Non-surgical treatment
There are a number of non-surgical treatments that can help to relieve the symptoms of damaged articular cartilage. They are described below.
- Physiotherapy – exercises that strengthen the muscles surrounding or supporting your joint may help to reduce the pressure on the joint and reduce pain.
- Painkillers – non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help to reduce swelling and pain. However, avoid taking ibuprofen if you have, or you have had, a stomach problem, such as a peptic ulcer.
- Supportive devices – such as a cane or a leg brace.
- Lifestyle changes – such as reducing activity that involves the affected joint.
In more severe cases of articular cartilage damage, non-surgical treatment may only provide short-term relief and surgery may be required.
Surgical treatment
Surgical treatment for damaged articular cartilage includes the following procedures:
- arthroscopic lavage and debridement
- marrow stimulation
- mosaicplasty
- allograft osteochondral transplantation
- autologous chondrocyte implantation
These procedures are described in more detail below.
Arthroscopic lavage and debridement
Arthroscopic lavage and debridement is a technique that is used when pieces of cartilage have become loose in the joint, causing the joint to lock up.
The surgeon makes an incision (cut) in the joint before using an arthroscope (a flexible tube with a camera on the end) to assess the damage. They then ‘clean out’ the joint by using a saline (salt) solution.
Arthroscopic lavage and debridement cannot repair the damaged cartilage, but it can help to reduce pain and increase mobility.
Marrow stimulation
Marrow stimulation is a procedure that involves drilling tiny holes (microfractures) into the bone beneath the damaged cartilage. This exposes the blood vessels inside the bone and leads to a blood clot forming within the damaged cartilage.
The blood cells then begin to stimulate the production of new cartilage. The drawback to marrow stimulation is that the newly generated cartilage is fibrocartilage rather than hyaline cartilage. As fibrocartilage is not as supple as hyaline cartilage, there is a risk that after a few years it will wear away and further surgery may be needed.
Mosaicplasty
Mosaicplasty is a new technique where healthy cartilage from the non-weight bearing areas of a joint, such as the side of the knee, is removed and used to replace the damaged cartilage.
Mosaicplasty seems to be successful in most people. However, at the moment there is not enough evidence to determine the long-term advantages and disadvantages of the technique.
Before having mosaicplasty, your surgeon should discuss the possible risks and benefits of the technique with you.
Allograft osteochondral transplantation (AOT)
If the damage to your cartilage is thought to be too extensive to be treated with mosaicplasty an alternative procedure called allograft osteochondral transplantation (AOT) may be considered.
AOT is a similar procedure to mosaicplasty, but the cartilage is obtained from a recently deceased donor. The cartilage will be tested in a laboratory to make sure that it is free from infection before being prepared for transplant.
Autologous chondrocyte implantation (ACI)
Autologous chondrocyte implantation (ACI) is another new technique where the surgeon takes a small sample of cartilage cells from the edge of your knee.
The cells are sent to a laboratory and placed in an incubator where they are given nutrients to encourage them to divide and produce new cells. After a few weeks, the number of cartilage cells will have increased by 50 times. The new cartilage is used to replace the damaged cartilage.
After studying ACI, the National Institute for Health and Clinical Excellence (NICE) has decided that there is not enough evidence about the procedure’s long-term effects or safety. Therefore ACI is not available on the NHS unless used as part of a clinical trial (a type of research that tests one treatment against another).
However, a number of private clinics may offer ACI. The cost of treatment ranges from £3,000 to £5,000.
As there is uncertainty about the possible long-term effects of ACI, discuss the possible risks and benefits with your surgeon before deciding whether to have the procedure.
Ongoing research
A number of ongoing research projects are currently investigating more efficient and effective ways of repairing cartilage. Examples of current research projects include:
- creating hybrid cartilage by combining human cells with synthetic fibres
- investigating ways of using special cells, known as stem cells, to generate new cartilage
Although these projects are still in their early stages, researchers are optimistic that they will lead to new kinds of treatment.
