CNY Orthopedic Sports Medicine, PC: Treatment: Cartilage Defects
 
Injuries and Conditions: Knee: Cartilage Defects: Treatment Options
 
Overview
Damage to cartilage on the kneecap will not typically require surgery for a full recovery. Cartilage defects may range from minor tears to severe wearing away of the cartilage beneath the femur and above the tibia. These differences in the severity of degradation will affect the treatment decision, as will the degree of activity that the patient wishes to pursue after treatment.

Some patients, even with quite severe damage, may choose to not undergo surgery. However, damaged cartilage cannot rebuild itself, surgery will be required to produce additional cartilage-like material to supplement cushioning in the joint.


 
Treatment options:
Conservative Treatment: Injections for Cartilage Defects Conservative Treatment of Cartilage DefectsCartilage Defects - Microdrilling



Non-Surgical Treatment: Conservative Treatment: Injections for Cartilage Defects
Synvisc injections may be suitable for patients who have not responded to traditional physical therapy or NSAID use. Synvisc is made from hydraluronan, a substance present in normal joint fluid which helps keep the knee joint elastic and viscous, and also allows the knee to better absorb shock.

A physician will administer Synvisc through a series of injections. Generally, this will include a weekly injection for 3 or 4 weeks. A local anesthetic is used to numb the area of the injection, and the physician will assess the position of your patella to determine the injection site. If any synovial fluid has collected and has caused swelling within the joint, the fluid will be aspirated. The physician will then inject the Synvisc directly into the joint.


Non-Surgical Product Considerations

NSAIDs
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.




  • Non-Surgical Treatment: Conservative Treatment of Cartilage Defects
    Initial care will focus on rest and avoidance of activities that aggravate the condition. Actions that involve any pounding force against the knee, such as running or jumping should be avoided. Physical therapy will work to increase strength and stamina within the quadriceps and hamstrings, which will help stabilize the knee and the tracking of the kneecap.


    Non-Surgical Product Considerations

    Knee: Compression Sleeves
    Knee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.

  • NSAIDs
    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Surgical Treatment: Cartilage Defects - Microdrilling
    An arthroscope is inserted into the knee joint through a small incision in the skin. The area of the damage can be viewed through the arthroscope and may resemble a small flap of cartilage that has partly lifted from the surrounding larger mass of cartilage.

    Fluid is introduced to the knee through another incision to clear away any blood and to expand the joint.

    The doctor will make one or two further incisions to allow the working instruments (such as a burr, a probe or a small drill) to enter the joint. As the doctor views the interior of the knee from the monitor, they are able to work the surgical instruments with one hand while placing the arthroscope with the other hand.

    Using the instruments, the area of the damaged cartilage is cleaned, removing stray fragments or bits of cartilage that may not be repairable.

    A burr is used to rough the areas of bone surface that are exposed under the flap of cartilage or other areas where the cartilage has been damaged and needs to be repaired. A drill may also be used to make several small holes in the outer surface of the bone. Either instrument will remove surface material until the subchrondal area of the bone is exposed and has been well roughed and abraded by the doctor. After the operation and during recovery, the roughed and abraded subchrondal material will produce scar tissue on the outside of the bone as it heals. This new material will work to replace the damaged or missing cartilage and help the knee to function smoothly.

    If the flap or other surrounding bits of cartilage are damaged and able to be repaired, these pieces will be sutured or tacked back into place. Any other areas of cartilage that remain jagged or that protrude into the joint will be smoothed and curved to ease motion of the knee.


    Surgical Product Considerations

    NSAIDs
    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.

  • Knee: Cold Therapy
    Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.

    Cold therapy can be used to treat: Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.

    Knee Examples include:

  • Pre-operative ACL/PCL injuries.
  • Non-surgical ACL/PCL injuries.
  • General knee pain or swelling.
  • Soft tissue injuries.

  • Surgical Hardware Considerations
    The micro-drilling process does not require surgical hardware implants.
     
    Factors in Transplant Source
    The micro-drilling process does not require transplanting any tissue.

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