Chondral injuries refer to damage or lesions affecting the articular cartilage, which covers the ends of the bones within the knee joint. This cartilage serves as a smooth, low-friction surface that allows for pain-free movement of the knee joint.
1. Trauma: Direct impact or sudden twisting motions can cause chondral injuries.
2. Degenerative Changes: Wear and tear over time can lead to thinning or deterioration of the cartilage.
3. Repetitive Stress: Certain activities or occupations that involve repetitive knee movements can contribute to chondral injuries.
4. Joint Instability: Conditions such as ligament injuries or malalignment can predispose individuals to chondral damage.
Pain: Often worsens with activity and may be accompanied by swelling.
Swelling: Due to inflammation within the joint.
Stiffness: Difficulty bending or straightening the knee fully.
Catching or Locking Sensation: Especially with movement of the knee joint.
A thorough history and examination will be enough to raise suspicion of a chondral injury to the knee. An MRI is usually requested to confirm the injury and look for any other causes of pain within the knee. Additional imaging may be required depending on the size and location of the lesion to further evaluate treatment options.
There are several treatment options and the right one for you will depend on several factors including patient factors and the severity of the damage done. Your options will include non-surgical which include, Physiotherapy, Activity modification and pain-relieving options and Surgical options.
The surgical options will depend greatly on the size and location of the lesion.
These include:
- Debridement: Removal of loose or damaged cartilage fragments.
- Microfracture: Creating small holes in the underlying bone to stimulate the formation of new cartilage.
- Autologous Chondrocyte Implantation (ACI) or Osteochondral Autograft Transfer (OATS): Surgical techniques aimed at repairing or replacing damaged cartilage.
- Knee Replacement: In severe cases of chondral damage, total or partial knee replacement surgery may be necessary.
The prognosis of chondral injuries of the knee can vary depending on several factors, including the severity of the injury, the size and location of the chondral defect, the patient's age, activity level, and any underlying conditions such as osteoarthritis. In general:
Mild to Moderate Injuries: If the chondral injury is small and does not involve significant damage to the surrounding tissue, it may have a relatively good prognosis. These injuries may be managed conservatively with physical therapy, activity modification, and possibly injections to reduce inflammation and pain.
Severe Injuries: Larger lesions, in particular those involving the underlying bone can vary depending on the specific procedure performed and the individual patient's response to treatment.
Long-Term Outlook:
While many patients experience improvement in symptoms and function following treatment for chondral injuries, some individuals may continue to have persistent pain or limitations in knee function, especially if osteoarthritis develops as a result of the injury. Ongoing monitoring and management may be necessary to optimise long-term outcomes and minimise the risk of progression to osteoarthritis.
It is hard to prevent a chondral lesion from occurring but maintaining a healthy weight and strength around he knee can assist with overall knee health.
Once a chondral injury has occurred then this becomes even more important to help prevent or slow down potential further chondral damage.
Chondral injuries of the knee can cause significant pain and functional impairment, but with appropriate diagnosis and management, many individuals can achieve satisfactory outcomes and return to their desired level of activity. Early intervention and a comprehensive treatment plan tailored to the individual's specific needs are key to successful recovery. If you suspect a chondral injury, make an appointment with Dr Shales.
