Articular cartilage injury
The severe and re occurrence effect and a winding force in joint packing that arises through taking part in sports and games can damage articular surfaces causing pain, disturbance in the normal functioning of joints, and unrestrained expression of acute discomfort. In some cases, these articular surface injuries run over to accelerate joint degeneration.
The articular cartilage is damaged when injuries occur. Then cartilage damage and then articular cartilage occur therefore the cartilage is not healed but by surgical techniques, its new cartilage grows. Articular cartilage will be restored and will get better functioning.
Definition of articular cartilage
The cartilage is the connective tissue that is present in many body parts like ears, nose etc. Cartilage is tough and the flexible tissue, fine elastic and rubber shaped structure is involved in the joint formation and between the joints.
Cartilage can be easily damaged. The joints of bone cartilage damage and pains of joints occur and then the pains and the inflammation in joints occur.
Articular cartilage or hyaline cartilage covers the joint surface(where two bones fuse or meet with each other)It is the smooth, white ,connective tissue without any blood vessels ,or nerves that surrounds up the bone ends and joint formation takes place.
Cartilage helps in the movement of the joints .It provides little friction and lubricated surface between the bones and allows them to glide over each other.
It is damaged by injuries. Although the cartilage is a very tough structure but due to its flexible nature it can be damaged with ease by normal wear and or injuries. It is made up of chondrocytes cells that are highly developed with an exiguous dispersion in heavy extracellular matrix
The purpose of the nourishment diffusion method is used to provide food nutrients to chondrocytes cells as they have no blood vessels for blood supply. Pressure exerted by articular cartilage and the bending of joints of elastic cartilage are responsible for the flow of watery substance.
When the fluid flows diffusion takes place and nutrients are exchanged between chondrocytes cells and cartilage. In a comparison with other types of connective tissues, cartilage does not patch up and shows very slow revenue of the outer cell matrix (ECM).
Beside the damages that are restricted only with the cartilage, there are some injuries that are source of seepage and spread inside the subchondral bone.accumulation and formation of fibrin, the provocative response is triggered with in 28, 30 minutes quickly when damage occur, outflow of the blood take place on or after the blood vessels of damaged and injured bone forms a hematoma that in the first instance fills the injury spot.
Fibrinogen protein synthesized fibrin within the hematoma and continues to grow, platelets bind with this fibril collagen.Bone defect is sealed by an unbroken lump of fibrin and range of an adjustable space between the injuries of cartilage.
Vasoactive mediators, growth factors or cytokinesis released by platelets within the clot. Cytokines are small proteins that affect numerous cell tasks containing relocation, propagation, variation, and media production) including TGF-β and PDGF.
Some growth factors are also present in the matrix of bone cells. These advanced elements may possibly take a significant part in the mending of osteochondral imperfection when they are liberated and discharged.
Typically the tissues of chondral restore by replacing a part are made up of intermediate structure of articular cartilage or hyaline and the fibrocartilage, and it is very often,on the odd occasion duplicates the embellished structure of standard articular cartilage.
The response of articular cartilage to injury:
Depending upon the basis of which type of damage in tissue and patch up reaction, chondral and osteochondral damages are divided into three main classes.
If there is no visible mechanical disruption of articular superficial caused by injury damage to the joint surface, but it may involve in chondral damage and it may be a source of damage in subchondral bone
restriction of the damage to the surface of articular cartilage and mechanical disruption to whole articular cartilage
If the injury occurred in the subchondral bone and cause damage in the articular cartilage
Articular injury growth may depends upon certain thing that involves age of the person (in old age process of the degeneration of the cells is at its peak, so there is a high risk to become a victim of this injury), weight of the patient and activeness in work, and destruction of ligaments.
The problem can not be treated so easily it is very hard to cure as this disease does not appear at once its symptoms became visible slowly hence it can not be detected at instance
The matrix and cell injuries:in particular cartilage matrixCritical, persistently continual insensitive distress together with too much effect stocking can cause modifications that contain a reduction in the concentration of proteoglycan and probably the collagen fibril structure troubles.
Deformity And destruction in articular cartilage with acute and repeated pain can cause abrasion on joint surface and making it resistant to move and show difficulty to guide over the bone surface.
In maximum cases joints overcome the damage and heal only if the injury is not disturbing the appearance surface of articular cartilage if further damage is prevented and secures the joint. Some growth factors stimulate the synthesis of new surface for joint and generate it for the repair of damage.
Articular cartilage may have lacking clarity and causing confusion because of the presence of different types of the cartilage in the body of human beings.
Different kinds of cartilage
Cartilage found in the body of a person is of three kinds which are mentioned below as follows, These all are made up of similar components of connective tissue but all have different characteristics and structure.
The articular cartilage: It can also be called as the hyaline cartilage and is most commonly found type cartilage derived from Greek word “Hyalos “mean glass.
They are only 2 to 4 mm thick;they are usually present in the ribs,in the nose,larynx, trachea, and joint. Collagen fibers of Hyaline cartilage are mainly of type II,are undetectable to compound microscopes, extremely thin due to related stubborn properties to the matrix by its own. It covers the joint surface. Articular cartilage is complicated structure consisting of interconnected parts, tissue that is alive, outlines the outer boundary of the joint’s bones.
Its foremost role is to be responsible for minimum abrasion between the bones surface assisting the joints to resist pressure exerted by series of changing mobility and location which is required for performing action and deeds of routine life as well as sporty activities.
Simply it can be clarified that the articular cartilage can work as a tremor absorber, as it is very narrowing not dense. It is well developed within five separate sheets of single thickness that can be easily differentiated from one another due to their different structure and biochemical nature.
Fibrocartilage is a connective tissue, made up of a fiber bundle of collagen which is very strong and pliable and allows low level of stretch. It is found where tendons and ligaments meet bones .Its color is white due to the existence of collagen.
It is present in knee meniscus and vertebral disk. It acts as a cushion like structure and avoids friction, functions as shock absorber.
Mostly it is present in Eustachian tube,ear pinna,and epiglottis. It offers flexibility and elasticity and performs a basic role in pliability.The reason is the combination of elastic fibers and type II collagen fibers. Its color is yellowish.
We can distinguish between these different kinds of cartilage present in the body from their structural composition, elastic nature and by their strength and flexibility.
Functions of cartilage:
- Provide support ,precursor to bone
- Template for rapid growth of musculoskeletal system
- Act as a shock absorber
- Preventing abrasion and damage
- Allows joints to bend due to its flexibility
- prevents collapse and damage of rings in trachea
- It allows the movement of ribs up and down in respiration process
- Take part in the restoration of bones
- Provide template for ossification
- minimize rubbing and behave like a cushion between joints which help when we run and support them
- cartilage play an important role in reducing friction
- Play important role in the holding of bones and supporting of the bone and support the bones of rib cage
- Cartilage play an important role in making body parts like nose and ear
- It is very important in the formation of long bones in children
As there is no blood supply in cartilage like other connective tissues it is comparatively easy to damage and take much extensive period to restore as related to further tissues with blood supply.
Articular cartilage injury occur when a cartilage on joint get damaged. It is generally due to a bumps, demolishment or traumatized knee injury or in affiliation of other injuries in knee joints. It causes severe pain and irritation and swelling and some degree of infirmity. Pain in joints, inflammation and stiffness are common symptoms found in the people that are facing articular cartilage injury.
Hyaline cartilage is also notorious for a very smooth, hard material that outlines the bones’ split ends. Its composition involve a collagen protein and it act as a protective layer around the edges and corners of bones and make possibility of the movement free from obstruction or proceeds without jolts and turbulence in the bone surface.
Furthermore, articular cartilage is extracellular, in other words it is not facilitated with direct blood supply and circulation. In addition it means that the cartilage is difficult to heel if injury is occurred once.
Symptoms of articular cartilage injury
People having articular cartilage injury will suffer from the following symptoms and experiences
- Inflammation in the joint area that swells, becomes warmer as compared with normal body parts, and is gentle, painful, and aching.
- Extreme Harshness, move with pain or difficulty
- Range circumspection as the damage headways, the damaged limb will not show free movement
- Articular injuries are most commonly observed in the knee joint but it may affect other joints like wrist, elbow, hip and shoulder joint.
- Fracture can be observed in more severe cases, joints emerge as stiffened and rigid . this results in hemarthrosis (bleeding in the joint); the place can be noticeable with irregularly shaped spots or blots and have a scratched surface
- Symptoms include recurring discomfort and worsening in the knee. It may become rigid and immoveable due to loose bodies not firmly connected moveable within the joint. When the knee shows movement it produces click sound and audible clunks that can be easily feel by the patient.
How often does it occur?
In most circumstances, swelling inflammation and vague pain is observed by the patient with this injury. At this stage it is not possible for the patient to do continuous activity. If a loose body is present, the problem increases and is said to be locking or catching of the joint.
Due to mechanical degeneration the person usually faces painfulness and inflexibility, reduced range of motion, acute pain in joints, swelling and inflammation.Impairment can occur to the articular cartilage by itself as a sequestered state, or in aggregation with other knee injuries.
Causes of articular cartilage injury
Articular cartilage injuries occurred due to wear and tear of the cartilage. In other words it may arise from the injuries that are traumatic and causing degeneration and damages.
Articular cartilage can be damaged by normal wear and tear, by direct blow or other trauma that can injure the articular cartilage.
The injury depends on the location of the damage and the intensity of the damage. sometimes it’s capable of being imagined that the cells of cartilage restore and heal themselves.
As Articular cartilage is extracellular with no blood circulation directly so it is very hard for them to rebuild and have no ability to repair on its own .
In case of severe damage caused by the injury in underlying bone to curtilage, some blood is given to that position providing a chance to heal and repair. There are some causes of the articular cartilage injury which are as follows;
Direct blow -If a joint receives unmanageable bounce,( by chance during a bad fall or a motor vehicle accident the cartilage joint gets Algarve impacts.
There is a high risk of getting damaged in sport, particularly in those who take part in games like American football may suffer and cause articular cartilage injuries.
The wear and tear: mechanical degeneration may be a cause of injury. it is mainly associated with the continuous damage of the cartilage and disturbs its structural composition and function.
When bones become soft and have no protective layer around it leads to destruction of the cartilage. Mechanical destruction in routine life during work starts to break down the articular surface this causes osteoarthritis of bones i.e. swelling, wear and tear, and resulting injury of cartilage in the joints.
Osteoarthritis also causes the cartilage damage as it breaks the cartilage and leads to articular injury.If the joint is exposed to stress for a very long period of time it may be damaged. It is more common in tubby and obese persons.
Their knees are worn out and damaged 20 years ago than that of a normal weight person as their body is under the pressure of higher weight and physical stress.
Lack of movement – Dronish and fainéant people usually become a victim of this disease as it is necessary to move the joints. If the joints remain inert and in inactive state and do not show movement for longterm the risk of damaging and articular cartilage injury increases.
Diagnosis of articular cartilage injury
It can be diagnosed by symptoms. The doctor of medicine spotted it by observe knee searching for reduced assortment of mobility,soreness lengthwise in the infected joint , inflammation, presence of some type of liquid fluid in the joint of knee, when the bones fuses with one another with unusual placement during joint formation, and ligament or meniscus injury.
Articular damage is also diagnosed by following methods but the knee and ligament injury symptoms are also similar and telling about the difference between the cartilage damaging.
Because noninvasive and the modern test makes it easier and when carrying out the physical examination. It is very challenging to identify the damage of articular cartilage and it can be predictable with MRI.
In the case of magnetic field and radio waves, to produce imaging detail from the body, it also provides detailed information about the cartilage damage.
Arthroscopy is also important for the diagnosis of cartilage damage and for the appropriate observation by the general practitioner.Use of plain X-RAY is not ideal for the detection of the injury site but they are commonly taken to find out abnormalities and for examination.
There are many methods to treating particular damage that are present in the form of surgical and non-surgical treatments to the conservative treatment. It is a well responding method. Physical therapy and exercise are most important for the patient with this injury .
It may be perfect to use steroid medicines and do exercises if the injury is not severe than conventional control may use to take rest with gentle exercise for rehabilitation. Cold therapy and use of ice is useful to reduce puffiness.
Use ice in severe condition for 15 minutes after every hour in a day. Subsequently two days after injury, minimize the use of cold treatment duration when the swelled portion got settled.
An additional surgical procedure involves trying to stimulate the retrieval of the articular cartilage itself such as occupying marrow stem cells into the pretentious area by penetrating the subchondral.
The marrow stimulation is playing an important role in treating the articular cartilage damage. in this case drills the tiny holes in the vessels of blood into bone joints.
In this blood clotting occurs and stimulates to form original cartilage by self and the person becomes fit.
Evaluating treatments of articular cartilage injuries:
To determine which method is useful for the treatment of restoring the surface of articular cartilage and more importantly providing improved long-term joint function depends on comparing their results but the major problem in comparing the results and multiple methods to cure cartilage injury by physicians and scientists is the variability in experimental models and clinical applications.
Cure of these articular cartilage abrasions are a challenge for the reason that this tissue is unable of quality repair and/or renewal to its natural form. Non operative treatments determined to regulate the symptoms, and include anti-inflammatory treatment, viscosupplementation, bracing, orthotics, andAdaptations in activity and modification of movement.
The existing tentative confirmation proposes that chondral and osteochondral repair tissue development generally take 6 weeks for completion or less after an effort to excite repair of an articular surface, but that makeover of the repair tissue may come to an end for many months and perhaps years.Surgery may not be required for smaller articular cartilage defects that have no symptoms of disease and are asymptomatic. But in the case of larger defects it is essential to operate and transplantation of the cartilage.
For the treatment and lessening the pain, inflammation and swelling,NSAIDs e.g. Ibuprofen may be suggested by the doctor.
Osteoarthritis patients can use non steroid and anti-inflammatory medicines, change in lifestyle, physical therapy, and exercise for the lessening of the injury symptoms surgical preferences are very precise to osteoarthritis brutality and can be responsible for a lessening in warning sign that are by and large only short lived.
Total joint replacement can offer contentment and comfort for the symptom of progressive osteoarthritis, but it usually has a need for a change in a person’s standard of living or being active, moving, acting rapidly and energetically.
The recovery process of articular cartilage injury
It includes different methods and surgical operations used to overcome the damage and healing of damaged parts including the debridement process, marrow stimulation process, arthroscopic process and microfracture techniques.