A chondral injury is the medical term used to describe an injury to a joint surface (known as hyaline cartilage). Often these injuries are known as a cartilage injury to the general public.
Cartilage is a tissue which has several properties which significantly reduce joint forces during the movement or weight bearing through the joint. Firstly, cartilage is an extremely friction free surface which is helped by the production of liquid known as synovial fluid within the joint. Secondly, cartilage also possesses a spring like mechanical property when compressed.
The majority of chondral injuries occur as a result of a joint trauma which involves compression and rotation or a shearing force to the joint. These combined forces tear the cartilage leaving a hole on the cartilage surface, sometimes referred to as an osteochondral defect (OCD).
In some cases a chondral injury will occur without any obvious identifiable injury. Commonly, symptoms may occur during the teenage years as the hip, knee and ankle joints develop.
Acute symptoms of a chondral injury include pain and swelling to the affected joint. Due to the forces needed, in the vast majority of chondral injuries there will be associated damage to the joint ligaments. Ongoing chondral injury symptoms may be pain and swelling and in the case of associated ligament damage, this may result in ongoing joint instability. If there is a loose body of cartilage or bone left within the joint, this can also result in a catching or locking sensation to the joint.
Individuals suffering with a possible chondral injury may benefit from immediate diagnostic imaging. In some cases, x-rays may provide some information but the gold standard imaging for diagnosing a chondral injury and associated injuries is an MRI scan.
Circle Health is able to offer short notice appointments with orthopaedic consultants of various specialty following injury. Following an expertly conducted history taking and physical assessment of the joint in question, we are able to offer immediate booking for MRI scans and follow up orthopaedic consultations to discuss the results and best onward management.
Unfortunately, hyaline cartilage is not able to repair itself with similar tissue so following injury it is rare that the joint recovers fully. Furthermore, severe chondral injuries particularly when affecting weight bearing joints, may quickly progress to arthritis. For this reason, with any chondral injury it is recommended that patients see an expert orthopaedic consultant to guide their management.
The decision to manage a chondral injury surgically will be made based on several factors:
- Age and activity level of the patient involved
- The joint affected by the chondral injury (more stable joints may have a better outcome with non-surgical management)
- Associated ligament injury
- The size of the chondral injury
- The severity of the symptoms
- Whether the joint in question is arthritic
- Whether any associated loose body is involved
Due to the specific properties that cartilage possesses, a synthetic replacement has eluded science and medicine thus far. Due to this, a suspected chondral injury must be treated with caution.
Surgical management of chondral injury can be performed in two main ways. For chondral injuries which result in a large cartilage and bone fragment detached from the joint surface which has remained in a stable position pinning the fragment back in place remains a possibility. I available, this is a better option than a cartilage transplantation procedure due to the latter being a far more technically difficult procedure.
A cartilage transplant operation known as an autologous chondrocyte implantation in medicine, is performed in two stages. The first stage is a keyhole operation to harvest some cartilage cells (chondrocytes) from the affected joint. These cells are then used to form a larger cartilage matrix under laboratory conditions.
The second stage involves stitching the cartilage matrix over the chondral injury site. This is normally done with keyhole technique but some cases may require an open incision as part of the procedure.
Although this novel orthopaedic approach to managing chondral injuries has enabled many patients to return to normal function and sports a common post-operative problem following an autologous chondrocyte implantation is that the matrix becomes loose and unstable from the chondral injury site. Therefore, following this procedure, the cartilage matrix needs protecting for many weeks and sometimes months necessitating a lengthy period of using crutches after surgery and very slow progress with strength exercises thereafter.
In some circumstances, patients may opt for a non-surgical approach to managing a chondral injury. In these circumstances, patients will be managed by Circle Health’s expert physiotherapists who have the experience needed to progress exercises safely and effectively.