue that is found in many components of the body, from the rib cage to the ears. It is most commonly found attached to the ends of bones at the joints.
Hyaline cartilage’s function is to act like a padding that covers and protects ends of bones and nerves. It is not as rigid or inflexible as bone, however, it is much stiffer tissue than that used in the muscles.
Cartilage is a tissue that has several properties that significantly reduce joint forces during the movement or weight bearing through the joint.
With the aid of a liquid known as synovial fluid, cartilage provides a friction-free surface for the bones to move. This elastic cartilage also possesses a spring like mechanical property when compressed.
Cartilage has limited capability to repair itself, so when cartilage is damaged is can be difficult to heal. Over time, this can lead to a variety of other problems, such as arthritis, developing.
The majority of chondral injuries occur as a result of a joint trauma, which involves compression and rotation or a shearing force to the joint. These combined forces tear the cartilage to leave a hole on the cartilage surface. This is sometimes referred to as an osteochondral defect (OCD).
Because a chondral injury is usually caused by trauma it can be easy to confuse it with other type of injuries, such as an ankle injury, which also causes ankle pain.
In some cases a chondral injury will occur without any obvious identifiable injury. These cartilage defects may occur during the teenage years as the hip, knee and ankle joints develop.
Chondral injuries can affect the body anywhere that cartilage is found, however, the most common types of chondral injury are those joints that are most prone to trauma injury. These include:
The symptoms of a chondral injury are largely dependent upon location. However, the most common symptoms are:
·
- Acute pain in the affected area
- Swelling to the affected joint
- A weakness in the affected joint, such as foot and ankle instability
Due to the forces needed to cause a chondral injury, in many cases of chondral injuries there will also be associated damage to the joint ligaments, such as an ankle sprain.
Ongoing chondral injury symptoms may be pain and swelling and in the case of associated ligament damage, which may result in ongoing joint instability.
If there is a loose body of cartilage or bone left within the joint, this can also result in a catching or locking sensation to the joint.
The first course of action to treat a chondral injury is to tackle the pain. This can be done with over-the-counter pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help give pain relief.
After looking at your history of the condition, our consultant will conduct a physical examination of the affected joint. To diagnose a chondral injury, the first step will involve a series of diagnostic imaging tests.
In some cases, X-rays may provide enough information to identify a chondral injury. However, your consultant may recommend an MRI or CT scan as this will provide much more detailed information about the joint.
Unfortunately, hyaline cartilage regeneration is not possible because it is unable to repair itself. For this reason, an osteochondral defect of the knee or an osteochondral defect of the ankle may not fully recover following an injury.
In addition, severe chondral injuries, such as those that affect weight-bearing joints, may quickly progress to arthritis.
For this reason, it is recommended that you see an expert orthopaedic consultant to guide your management of a chondral injury and take you through the range of treatment options.
The decision to manage a chondral injury surgically will be made based on several factors: ·
- Age and activity level of the patient involved ·
- The joint affected by the chondral injury (more stable joints may have a better outcome with non-surgical management) ·
- Associated ligament injury
- The size of the chondral injury
- The severity of the symptoms
- Whether the joint in question is arthritic
- Whether any associated loose body is involved
If you opt for a non-surgical approach to managing a chondral injury then a physical therapists will be able to guide you with a series of exercises that will help to strengthen muscles. This will help you to manage and reduce pain without aggravating the injury.
In addition, regular exercise can increase the full thickness of hyaline cartilage as well as improve your range of motion in the affected joint.
If your consultant recommends surgery then this can be performed in two ways.
For chondral injuries where a large cartilage and bone fragment has detached from the joint surface but has remained in a stable position then surgery may possible to pin the fragment back in place. If this option is available then if may provide a better treatment than a cartilage transplantation, which is a much more difficult procedure.
A cartilage transplant operation, which is called an autologous chondrocyte implantation, is performed in two stages.
The first stage involves a keyhole operation to harvest some cartilage cells (chondrocytes) from the affected joint. These cells are then used to form a larger cartilage matrix under laboratory conditions.
Once the transplant cells have been grown, a second operation is performed to stitch the cartilage matrix over the chondral injury site. This is normally done with keyhole technique but some cases may require an open incision as part of the procedure.
Although this novel orthopaedic approach to managing chondral injuries has enabled many patients to return to normal function and sports, a common post-operative problem following an autologous chondrocyte implantation is that the matrix becomes loose and unstable from the chondral injury site.
Therefore, following this procedure, the cartilage matrix needs protecting for many weeks and sometimes months necessitating a lengthy period of using crutches after surgery and very slow progress with strength exercises thereafter. Your Consultant will take you through the different surgical procedures and discuss the benefits and risks associated with each one.
