Cartilage injuries: chondropathy

‘Chondropathy’ is a generic term for any cartilage lesion. Frequently, these are inflammatory or post-traumatic changes

Cartilage is a specialised connective tissue found in various body districts

It is present between bones and has the purpose of providing support, cushioning shocks and reducing friction between bone heads.

Like any other tissue, cartilage can be subjected to trauma and injury, which subjects it to progressive erosion.

When its surface thins, there is bone rubbing that, in the long run, can lead to various consequences on the affected joint and the entire surrounding area.

The situation can be further aggravated by the formation of osteophytes, real bone thorns that are created in the periarticular area, further damaging all tissues.

Unfortunately, cartilage is a tissue without blood vessels and therefore its reconstruction is particularly complicated.

This is why chondropathies belong to degenerative diseases and, most of the time, the only way to solve them is artificial cartilage reconstruction through surgery.

A meta-analysis of available studies has shown that those most affected by chondropathies of all kinds are young people, sportsmen and women.

While the reason why the latter are included in the list lies in the lower availability of strength and muscle mass, for the other two categories the issue is more complex.

Adolescents and young people are among the most affected not only because they are more active but also because, in the growth phase, there may be remodelling of the cartilage structure that predisposes it to pathological changes.

In sportsmen, chondropathy is instead caused by repeated microtraumas that, in most cases, result from practising high-impact exercises such as athletic activities, which put a lot of strain on the joint districts.

How much does the type of cartilage influence the development of a chondropathy?

Although the cartilage tissue found throughout the body is made up of one and only one type of cell, the chondrocytes, different types of cartilage have been identified based on their composition and anatomical location.

Hyaline cartilage is the most widespread in the body and is the one that, due to its location not in direct contact with the joints, is very rarely injured.

This is the cartilage found in the nose, but also in the larynx, trachea, bronchi and ribs.

Elastic cartilage is able to respond to sudden shocks and bending without breaking.

It is the one that contributes to the formation of our pinnae, Eustachian tubes and epiglottis.

Finally, fibrous cartilage is typical of intervertebral discs and menisci.

As it is located directly in the joint districts, it is the only one that, by its nature, is most resistant to stresses and loads.

Types of chondropathy and symptoms

Here is a list of the most common chondropathies and the symptoms they are associated with.

  • Osteoarthritis, more commonly called osteoarthritis, is an inflammatory process that affects the cartilage layer that covers the bones. Degenerative in nature, it can worsen over time. The most severe pictures are, in fact, found in elderly patients. Osteoarthritis can occur in all joints, but the most susceptible are those of the hands, knees and spine. Osteoarthritis presents with symptoms such as joint pain, oedema and stiffness that makes movement difficult. If not treated in time, it can create very painful bone osteophytes.
  • Patellar or patellar chondropathy. This is the most common form of arthrosis, characterised by erosion of the cartilage between the patella and femur. In advanced stages, the inflammation affects the entire knee joint. When the cartilaginous layer between the two bones, which usually do not touch each other, disappears, they begin to rub against each other, inflaming the surrounding soft tissues. It can affect only one knee or both and is typical of athletes. This is why it is improperly called ‘runner’s knee’. In adolescents, it is the effect of particular hormonal changes that make the cartilage weaker. While in adults it may be asymptomatic, with advancing age there may be pain under strain or at rest, difficulty in climbing and descending stairs and creaking when bending the knee.
  • Chondrosarcoma. It is a malignant tumour that arises from the chondrocytes of cartilage. Thanks to the vascular and lymphatic system, it can extend to the bones. The cartilaginous areas most affected by this neoplasm are the scapulae, humerus, ribs, femur and iliac bones. Symptoms are bone and joint pain with predisposition to pathological fractures and metastasis.
  • Costochondritis is a chondropathy affecting the costal cartilages. It usually appears as a result of intense chest trauma, such as that suffered during sporting activity or following road accidents. It can occur, more rarely, due to bacterial infections, tumours (breast and lung) and infectious diseases such as tuberculosis, salmonella, staphylococcus and sexually transmitted diseases. The typical symptom is chest pain, which may also radiate to the abdomen and back.
  • Tietze’s syndrome is a condition, now considered a severe form of costochondritis, characterised by pain and swelling of the upper costal cartilages.  The pain is usually unilateral and is aggravated by abrupt chest movements (coughing, strangulation, trunk flexion) but also by anxiety, stress and microclimatic variations.

Herniated disc is a typical chondropathy

The intervertebral discs act as a cushion between one vertebra and another and have the purpose of absorbing the shocks and traumas to which the spine is subjected.

It can happen that, as a result of trauma, incorrect lifting of weights, but also as a result of incorrect posture and physiological ageing, the cartilage of these discs fractures, causing the nucleus pulposus to spill out.

The symptoms are back pain, numbness and pain in the lower limbs with possible sciatica, neck pain and stiffness.

Less common than the previous ones, polychondritis is an inflammation of the hyaline or elastic cartilage of the nose, auricle, larynx, trachea, bronchi and ribs.

The trigger is an abnormality of the immune system that causes symptoms such as swelling and pain and, in the case of the upper respiratory tract, hoarseness.

Osteochondritis refers to a group of degenerative diseases affecting articular cartilage and the underlying bone.

It presents with pain and difficult mobility, swelling and joint weakness.

They can degenerate into osteonecrosis. Knees, ankles and elbows are most affected and are frequently caused by injuries and high-impact sports activities.

Chondropathies of genetic origin include chondrodysplasia, which manifests as skeletal deformities and misalignments, and achondrodysplasia characterised by reduced cartilage formation in the long bones.

In achondrodysplasia, the bones do not grow completely, resulting in dwarfism.

Stages of severity

For a better understanding of the problem and better management of patients, chondropathies have been classified into 5 different groups according to the characteristics of the lesion and the intensity of the symptoms.

Chondropathies can occur for several reasons

The most common cause is post-traumatic.

The joint can also be damaged by inflammation, which can be a direct consequence of incorrect postures.

In both cases, chondrocytes take a long time to reproduce and never do so completely, which is why every type of chondropathy tends to be degenerative.

Patellar chondromalacia is a pathology characterised by degeneration of the surface lining the back of the kneecap.

It is common in youth.

Teenagers are not only more active and sporty (they subject their bodies to greater trauma), but they also have a hormonal set-up that adversely affects the strength of the cartilage, making it weaker and more easily damaged.

Intense sports activity is the main cause of many types of chondropathy due to the continuous microtraumas that the body undergoes in high-impact activities.

If this cause is suspected, even at an early stage and with mild symptoms, it is a good idea to stop the activity.

The sports that most frequently predispose to chondropathy are running, jogging, athletics, football, rugby and basketball.

Gender and genetics also play their part in the onset of chondropathy.

These conditions are more frequent in women most likely because they have less strength and muscle mass than men.

Chondropathy, the diagnosis

In order to diagnose a chondropathy, it is necessary to visit your doctor as soon as you experience typical symptoms, especially pain, swelling and joint creaking.

The examination will include an initial history phase followed by a thorough physical examination, during which muscle and kinetic tests are usually carried out to see how the joints respond to different stimuli and to understand the extent of the damage.

If, as a result of the information obtained from the history and objective examination, the presence of a chondropathy is suspected, further investigations will be necessary.

Radiography is useful to show cartilage lesions and possible bone misalignment, as well as the presence of arthrotic phenomena.

More advanced biomedical imaging techniques, such as magnetic resonance imaging, make it possible to observe the health of soft tissues, i.e. muscles, tendons and ligaments near the joint.

If the diagnostic techniques do not provide satisfactory answers, the physician may opt for an arthroscopy. The test is performed by introducing an instrument into the suitably prepared joint cavity that is able to directly view the joint surfaces.

This technique also allows treatments to be performed, thanks to the possibility of introducing operative instruments.

Chondropathies, treatments

Treatments vary depending on the anatomical area affected and the stage of severity of the symptoms.

Although one always tries to resort to conservative therapy alone, which makes use of medication and physiotherapy, it may be necessary to resort to surgery in the most severe cases.

It will be up to the doctor to determine which procedure is most appropriate to follow, also taking into account the patient’s medical history, age, sex, and the activities he or she normally carries out in daily life.

Based on the patient’s characteristics, recovery time and prognosis can be estimated.

Conservative therapy is most suitable for mild chondropathy, from grade 0 to grade 2.

This approach involves a combination of pharmacological and natural remedies and exercise:

Pain management with NSAIDs.

When the pain is intense, treatment with cortisone drugs can be instituted, which, however, must be short-lived, otherwise there will be significant side effects.

A balanced diet and adequate exercise are useful for weight control.

Maintaining one’s ideal weight is essential if one wants to reduce the load on the joints.

Physiotherapy exercises should be carried out both under medical supervision and at home to ensure a steady improvement in function.

The exercises should be targeted, but not put additional strain on the joints under observation.

Kinesiotherapy. Applying Kinesio patches to the skin near the affected joint helps relax the muscles and decrease pain, as well as amplify movement.

Laser therapy and shock waves directed at the joint being tested usually help reduce pain.

Infiltrations of hyaluronic acid into the inflamed joint area can decrease pain and allow movement.

The new frontier of regenerative medicine is evaluating the potential of Platelet-Rich Plasma (PRP).

In addition, a particular molecule, polyacrylamide gel, has been discovered that can alleviate the typical symptoms of chondropathy.

It protects the joint cartilage and does not allow it to be damaged further. The gel, directly injected into the affected joint, is composed of silver ions that act as bactericides.

It also reduces pain because it acts on the nerve endings in the joint.

It is absorbed slowly by the body, so its protective and pain-relieving action lasts longer than with other therapies.

The most commonly used natural remedies reduce pain but are only effective for mild chondropathies:

Application of ice (3 times a day for 10 to 15 minutes). Cold relieves pain and inflammation

Arnica and anti-inflammatory creams and ointments

Rest for a few days when the joint is painful and swollen

Braces that reduce the load on the joint.

If conservative therapy does not provide the desired response, the only solution to relieve pain and restore mobility is surgery.

To date, the most widely used intervention is minimally invasive and uses arthroscopy.

Increasingly used to treat chondropathies of the shoulder, elbow, wrist, ankle, knee and hip, it does not require hospitalisation and the patient can return home a few hours after the operation.

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