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June 8, 2015
When we think of cartilage, often we think of the cartilage that gets torn in the knee that requires the common "scope" surgery of the knee. However, there are actually three main cartilages in the body. Articular cartilage is the type of cartilage that covers the ends of bones found in the joints. The cartilage that makes up the meniscus in the knee and intervertebral disks is fibrocartilage, while elastic cartilage makes up the nose and ears.
We are going to discuss articular cartilage, and what it does to you when it is injured. The surfaces of joints, covered with articular cartilage, can be susceptible to wear and tear over the years. Itÿs function is to provide low friction surfaces allowing one to move the joint or weight bear in a manner that allows us to perform activities of dialing living as well as our sports endeavors. It is like a shock absorber in the weightbearing joints of our hips, knees, and ankles.
Articular cartilage can be injured usually by an acute traumatic destructive force or by progressive mechanical degeneration. In a traumatic event, like an automobile or high impact energy blow, the fractures of the bones can extend into the joints causing displaced œtype injuries to the cartilage surfaces of the joints. Normally, this can heal, as the underlying bone can supply adequate blood to nourish and sustain the healing structure. In severe injuries, this cartilage can flake off causing "joint mice." These small objects float around in the knee and can cause minimal discomfort, usually. Sometimes they will interfere with normal joint motion and have to be removed.
Mechanical deterioration of the joint, often seen in advanced cases of arthritis, begins with fragmentation, cracking, and flaking of the articular cartilage. This systematic loss of the articular cartilage can lead to severe arthritis (osteo). The cause of this progressive disease is not understood. Some jobs that result in repetitive injuries, such as twisting or turning sharply can cause worsened conditions.
Diagnosis can be made by history and physical alone. A complaint of decrease range of motion, swelling, and increase heat around the joint can typify the osteoarthritic nail.
MRI, X-ray, and bone scans can be helpful in determining the correct diagnosis. Surgery is indicated when the pain in unbearable, and the radiographs do not reveal a significantly advanced setting in the joint. Defects in the cartilage less than 2 cm have the best prognosis. Arthroscopic surgery that allows the surgeon to wash and debride the joint are excellent viable options. Physical Therapy, bracing, oral and injectable medicines are the best options presently.
Gaining or maintaining optimal weight is crucial, as obesity probably has a key to the cause many cases. Low impact aerobics such as water exercises is a great choice. This usually will calm the joint down over time, and improve the flexibility as well. But, it is a lifestyle change, and many are stubborn to start or maintain it. Exercises, solid healthy diet, and non-steroidal anti-inflammatory medicines are the keys. Surgery to wash, debride and shave the worn out cartilage is also an option, but some studies due support this. Arthroscopic debridement can be a viable option to treat this when it is in advanced stages.
Through education, conservative measures, and change of lifestyle habits, freedom from arthritis pain is possible and a realistic goal.