Lesions of the articular cartilage frequently occurs in athletes, who indulge in activities involving vigorous knee bending.
The articular cartilage gradually wears down, and the subchondral bone gets exposed. Damage to the cartilage causes pain in the knee, which gets aggravated with movements.
The wear of the articular cartilage has been classified by Outerbridge, and is widely accepted.
The treatment of such a case varies from physiotherapy to micro-fracturing; to mosaicplasty or sometimes Autologous Chondrocyte Implantation.
Patients with Outerbridge Grade 1 are best managed with supervised physiotherapy and protected weight bearing.
Patients with Outerbridge 2/3 need micro-fracturing or mosaicplasty, depending on the size of the lesion and condition of adjacent articular cartilage.
Micro-fracturing is done using a drill, and the bleeding bone surface is exposed to allow healing by formation of fibro-cartilage. This against the hyaline cartilage of articular margin, has poor tolerance to stresses.
On the other hand, mosaicplasty is best reserved for lesions between 5-12 mm, which are Outerbridge 3 or 4.
In Mosaicplasty, a portion of hyaline articular cartilage and subchondral bone is harvested, and inserted into the bed at recipient site.
Important to explain to the patient is - Prolonged and slow healing ; and necessity to prevent weight transmission across the operated joint. However, knee range of movements may be started early.
The articular cartilage gradually wears down, and the subchondral bone gets exposed. Damage to the cartilage causes pain in the knee, which gets aggravated with movements.
The wear of the articular cartilage has been classified by Outerbridge, and is widely accepted.
The treatment of such a case varies from physiotherapy to micro-fracturing; to mosaicplasty or sometimes Autologous Chondrocyte Implantation.
Patients with Outerbridge Grade 1 are best managed with supervised physiotherapy and protected weight bearing.
Patients with Outerbridge 2/3 need micro-fracturing or mosaicplasty, depending on the size of the lesion and condition of adjacent articular cartilage.
Micro-fracturing is done using a drill, and the bleeding bone surface is exposed to allow healing by formation of fibro-cartilage. This against the hyaline cartilage of articular margin, has poor tolerance to stresses.
On the other hand, mosaicplasty is best reserved for lesions between 5-12 mm, which are Outerbridge 3 or 4.
In Mosaicplasty, a portion of hyaline articular cartilage and subchondral bone is harvested, and inserted into the bed at recipient site.
Important to explain to the patient is - Prolonged and slow healing ; and necessity to prevent weight transmission across the operated joint. However, knee range of movements may be started early.
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