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Cartilage Injuries
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What are Cartilage Injuries?
Cartilage injuries in the knees and hips can significantly impact an individual’s quality of life by causing pain, swelling, and reduced joint mobility.
Both the knee and hip joints contain several types of cartilage, including articular cartilage, which coats the ends of bones, and in the knee, the menisci, which act as shock absorbers. Cartilage injuries can range from minor cartilage wear and degeneration to severe cartilage loss, potentially leading to osteoarthritis if left untreated.
Types of Cartilage Injuries
The types of cartilage injuries commonly seen in knee and hip joints include:
Articular Cartilage Wear and Tears
- Knee: Injuries may occur on the femoral condyles, the tibial plateau, or the patella.
- Hip: Damage often involves the cartilage covering the femoral head or the acetabulum, leading to hip pain and stiffness.
Meniscal Tears (Knee-Specific)
The knee has two menisci that can tear due to trauma or degeneration, causing pain, swelling, and limited movement.
Labral Tears (Hip-Specific)
The labrum is a ring of cartilage around the acetabulum of the hip joint that can tear due to trauma, femoroacetabular impingement (FAI), or degenerative changes, leading to hip pain and mobility issues.
Chondral Defects
Localized areas of damaged cartilage that can occur in both the knee and hip joints, often resulting from acute injuries or the wear and tear associated with osteoarthritis.
Common Causes of Cartilage Injuries
Trauma
- Direct Impact: Falls, sports injuries, or accidents that directly impact the knee or hip can cause immediate cartilage damage.
- Twisting Movements: Sudden, forceful twists can tear the meniscus in the knee or the labrum in the hip.
Overuse
Repetitive stress on the joints from activities like running, cycling, or occupational tasks can lead to gradual wear and tear of cartilage.
Misalignment
Abnormal alignment of the knee or hip joint, such as genu varum (bow legs), genu valgum (knock knees), or hip dysplasia, increases stress on certain areas of cartilage, accelerating degeneration.
Age-Related Degeneration
As individuals age, the water content of cartilage decreases, and its protein makeup changes, making it more prone to wear and tear.
Obesity
Excess body weight puts additional pressure on the knee and hip joints during everyday activities, contributing to faster cartilage degradation.
Medical Conditions
Conditions like rheumatoid arthritis and metabolic disorders can directly affect joint health, leading to cartilage damage.
Symptoms of Cartilage Injuries
in the Knees and Hips
Cartilage injuries may present with a range of symptoms, reflecting the extent of damage and the specific joint affected. Key symptoms include:
Pain
- Knee: Often felt during weight-bearing activities, such as walking or climbing stairs, and may be localized to a specific area of the knee.
- Hip: Pain is typically located in the groin area but can also radiate to the thigh, buttock, or knee.
Swelling
May occur due to inflammation caused by cartilage damage, although it may be less pronounced in the hip due to its deeper location.
Stiffness
A common symptom in the morning or after periods of inactivity, stiffness can affect both knee and hip mobility.
Reduced Range of Motion
Difficulty in fully bending or straightening the knee or hip can indicate cartilage damage, limiting everyday activities.
Catching or Locking Sensation
This sensation occurs when a loose fragment of cartilage or bone interferes with joint movement, more commonly experienced in the knee.
Grinding or Clicking Noises
Known as crepitus, these sounds may be heard during joint movement if the smooth surface of the cartilage has been damaged.
Instability
A feeling that the knee or hip might “give out” under weight-bearing pressure can be a sign of severe cartilage injury or associated ligament damage.
Diagnosis
Clinical Examination and Patient History
A healthcare provider will conduct a thorough physical examination, assessing the affected joint for pain, swelling, range of motion, and signs of instability or misalignment. Specific manoeuvres may also be performed to test the integrity of the cartilage and associated structures along with understanding the patient’s medical history.
Imaging Studies
- X-rays: Although they cannot show cartilage directly, X-rays can reveal changes in the joint space that suggest cartilage loss. They are also useful for detecting bone changes that may accompany cartilage injury.
- Magnetic Resonance Imaging (MRI): MRI is particularly valuable for visualizing cartilage, as well as other soft tissues. It can show the extent and specific location of cartilage damage.
Arthroscopy
This minimally invasive procedure involves inserting a small camera into the joint to directly visualize the cartilage and other structures. While more invasive than other diagnostic tools, arthroscopy can provide definitive information about the condition of the cartilage.
Non-Surgical Treatment Options
Physical Therapy
Physical therapy plays a crucial role in the management of cartilage injuries, with tailored exercises designed to strengthen the muscles around the joint, improve flexibility, and increase the range of motion. This can help alleviate stress on the damaged cartilage and support joint stability.
Pain Management
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and inflammation. For those who cannot tolerate NSAIDs, acetaminophen may be recommended.
- Injections: Corticosteroid injections can provide temporary relief from pain and inflammation. Hyaluronic acid injections, also known as viscosupplementation, aim to lubricate the joint, reducing pain and improving mobility.
Activity Modification
Adjusting daily activities to avoid movements that exacerbate pain and stress on the joint is important. Patients may be advised on how to modify exercise routines or incorporate low-impact activities such as swimming or cycling.
Weight Management
For overweight or obese individuals, weight loss can significantly reduce the pressure on weight-bearing joints, decreasing pain and preventing further cartilage deterioration.
Orthotics
Custom orthotic devices may be recommended for individuals with foot or ankle misalignments that contribute to knee or hip stress, helping to distribute weight more evenly across the joint.
Surgical Treatment Options
- Arthroscopic Debridement
This minimally invasive procedure involves using an arthroscope to remove loose fragments of cartilage and smooth the damaged area, potentially reducing pain and improving joint movement. - Microfracture Surgery
Microfracture involves creating small holes in the bone beneath the damaged cartilage to stimulate the growth of new cartilage. This technique is often used for smaller areas of cartilage loss. - Total or Partial Joint Replacement
In cases of extensive cartilage damage, particularly in older patients or those with advanced osteoarthritis, replacing the damaged joint with an artificial one may be the best option to relieve pain and restore function.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Preventative Measures for Cartilage Health
While it’s not possible to prevent all cartilage injuries, certain measures can reduce the risk and help preserve cartilage health in the knees and hips:
- Maintain a Healthy Weight
Excess body weight increases the stress on weight-bearing joints, accelerating cartilage wear. Engaging in low-impact activities such as swimming, cycling, and walking can keep joints mobile without excessive stress. - Avoid Repetitive Stress
Modify activities that put repetitive stress on the joints, especially in occupations or sports that involve heavy lifting, prolonged kneeling, or squatting. - Use Protective Gear and Proper Technique
In sports or activities that involve joint impact or risk of injury, use protective gear and ensure proper technique and form to minimize the risk of cartilage damage. - Stay Hydrated
Cartilage is primarily made up of water, staying hydrated helps maintain the elasticity and shock-absorbing properties of cartilage.
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Frequently Asked Questions (FAQs)
Can dietary supplements help in recovering from cartilage injuries?
While no supplement can directly repair damaged cartilage, some supplements, such as glucosamine and chondroitin sulfate, are thought to support joint health and may alleviate symptoms of cartilage damage. However, their effectiveness can vary, and it’s important to consult with a healthcare provider before starting any supplement regimen.
Are there any specific exercises to avoid if you have cartilage injuries in the hip?
High-impact exercises and activities that involve significant hip rotation or deep flexions, such as deep squats, high-intensity interval training (HIIT), and certain types of yoga poses, should be approached with caution or avoided to prevent exacerbating hip cartilage injuries.
Can weather changes affect cartilage injury symptoms?
Many individuals report that their joint pain, including symptoms from cartilage injuries, worsens with changes in weather, particularly during cold, damp conditions or when atmospheric pressure drops. While the exact mechanism is not fully understood, it’s believed that changes in atmospheric pressure might affect joint pressure or that cold weather could increase the viscosity of synovial fluid, making joints feel stiffer.
How long should I rest after a cartilage injury before resuming physical activity?
The duration of rest required after a cartilage injury varies based on the injury’s severity, the affected joint, and the individual’s overall health. Generally, a period of rest ranging from several days to weeks may be recommended to allow for initial healing. However, complete inactivity should be avoided as it can lead to joint stiffness and muscle weakness.