Chondroplasty is a surgical procedure performed to treat areas of damaged cartilage.
The articular cartilage is a thin layer of smooth, shiny white tissue that covers the surfaces of the ends of the bones in the knee joint, allowing smooth movement of the joint with very little friction. When articular cartilage is damaged or becomes worn, it cannot grow back or repair itself. Chondroplasty removes damaged tissue, allowing healthy cartilage to grow in its place.
Causes of Articular Cartilage Damage
Articular cartilage can be damaged from direct impact to the knee, degenerative wear and tear and disorders such as Osteochondritis Dissecans. This is a condition that develops in joints when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. Ultimately, the small piece of bone and the cartilage covering it begins to crack and loosen. The condition is more common in children and adolescents.
Articular cartilage damage can often result as a direct blow to the cartilage, such as a bad fall directly onto the knee, or following a bad tackle in rugby or football. It often occurs in sports people who play physical contact sports.
If articular cartilage damage is due to wear and tear (degenerative), it becomes thin and eventually, patches of the underlying bare bone may become exposed. Degeneration and arthritis are really the same thing, but tend to have different ways of expressing the severity of damage. Minor damage is usually referred to as wear and tear, whereas more severe damage, such as bare bone rubbing on bare bone, is usually diagnosed as full blown arthritis.
Symptoms of Articular Cartilage Damage
The most common location for cartilage damage is in the knee joint. Typical symptoms include:
- Joint pain
- A decreased range of movement in the affected joint
If a piece of cartilage has broken away and become loose, this can cause a feeling of the joint locking or catching. The joint may also have a tendency to give way.
Diagnosing Articular Cartilage Damage
Your doctor will ask you a number of questions about your symptoms, where it hurts and if there has been a specific injury or event that has resulted in the pain you are currently experiencing. Try to provide as much information as possible to assist with the diagnosis. A physical examination of your knee will be carried out to determine what is causing your knee pain. It is difficult for damaged cartilage to be diagnosed solely through a physical examination, particularly as symptoms are often similar to other types of knee injuries such as a sprain or damaged ligament. As such, you will likely be referred for imaging tests that can include:
MRI scans (magnetic resonance imaging) are often used to detect cartilage damage. The scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the knee joint. An MRI scan can also pick up other possible injuries to the knee such as meniscal tears.
X-rays are sometimes performed, although they cannot pick up cartilage damage as it is a soft tissue. However, they can rule out any fractures or pick up bone fragments.
Treatment of Articular Cartilage Damage
Depending on the severity of damage to the cartilage, your doctor may recommend conservative (non-surgical) treatment options before considering surgery. These can include:
- Painkillers such as ibuprofen and aspirin to help relieve pain and swelling. However, you should avoid taking ibuprofen if you have, or have had a stomach problem such as a stomach ulcer
- Physiotherapy to help strengthen the muscles surrounding or supporting your joint. This may alleviate pressure on the joint and reduce pain
- Lifestyle changes such as reducing activity that involves the affected joint
- Supportive devices such as a cane or leg brace.
Non-surgical treatments may only provide short-term relief, particularly if cartilage damage is more severe. If this is the case, your doctor will discuss the option of surgery with you.
Arthroscopic Chondroplasty is carried out arthroscopically (keyhole surgery) which involves using an arthroscope; a small, flexible tube with a camera on the end. The procedure can be carried out with a general anaesthetic, where you will be asleep throughout, or under a local anaesthetic where the area around the knee is numbed.
The surgeon will make a small cut in your joint and look into it through the arthroscope. From here, instruments are used to loosen any fragments of articular tissue, which are washed out and removed. The roughened edges of cartilage are then smoothed with a mechanised shaving instrument.
An abrasion Chondroplasty involves the use of a rotary burr to scrape off the bone tissue from the surface of the joint. The scraping action creates a bleeding surface and later forms scar tissue that replaces the original articular cartilage. This procedure is generally used when the defect is small.
If damage to the articular cartilage in the joint is more severe, particularly when the underlying bone is exposed, arthroscopic microfracture surgery will be performed.
The area being treated is prepared by removing any loose or damaged cartilage, then a small, metal pick is used to perforate small microfracture holes in the bone. Microfracture works best if the area being treated is less than 2cm in diameter with healthy surrounding cartilage. Patients with a 1-2cm area of damage require 5-15 small microfracture holes in the bone.
The holes allow the underlying bone to bleed into the defect which then forms a clot. This clot is rich in bone marrow cells, including stem cells which have great healing potential. Essentially, the body is able to repair the damaged area of cartilage by stimulating blood flow to the defect.
As Chondroplasty is carried out as a day case procedure, you will be able to go home the same day, provided there are no complications with your surgery. However, you will require someone to drive you and stay with you for the first few days.
Your knee will initially be put in a brace to hold it in place and restrict range of motion. Depending on the type of surgery carried out, you will need the aid of crutches for up to 6 weeks following your procedure, as you will need to minimise weight bearing on the knee.
You will be required to undergo physiotherapy following your procedure in order to maintain strength and motion of the knee joint. By the end of 6 weeks, the knee will feel very stiff, with weakened muscles and loss of reflexes. At this point, you will begin the second phase of your rehabilitation that focuses primarily on getting full range of motion back in the knee, along with gaining muscle strength and reflexes.
Full recovery from Chondroplasty can take up to 12 weeks, although you will be able to resume many of your normal activities before this time.
Returning to work will depend on the nature of your job. If you have a desk job, you may be able to return as soon as you are off prescribed pain medication and feel comfortable to drive. If your work is more strenuous and involves heavy lifting, you may require 2-4 weeks off work. Your doctor will discuss this will you at your follow-up appointment.
Risks and Complications
Chondroplasty is considered a safe procedure, but as with any invasive surgery, there are associated risks. These include:
- Bleeding and blood clots
- Increased stiffness around the knee
- Arthritis in the joint
- Cartilage breakdown over time
If you notice any of the following symptoms, contact your doctor immediately as it could be a sign of an infection that will need treating with a course of antibiotics:
- Fever, chills and sweats
- Redness around the incision site
- Warm around the joint
- Pus oozing from the incision site
- Persistent swelling
At One Healthcare we can book you in to see a specialist Orthopaedic knee surgeon for an initial consultation, usually within 48 hours. We perform many different surgeries on patient’s knees, including minimally invasive knee replacements and arthropscopic procedures, including ACL Reconstruction and Meniscal Repair.
You can use your private medical insurance or pay for your Chondroplasty treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at One Ashford Hospital
Why One Ashford Hospital
- Access to leading Consultants within 48 hours*
- 0% and low interest finance options**
- Competitive fixed-price packages
- Modern purpose-built hospital
- Private, spacious, ensuite rooms
- Specialist Physiotherapy and nursing teams
- Little waiting time for surgery
- Calm, dignified experience
*Dependent on Consultant availability
**Terms and conditions apply