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Articular Cartilage Injury

Dr.RAJAT JANGIRConsultant Arthroscopy and Orthopedic Surgeon

Saket Hospital, MansarovarAssistant Professor

Mahatma Gandhi Medical College, Jaipur

Fellowship In Arthroscopy(South Korea)International Olympic Committee Diploma Sports Medicine(UK)Sports Physician RIO Olympic 2016

• What Is Cartilage1

• Injury2

• Diagnosis and treatment3

Today’s Overview

FUNCTIONS

TO GIVE SUPPORT, BEAR WEIGHT

WITHSTAND TENSION, TORSION AND BENDING

Composed mostly of an intercellular material called “matrix”-ground substance is “gel-like

matrix

matrix

matrix

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Tissue cells are then contained in this intercellular matrix but are "far" apart, relatively speaking.

matrix

matrix

matrix

matrixmatrix

cells

Elastic CartilageFibrous Cartilage or

“Fibrocartilage”

Hyaline Cartilage3 Types of Cartilage

Tissue

Tire Analogy

• Tread of a tire = articular cartilage

Composed mostly of an intercellular material called “matrix”-ground substance is “gel-like

matrix

matrix

matrix

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Degenerative

Traumatic

Focal Cartilage Defects• Traumatic

o Concomitant ligament injury -- ex: ACL Osteochondritis Dissecans lesion

o Localized cartilage lesion due to unexplainable localized poor blood supply.

o Most commonly seen on lateral part of medial femoral condyle.

Cartilage Lesion Classification

Bad to the Bone

Diagnosis

• History/Physical• X-rays• MRI• Diagnostic arthroscopy

History/Physical

• Intermittent, vague, poorly localized pain

• Locking or catching if loose body present

• May have associated secondary degenerative changes if bony incongruity present.

X-rays

MRI

Treatment OptionsBone marrow stimulation (<5 mm).-- scar cartilage, not real weight bearing type of articular cartilage.

Bone Marrow Stimulation

Autologous Chondrocyte Implantation (> 2x2 cm lesions)--requires open arthrotomy and at least two surgeries but theoretically same type of weight bearing articular cartilage.

Autologous Chondrocyte Implantation

Osteochondral Autograft Transplant Surgery (O.A.T.S.)( <2 x2 cm lesions ?) -- limited number of donor plugs but covers lesion with same type of weight bearing articular coverage

O.A.T.S.

O.A.T.S.

O.A.T.S.

Rehabilitation Phases

• Protective (4 wks): NWB x 2 wks then 20-30lbs weight bearing.

• PROM exercises.• Transition (5th and 6th wks): • 25% weight bearing, mini squats and aqua jogging.• Maturation (7-12 wks): Full WB, full squats, walking

swimming and stairmaster.• Functional (>12 wks): Full activity.

Back to Work Issues• No sooner than 3 months

• ? Permanent work restrictions depending on size of lesion and concomitant injuries.

• Will more than likely have lifting restrictions depending on size of lesion and concomitant injuries.

Case Study

• 25 year old male sustained a fall/twist on right knee.

• PE: 2+ effusion, ROM 0-130 deg, 2+ Lachman, pivot shift and anterior drawer .

• Xrays: wnl• MRI: ACL tear, medial/lateral meniscus tears, full

thickness cartilage defect of medial femoral condyle.

MRI

Arthroscopic Findings

• ACL tear• MFC defect measuring

8mm x 16 mm.• Med/lat meniscus tears

Arthroscopic Treatment

• Partial Med/lat menisectomies

• O.A.T.S. of MFC• ACL reconstruction

Conclusions

• O.A.T.S. procedure provides quick and near complete coverage of most focal full thickness cartilage lesions.

• Covers cartilage lesion with same type of weight bearing articular cartilage

• Can be done at same surgery as other planned procedures.

• Can be done arthroscopically providing faster rehabilitation and sooner return to work.

Thank You…......

Articular Cartilage Injury

Dr.RAJAT JANGIRConsultant Arthroscopy and Orthopedic Surgeon

Saket Hospital, MansarovarAssistant Professor

Mahatma Gandhi Medical College, Jaipur

Fellowship In Arthroscopy(South Korea)International Olympic Committee Diploma Sports Medicine(UK)Sports Physician RIO Olympic 2016