Cartilage Disease

Condition

Cartilage is a tough, flexible tissue that is found throughout your body. There are three types of cartilage; however, the majority of the cartilage found in the joints of humans is hyaline cartilage. Hyaline cartilage has one primary function - to acts as a shock absorber. Hyaline cartilage covers the surface of joints, allowing bones to slide over one another, while reducing any friction, and preventing any damage.

The one disadvantage of cartilage is that unlike other types of tissue, it does not have a blood supply. Blood cells help repair tissue damage. This means that damaged cartilage will not heal quickly, in the same way that damaged skin or muscles can heal.

The two most common sources of cartilage damage are sudden, acute trauma to the cartilage and through gradual degeneration over time.

Cartilage damage can occur as a result of a sudden, direct blow to the joint - for example, a bad fall directly onto your knees. This is why cartilage damage is often a problem for people who play sports that involve physical contact.

Cartilage can also become damaged gradually, over a period of time, in a process of 'wear and tear'. Being overweight or having structural problems with your joint will increase the likelihood of this kind of type of damage, also known as osteoarthritis.

Treatment

At present, there is no cure for osteoarthritis. The management of osteoarthritis is broadly divided into non-pharmacological, pharmacological, and surgical treatments. Pharmacological management includes control of pain and improvement in function and quality of life while limiting drug toxicity. Surgical management is generally
reserved for failed medical management where functional disability affects a patient's quality of life.

A detailed overview of the current treatment regiment, listed in interventional order,
is provided below:

1) Non-pharmacologic treatment

-    Orthopedic shoes and shoe wedges
-    Transcutaneous nerve stimulation (TENS)
-    Heat/cold therapy
-    Topical creams and anti-inflammatories
-    Canes, walkers, and other mobility aids
     -    Patient education
     -    Weight loss
     -    Exercise/muscle strengthening
     -    Physical therapy/hydrotherapy
     -    Joint protection (Bracing)

2) Pharmacologic treatment

-    Corticosteroid injections
-    Physical therapy/hydrotherapy
-    Joint protection (Bracing)
     -    Non-steroidal anti-inflammatory
          drugs (NSAIDs)
     -    Cyclooxygenase-2 inhibitors
          (COX-2 inhibitors)

3) Hyaluronic acid (HA)-based viscosupplementation

4) Surgery

-    Autologous Chondrocyte Implantation
-    Joint replacement
-    Synthetic and cartilage transplants
      (still in development)
     -    Joint lavage and debridement
     -    Osteotomy
     -    Mosiacplasty
     -    Microfracture