Articular cartilage damage, OCD, Osteochondral Injury

What is it?

Articular cartilage damage refers to an injury to the cartilage lining the joint surfaces of the bones within the knee joint.

How does it happen?

The articular cartilage of the knee joint may be damaged in isolation following a direct injury to the knee. This may occur when you land on your knees, compressing the kneecap against the underlying bone and cartilage. Similarly, the articular cartilage within the knee may be damaged when any of the structures supporting the knee joint are injured (i.e. ligaments, menisci).

How does it feel?

Damage to the articular cartilage within the knee results in pain within the knee joint. Damage occurs frequently deep within the joint or behind the kneecap. The pain is often aggravated by activities which compress the damaged cartilage such as weight-bearing. Similarly, damage to the articular cartilage results in ongoing and persistent swelling within the knee.

What should you do?

If you have or suspect you have injured your articular cartilage, you should cease your activity or sport and begin initial treatment to control any swelling. To limit the severity of the symptoms it is advised you stop your activity immediately and start initial treatment. The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a necessary step in the healing process; however, too much swelling can delay healing and cause further tissue damage. To control the amount of swelling and limit the degree of damage to the knee, the RICE regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the injured area, thereby reducing the extent of swelling and tissue damage. Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg. Crutches may be required if you are having difficulty walking. Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied using crushed ice wrapped in a moist cloth or towel. Compression involves the application of a firm elastic bandage around your knee. It should be firm but not tight enough to cause pain. Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level of your heart. You should continue the RICE regime until you consult a sports medicine professional, preferably within two days of the initial injury.

What shouldn’t you do?

If you have or suspect you have damaged your articular cartilage, you shouldn’t undertake activities which increase blood flow to the injured area. These include hot showers, heat rubs, the consumption of alcohol and excessive activity. These may increase the swelling within the knee and potentially prolong your recovery.

Could there be any long-term effects?

Unfortunately, damage to the articular cartilage can result in long-term effects. Depending on the severity of the injury, damage to the articular cartilage within the knee can result in ongoing pain and swelling, resulting in a prolonged recovery. In addition, articular cartilage damage can result in the development of arthritis within the joint. Management The assistance of a sports medicine professional is important in the treatment of articular cartilage damage. Initially, they can assist in determining the extent of the damage. The use of imaging techniques such as X- ray or MRI may be of benefit. In addition, this injury may require arthroscopic surgery to directly visualise the cartilage. From this, they will be able to determine the most appropriate treatment. This may involve activity modification, treatments to decrease pain and swelling, and strengthening and stretching exercises.