Chondral Injury

Contents

What is Chondral Injury

A chondral injury refers to damage to the cartilage that covers the end of bones in a joint. This specialized tissue provides a smooth, gliding surface that allows for pain-free movement. Unlike other tissues in the body, cartilage lacks blood vessels, which significantly limits its ability to heal naturally when damaged.

Chondral injuries commonly affect weight-bearing joints, particularly the knee, though they can occur in any joint including the ankle, hip, and shoulder. These injuries range from small cracks or fissures to complete pieces of cartilage breaking away from the bone, sometimes taking a fragment of the underlying bone with it (known as an osteochondral injury).

The impact of these injuries shouldn’t be underestimated – even small defects can disrupt the joint’s biomechanics and potentially accelerate wear and tear over time. It’s important to understand that this is how osteoarthritis begins – what starts as a small cartilage injury can progress to widespread joint degeneration if not properly addressed.

Chondral Injury symptoms

The manifestation of chondral injury symptoms varies considerably among individuals. Some people experience pronounced discomfort while others may have significant cartilage damage with minimal symptoms. Common indicators include:

Joint pain that worsens with activity and improves with rest
Swelling that develops after using the affected joint
A sensation of catching or locking during movement
Grinding sensations (crepitus) within the joint
Joint instability or giving way
Reduced range of motion

Interestingly, the severity of symptoms doesn’t always correlate with the extent of cartilage damage. Small lesions in weight-bearing areas can cause substantial discomfort, while larger defects in non-weight-bearing regions might go unnoticed.

What Causes Chondral Injuries and What are the Risk Factors of Chondral Injury

What causes Chondral Injuries

Chondral injuries typically stem from two primary mechanisms:

Traumatic injuries: These occur suddenly due to:

Direct injury to the joint – such as falls, sports impacts, or accidents
Twisting injuries during sports or falls
Dislocations that damage the cartilage surface
Pivoting movements that place excessive shear forces on the cartilage

Degenerative changes: These develop gradually through:

Natural aging processes
Repetitive microtrauma from high-impact activities
Mechanical axis malalignment (bow legged, knocked knee), patella maltracking – which creates uneven pressure distribution across the joint surfaces
Underlying joint conditions like osteoarthritis

What are the risk factors of Chondral Injury

Several factors increase the likelihood of sustaining cartilage damage:

Age: Cartilage naturally becomes less resilient with age
Athletic participation: Particularly in high-impact, pivoting sports like football, basketball, and rugby
Previous joint injuries: Especially ligament tears or meniscal injuries that alter joint mechanics
Occupational demands: Jobs requiring repetitive kneeling, squatting, or heavy lifting
Anatomical factors: Including leg alignment issues (bow-legged or knock-kneed postures)
Obesity: Excess weight places additional stress on weight-bearing joints
Genetic predisposition: Some individuals have naturally thinner or more vulnerable cartilage

Chondral Injury complications

When left untreated, chondral injuries can lead to several complications:

Progressive cartilage deterioration: The initial defect may expand over time
Early-onset osteoarthritis: Damaged cartilage accelerates joint degeneration
Mechanical symptoms: Loose cartilage fragments can cause catching or locking
Functional limitations: Reduced ability to participate in sports or daily activities
Chronic pain syndrome: Persistent discomfort that becomes increasingly difficult to manage
Bone marrow lesions: Damage to the bone beneath the cartilage defect
Joint deformity: In advanced cases, the joint structure may become altered

How to Prevent Chondral Injury

While not all cartilage injuries can be prevented, several strategies may reduce your risk:

Maintain healthy body weight: Reducing excess weight lessens stress on weight-bearing joints
Strengthen supporting muscles: Particularly the quadriceps and hamstrings for knee protection
Improve movement patterns: Proper technique during sports and exercise reduces abnormal joint stresses
Use appropriate footwear: Shoes with adequate support and cushioning
Consider activity modification: Alternating high-impact activities with lower-impact options like swimming or cycling
Address biomechanical issues: Orthotics or braces may help correct alignment problems
Ensure adequate recovery: Allowing joints to rest between intense activities

How to Diagnose Chondral Injury

Diagnosing cartilage damage requires a comprehensive approach:

Clinical evaluation:

Detailed medical history focusing on injury mechanisms and symptom patterns
Physical examination assessing joint swelling, tenderness, and mechanical symptoms
Specialized tests to evaluate joint stability and provoke symptoms

Imaging studies:

X-rays: While they don’t directly show cartilage, they can reveal joint space narrowing or associated bone changes
MRI: A highly effective non-invasive test, especially with cartilage-specific sequences that enhance visualization of defects
Ultrasound: Sometimes used for dynamic assessment of superficial cartilage

Arthroscopy:

Allows direct visualization and probing of cartilage surfaces
Enables assessment of defect size, depth, and location
Provides opportunity for simultaneous treatment

Chondral Injury Treatment

Treatment approaches vary based on the injury’s severity, location, and the patient’s age, activity level, and goals:

Conservative management:

Activity modification to reduce joint stress
Physiotherapy to strengthen supporting muscles and improve joint mechanics
Bracing or taping techniques to optimize joint alignment
Weight management to reduce forces across damaged areas
Pain management with appropriate medications
Hyaluronic acid injections to improve joint lubrication and provide cushioning effect

Surgical interventions:

Arthroscopic debridement: Removing loose fragments and smoothing unstable edges
Stem cell therapy with drilling: Creating channels in the bone to allow stem cells to migrate to the damaged area and stimulate healing
Limb axis realignment: Procedures like high tibial osteotomy to correct bow-legged or distal femoral osteotomy for knock-kneed alignment and redistribute forces across the joint

Next Steps

If you’re experiencing symptoms that might indicate a chondral injury, don’t delay seeking expert care. Our specialized orthopaedic team at KLSMC has extensive experience diagnosing and treating cartilage injuries using the latest techniques and technologies.

Schedule an appointment with our doctors by calling +603-2096 1033 or clicking on our contact us link. KLSMC attracts international patients from across the region to Malaysia’s thriving medical tourism sector, known for combining high-quality treatment with exceptional value.

KLSMC is a specialist hospital based in Kuala Lumpur, Malaysia, with a strong focus on orthopaedics, regenerative treatments, and physiotherapy rehabilitation. Our dedicated team of medical professionals is committed to helping patients regain mobility and enhance their quality of life through personalised and evidence-informed care.

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