Cartilage surgery is performed to repair or replace damaged cartilage in joints, particularly in the knee, hip, and shoulder. Cartilage, a smooth, rubber-like tissue, covers the ends of bones in joints and allows for smooth movement. Unlike other tissues, cartilage lacks a direct blood supply, making it difficult to heal on its own when injured or worn down. Cartilage damage can lead to pain, joint stiffness, and impaired mobility, and may eventually progress to osteoarthritis if left untreated.
Symptoms of Cartilage Damage
Cartilage damage often presents the following symptoms:
- Pain in the joint: Particularly during weight-bearing activities.
- Swelling: This can develop around the affected joint due to inflammation.
- Stiffness and reduced range of motion: Difficulty in fully moving the joint.
- Joint instability: The joint may feel like it’s locking or giving way.
- Clicking or grinding sensation: This occurs due to the uneven surfaces rubbing together in the joint.
Causes of Cartilage Damage
There are several reasons for cartilage damage, including:
- Trauma: Injuries from falls, accidents, or sports that involve heavy impact or twisting motions.
- Wear and tear: Overuse or aging can cause the gradual degeneration of cartilage, leading to conditions like osteoarthritis.
- Repetitive stress: Activities or jobs that involve frequent kneeling, squatting, or lifting can cause cartilage wear over time.
- Genetic predisposition: Some individuals may be more prone to cartilage degeneration due to genetic factors.
- Inflammatory conditions: Autoimmune diseases like rheumatoid arthritis can lead to cartilage damage.
Types of Cartilage Surgery
Cartilage surgery aims to either repair, regenerate, or replace damaged cartilage, depending on the extent of the injury and the location of the damage.
1. Microfracture Surgery
- Purpose: To stimulate the growth of new cartilage by creating small holes (microfractures) in the underlying bone.
- Procedure: Surgeons drill small holes in the bone beneath the damaged cartilage to allow blood and bone marrow cells to form a clot that leads to cartilage formation.
- Recovery: Usually involves a long rehabilitation period to allow new cartilage to develop.
2. Osteochondral Autograft Transplantation (OATS)
- Purpose: To replace damaged cartilage with healthy cartilage from another part of the patient’s joint.
- Procedure: Small plugs of healthy cartilage and bone are taken from a non-weight-bearing area of the joint and transplanted into the damaged area.
- Recovery: Post-surgery rehabilitation is essential for regaining joint function.
3. Autologous Chondrocyte Implantation (ACI)
- Purpose: To regenerate cartilage using the patient’s own cells.
- Procedure: Cartilage cells (chondrocytes) are taken from the patient, grown in a lab, and then re-implanted into the damaged area.
- Recovery: This approach requires several months of recovery and physical therapy.
4. Osteochondral Allograft Transplantation
- Purpose: To replace large areas of damaged cartilage and underlying bone using donor tissue.
- Procedure: A cartilage and bone graft from a deceased donor is used to replace the damaged area.
- Recovery: This is often used for more extensive cartilage damage and may require longer rehabilitation.
Post-Surgery Physiotherapy
Rehabilitation after cartilage surgery is critical to ensure proper healing, restore function, and minimize the risk of future injury. A structured physiotherapy program is essential.
1. Phase 1 (0–6 weeks post-op)
- Goals: Minimize pain and swelling, protect the surgical site, and begin gentle movements to prevent joint stiffness.
- Exercises: Range of motion exercises, gentle stretching, quadriceps activation, and ankle pumps. Patients may use crutches or a knee brace to reduce weight-bearing.
2. Phase 2 (6–12 weeks post-op)
- Goals: Gradually restore mobility and improve muscle strength around the joint.
- Exercises: Stationary cycling, leg raises, partial weight-bearing activities, and isometric exercises. Balance and proprioception exercises may also be introduced.
3. Phase 3 (3–6 months post-op)
- Goals: Restore full range of motion and strength in the affected joint.
- Exercises: Progressive resistance training, swimming, light squats, and stationary exercises to build strength and improve coordination.
4. Phase 4 (6–12 months post-op)
- Goals: Full return to physical activity and sports-specific movements.
- Exercises: Advanced strengthening, plyometrics, agility drills, and full weight-bearing exercises. Athletes may focus on sport-specific drills and functional movement training.
Non-Surgical Treatment Options
In some cases, non-surgical treatments may be considered, especially for minor cartilage injuries or early-stage cartilage wear.
- Physical therapy: Strengthening the muscles around the joint to reduce stress on the cartilage.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.
- Corticosteroid or hyaluronic acid injections: To relieve pain and improve joint function.
- Activity modification: Reducing high-impact activities to prevent further cartilage damage.
Conclusion
Cartilage surgery can effectively treat cartilage damage and improve joint function, but the recovery process is lengthy and requires commitment to rehabilitation. Physical therapy is crucial for regaining strength, mobility, and stability in the affected joint.