Articular cartilage wraps the end of the bones and has a smooth, slick surface that allows the bones to slide over one another without friction or direct contact – minimizing pressure during movement. While cartilage tissue is void of nerves, worn or torn areas on the cartilage may result in inflammation of the joint and cause pain. Injuries to the articular cartilage often present as tears or holes in the surface of the cartilage. Lesions can vary in thickness of injury. Most superficial injuries, or partial thickness injuries, are not serious. If the lesion is large, full thickness, and exposes the bone below, it could result in arthritis.
At the Sanders Clinic, initial recommendations are not surgical – provided the knee is not locked and is able to come to full extension. A significant number of patients are able to avoid arthroscopic surgery with a proper Reconditioning Program. Anti-inflammatory medications such as Celebrex, or Advil are started. Nutritional supplements for articular support are added and an exercise program is instituted utilizing a Step Box for both legs. This simple device is used for the performance of closed chain knee extension exercises on both legs, beginning with four sets of 25 reps of two-inch excursions each day then increasing until 50 reps can be performed. The same routine is then continued with a four-inch excursion. After the same goal is reached, the excursion is increased to six, then eight inches. Patients must do at least four sets per day on each leg. The patient may start to work in the stationary bike and/or the Stairmaster, as well as continue with the Step Box at increasingly longer excursions through the end of the second week. Additionally in the second week, programs of jogging, swimming, and specific sport-related activities are begun if a specific sport is not already in progress. Athletes may continue to participate in their desired sport.
Occasionally in recalcitrant cases, arthroscopic surgery is necessary. Indicated procedures in most cases include simple debridement of the lesion. In rare cases, transplantation of articular cartilage from another area of the knee, or from a cadaver, is necessary.