Cartilage Damage

The cartilage in our knees we call meniscus acts as a shock absorber to protect our smooth joint cartilage and spread the load during activities, allowing our knee joint to move freely and without pain.

Damage to the joint cartilage can be from an injury or from osteoarthritis and it can happen in those young and the old.

It can cause a catching or clicking sensation and is often associated with knee swelling. You are likely to need an MRI scan which will show us where the damage is and if it needs surgery or can be managed through physical therapy. The scan will also show any other injury to the meniscal cartilage or ligaments that needs treatment.

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What is a Joint Cartilage damage?

Our knee joint cartilage spreads the load going through our knees during activities, allowing our knee joint to move smoothly and without pain. It is protected by the menisci which act as shock absorbers

The ends of our thigh bone (femur), shinbone (tibia) and kneecap (patella) are covered in joint cartilage to allow for smooth, pain-free movement. This cartilage is very tough as it has to last our lifetime and does not repair itself when damaged.

How do I injure my Joint cartilage?

Injury to the joint cartilage can be confused with an injury to the meniscus which is often called a 'torn cartilage'. It is not a common knee injury in younger people, mainly affecting those with unstable knee caps or following a larger knee injury such as an ACL rupture. It is important for our surgeons to see a younger person with a suspected piece of loose cartilage as soon as possible (in our Acute Knee Injury Clinic) as it may be possible to fix it back.

However, as we get older, our joint cartilage gradually becomes more brittle and prone to wearing away or tearing with less force. We tend to see middle-aged and older patients who have worn out their knee cartilage (osteoarthritis) which may have been stirred up by a mild injury.

What do I feel or notice (symptoms)?

If you have suffered an acute injury to the knee which damages the joint cartilage, you may feel a catching sensation or a deep aching pain. It can be painful in the early stages but this pain may be from other injuries such as a dislocated patella. There is often some swelling which is usually at its worst within a few hours of the injury. If the injury has created a loose piece of cartilage within the knee, this can get trapped between the joints causing a catching or clicking sensation. Occasionally the tear can cause the knee to 'Lock'. This is where it is not possible to fully straighten the knee. Sometimes it can be ‘unlocked’ by wiggling and twisting the leg although often it needs surgery to remove or repair the loose piece of cartilage.

If your knee joint cartilage damage is from wear and tear arthritis, you would usually experience an aching pain on that side of the knee, usually the inner (medial) side of the kneecap (patella). This is usually worse with exercise such as walking and can also be painful at night. The knee will often click and catch.

How is it diagnosed?

What are my treatment options?

If your knee is locked or there is a loose piece of cartilage from a recent injury, then urgent surgery may well be indicated. Nearly all other patients with a meniscal tear will benefit from a range of non-operative treatments before going for surgery.

First, we help you to settle your knee down so that it can be used for day-to-day activities again without pain. This involves using anti-inflammatories such as ibuprofen, diclofenac, or meloxicam for a short course of 1 to 2 weeks. This helps to reduce any swelling and pain in the knee. **(Please check with your doctor or specialist that these medicines are safe for you first.)

It is important to reduce the impact going through your knee while it is recovering with running and jumping being the highest impact. Some compression bandaging or bracing can be useful as can ice packs.

The next stage is to have a thorough functional assessment by one of our MTP Health Exercise Physiologists to determine the the strength and function of your legs, not just in the knees but also in the stabilising muscles of your hips and core. In collaboration with our MTP Physiotherapists they can then design and implement a tailored exercise program which will reduce the load going through your knees, balance that load to reduce your risk of re-injury, and strengthen you to help improve your speed, your endurance, or your distance with the driver off the first tee.

The MTP Knee Program is designed to provide regular supervision and guidance throughout the 12 weeks of your rehabilitation program. This is the ideal time required to ensure results from your exercise program.

If the cartilage damage or meniscal tear is still causing problems despite all the above then it is time to consider surgery.

The surgical treatment for joint cartilage damage ranges from an arthroscopy or keyhole procedure to remove loose pieces to more invasive procedures to repair loose fragments or in the case of arthritis, knee replacement surgery. Please make an appointment with the surgeon to discuss what is most appropriate for you.

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