Surgical Hospital :: Orthopedic Surgery

Cartilage Treatment

By Dr. Allan Larsen, MD, Ph.D.
Head of the Cartilage Treatment Group
Marbella High Care International Hospital

A lot of people have problems with their knees due to cartilage damage. These people will experience that their quality of life has diminished, their possibility to perform sports activities has declined, some of them sleep badly at night, all of them will suffer from pain, and the pain gradually increases lowering their activity level.

In early days people had to live with their damaged knees, but in the last twenty years these patients have been offered several treatment possibilities, from the less dramatic being the advice from a doctor about the positive effect on pain related to weight loss to having a total knee replacement as the most dramatic offer anyone could get.

Between these two possibilities there are several other options, but let us first look upon why these patients suffer from cartilage damage.

The reason why they have achieved their cartilage damage can be many

About twenty percent of people suffering from osteoarthritis have inherited it. The mechanism genetically is still not sufficiently described, but will probably be so within the next years to come. Some people experience wear and tear to their knees due to overweight, although some very obese people never seem to be bothered by their knees!!
In some people the cartilage damage is achieved after a trauma to their joints both related to sport activities and normal daily living. The damage can be acute with a sever lesion to the cartilage which breaks of in a large piece which has to be operated upon as soon as possible others suffer from a blunt trauma to the joint where the cartilage is torn and in the months and years to come gradually breaks down. Some of these patients can hardly remember the trauma which released their cartilage damage due to the delay in time when the pain starts gradually to become so ignoring that they go to see a doctor.
Other patients, who suffer from instability to the knee especially the anterior cruciate ligament, will have a much higher risk of developing osteoarthritis than patients with a stable knee. These patients will continuously damage their cartilage while making sports activities or normal daily activities if at all they are capable of this due to their instability. Every time they put weight on the knees and make fast turns, twist or side shifts they will experience instability and later swelling/pain which is due to overload of the knees soft tissue and cartilage.

So what can be done?

Non-surgical treatment includes:

Weight loss if needed, bandages to keep the knee joint warm shoe insoles to reduce the load on the joint, additional diet being glucosamine, MSM, chondroitinsulphate and ginger when taken combined has a synergistic effect by reducing pain, swelling and the degeneration of cartilage, and when combined with treatment increases the success rate of cartilage treatment. When bicycling 3 times a week the knee increases its production of hyoluronic acid which lubricates the joint, this can be used both to conservative and operative treatment of damaged cartilage.

Surgical treatment

When performing surgical treatment to damaged cartilage one has to keep in mind not to shoot crows with a cannon ball, meaning you start the treatment with the least traumatic and less painful treatment, and if this is successful you do not need to go to a higher level of surgery. Opposite if the cartilage damage is sever it often is necessary to perform further treatment.

1.step/operation: People suffering from minor cartilage damage will often benefit from arthroscopic debridement meaning that the wear and tear to their cartilage is trimmed, all flaps removed, if the menisci is torn or degenerated it needs trimming as well. Often the capsule needs trimming due to the persistent irritation and overload.

2.step/operation: When the patients suffer from sever/deep cartilage defects trimming is often not enough. These patients are very often treated successfully by a so-called microfracture treatment. This treatment will create cartilage-like tissue after 6 to 9 months but includes initially after the operation that the patient uses crutches for 6 weeks and follow and intensive rehabilitation program.

3 step/operation: If eventually the microfracture treatment fails the patients can have a cartilage transplantation. This operation is normally used to patients who have had a microfracture procedure performed non successfully mostly due to the size of their lesion. Larger lesions is more successfully treated by using an autolog cartilage transplantation, which means cartilage from the patient cultured in a cell laboritorium, when taken out during an arthroscopic procedure 4-5 weeks before the transplantation.
All of the above described procedures is done arthroscopically.

If the patients do not achieve any pain relief or better quality of life when treated as described the only surgical solution will be to have a total knee replacement done.

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