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Cartilage injuries

What is cartilage injuries?

There are two types of cartilage injuries inside the knee and they can be injured in different ways. These include:

  • The lateral and medial menisci – C-shaped and made of tough, rubbery fibrocartilage, which are located within the knee joint. This type of cartilage acts like washers to help with with shock absorption and aiding joint stability. This injury usually occurs when a sudden onset or wear and tear (degenerative).
  • Joint (articular) cartilage – a solid layer of cartilage that covers the bony surfaces inside the knee joint. This type of cartilage allows for a shiny, smooth, friction-free surface for the joint to glide on. This injury occurs when the knee has gone through a traumatic injury, wear and tear or by other conditions.

What causes a knee cartilage injury?

Menisci and lateral injuries usually fall into two categories:

  • Acute injuries: This type of injury is usually caused by sudden movements involving rotation and can occur in sports. Meniscal injuries vary in severity depending on the size and location of the tear within the meniscus.
  • Degenerative injuries: This type of injury can occur as you age, where the cartilage becomes thin and not as strong. The injury can happen without memorable incident or twisting motions.

Articular cartilage injuries can occur in a many ways including:

  • Trauma or acute injury:  This may occur if the person sustains a high force injury where it may result in chipping of the articular cartilage or a cartilage compression injury. 
  •  Via a patellar dislocation: This may occur if the person has sustained a patellar (kneecap) dislocation where a piece of the articular cartilage may be chipped or fractured.
  • Conditions such as osteochondritis dissecans (OCD): This condition is considered a stress injury where a small patch of bone beneath a portion of articular cartilage develops a lesion. This injury is mostly found in adolescents and young adults
  • Wear and tear (OA): This injury can occur as you age usually when the person has had previous traumatic knee injuries, highly physical jobs, or who have movement patterns (biomechanics), therefore creating extra stress.
  • Apophysitis: This injury is related to growth and load where the cartilage is transitioning to bone at the tendon insertion, with injury also in the adjacent tendon and bone.

How do I know if I have a knee cartilage injury?

Your physiotherapist, doctor or surgeon will need to examine your knee to give you a diagnosis. You may be asked to perform small test or be referred to imaging. Symptoms usually include:

Meniscal injuries

  • Sharp pain whilst walking, twisting and turning
  • Reduction with knee bending and straightening
  • Inability to complete activity.
  • Mild to moderate swelling
  • Clicking or catching sensations – this may not be painful
  • Bucket-handle meniscal injuries (severe injury) – can cause knee to be locked in certain position. .

Articular cartilage injuries

  • Those articular injuries that occur with an incident are painful, swollen and restrict movement.
  •  Those articular injuries that occur due to OCD may have symptoms such as limping, pain, swelling, clunking and may have limited movement.
  • Those articular injuries that occur due to wear and tear have gradual symptoms and progress over years. Symptoms may include; swelling, pain and appearance of knee may change.  

How can physiotherapy help with knee cartilage injuries?

Physiotherapy is important for managing knee cartilage injuries although each treatment plan will depend upon each individuals cartilage injury. Commonly exercises are used to optimise bending and strengthening and to improve muscle strength and coordination of leg position. Your physiotherapist will also be able to give you advice about general activity and pain management.

Meniscal injuries

  • In the early stages of a Meniscal injury it will be inflamed so using ice, activity reduction and gentle exercises will help settle your knee.
  • Once your knee has settled, your physiotherapist will give you a personalised program for your rehabilitation to return to full activity.
  • If the knee continues to have significant mechanical symptoms once the inflammatory stage has settled and rehabilitation program has been completed, your physiotherapist may refer you to a sports doctor or orthopaedic surgeon.
  • Surgery will be required if you have a bucket-handle meniscal tear to allow joint to regain movement. Physiotherapy is required after surgery to safely regain full strength and knee function.

Articular cartilage injuries

  • If the articular cartilage injury is severe, surgery is usually requires and physiotherapy is required after the operation to ensure you can return to your desired activity safely.
  • Physiotherapy is recommended to manage knee osteoarthritis.
  • If the articular cartilage injury is mostly in the patellofemoral joint, physiotherapy will usually include strengthening exercises.
  • If the articular cartilage injury is a stable OCD then your physiotherapist will be able to show you activity modifications and exercises to allow the cartilage and bone to heal.
  • If the articular cartilage injury is a unstable OCD it may require surgery and physiotherapy will be vital for rehabilitation.
  • If the articular cartilage injury is a apophysis (usually in children) then it usually occurs after repetitive activities, your physiotherapist can help with managing loading, activity modification, an exercise program, taping and advice on self-massaging techniques.

What can I do at home?

When you are diagnosed with a cartilage injury by your physiotherapist, GP or surgeon, they will provide you with a personal at home treatment plan. Personal home management plans will include:

  • Giving you information about the nature of your knee condition and important advice.
  • Managing and maintaining knee mobility which will include exercises
  • Improving and maintaining strength of the muscles that support your knee, recommendations for this will be given by your physiotherapist.
  • Improving strength and coordination of the other muscles that contribute to knee posture.
  • Maintaining general fitness
  • Stretches
  • Gait re-education (walking training)
  • Recommending using heat or ice packs on your knee in certain situations
  • May be suggested to use knee braces or taping techniques

How long will my recovery be?

Your recovery time will depend on how severe and what type of cartilage injury it is. People may have reduced pain or resolution of the condition within a few weeks or months, although this can only occur with correct physiotherapy treatment and management. If physiotherapy treatments and management plans do not respond to the person then you may be referred to a sports doctor or a surgeon.

If you would like to find out more please call us or book an appointment here.

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Reference: Australian Physiotherapy Association 2019, Your Body, viewed 19 November 2019, < https://australian.physio/>.