How to Treat Articular Cartilage Defects?

Articular Cartilage Defects: Causes, Treatments & Recovery Time

Articular cartilage defects can affect your joints, causing pain and dysfunction that may lead to long-term problems like osteoarthritis if not addressed. These defects happen when the smooth, white cartilage that cushions the ends of bones in your joints gets damaged, whether from an injury or just the wear and tear of everyday life.

The goal of effective management is to restore joint function, ease pain, and help delay or even prevent the development of arthritis.

Different Treatment Options for Articular Cartilage Injuries

When it comes to treating articular cartilage defects, medical experts generally break down the options into two main categories: conservative (non-surgical) and surgical methods. The choice between these approaches depends on various factors, including the size, location, and depth of the lesion, as well as individual patient factors like age and activity level.

1. Conservative Treatment

The conservative treatment strategies mainly comprise:

• Pharmacotherapy: It involves the utilisation of non-steroidal anti-inflammatory drugs (NSAIDs) and pain relievers to help manage discomfort and inflammation.
• Physiotherapy: This is more about engaging in exercises designed to enhance joint mobility and strengthen the muscles around the joint.
• Arthrocentesis: It is a dedicated procedure where fluid is drawn from the joint to help reduce swelling.
• Weight Management: Shedding some pounds can significantly lessen the load on your joints. Thus, doctors consider this strategy an effective form of treating articular cartilage defects.
• Steroid Injections: These can provide temporary relief from pain symptoms in certain cases.
   

2. Surgical Treatment

Doctors go for the surgical options only when they see that conservative treatment options are ineffective. These include:
 

• Debridement/Chondroplasty: This necessitates removing loose or damaged cartilage pieces to alleviate mechanical symptoms and smooth out the joint surface.
• Microfracture: Tiny holes are made in the subchondral bone to initiate new cartilage growth from bone marrow stem cells. However, this mainly generates fibrocartilage, which is not as durable as the original hyaline cartilage.
• Drilling/Abrasion arthroplasty: Similar to microfracture, these methods use drills or burrs to reach the affected individual’s bone marrow and stimulate cartilage repair.
• Autologous Chondrocyte Implantation (ACI/MACI): In this method, a medical team collects healthy cartilage cells, grows them in a lab, and then reimplants them into the defect. The purpose of this method is to regenerate cartilage that resembles hyaline and is especially beneficial for larger defects in younger patients.
   

Besides these procedures, ongoing research is in process on using stem cell therapies, growth factors, and synthetic scaffolds. However, these methods still need more clinical validation.

Can Articular Cartilage Repair Itself?

Articular cartilage possesses minimal ability to heal itself because it does not have a direct supply of blood, which is a must-have for any healing process. Therefore, small, surface-level injuries may not heal at all, and even when it comes to deeper injuries, they rarely regenerate into the original hyaline cartilage.

Instead, the body tends to create fibrocartilage, which fails to match the same strength or mechanical properties as the natural cartilage. This mismatch can lead to persistent symptoms and an increased risk of developing osteoarthritis.

What is the Best Medicine for Cartilage Repair?

At present, no injectable or oral steroids are available for restoring articular cartilage defects. However, your healthcare provider may recommend a few medications and supplements to support your joint health in the long run.

• NSAIDs and Analgesics: When it comes to managing pain and inflammation, these painkillers are commonly used for temporary relief.
• Intra-articular Steroidal Injections: These can provide some short-term relief, but like analgesics, they do not actually help with healing.
• Hyaluronic Injections: Doctors suggest these injections for better joint lubrication and as a medium for symptom relief in selected cases.
• Supplements: As for supplements, glucosamine and chondroitin are quite popular, but there is no solid evidence to support their effectiveness in regenerating cartilage.
• Biological Therapies: Therapies such as platelet-rich plasma (PRP) and stem cell injections are being explored for their potential to improve cartilage healing. However, medical groups still need more research to fully understand their effectiveness.
   

How Long Does Articular Cartilage Take to Heal?

The timeline dedicated to healing articular cartilage defects usually varies depending on the treatment strategy and how severe the injury is:

• Conservative Management: This method may help ease symptoms in just a few weeks, but it will not truly heal the cartilage.
• Microfracture and Bone Marrow Stimulation: You can expect initial recovery to take about 6 to 12 weeks, but it may take up to 12 to 18 months for the repaired tissue to fully mature.
• Autologous Chondrocyte Implantation (ACI/MACI): The rehab process can potentially continue for a few months, often taking up to a year before you can get back to your usual activities.
• Osteochondral Grafting: Recovery usually takes several months, with a gradual return to activity as the graft integrates and matures.
   

Dealing with articular cartilage defects can be quite tricky because this type of tissue does not heal well on its own. While conservative treatments can help lessen the symptoms, surgery is often the best way to restore joint function and stop further deterioration. It is essential to customise the treatment plan based on the specific characteristics of the defect and the individual needs of the patient.