Articular cartilage repair: treatment options and recovery

Articular cartilage repair refers to the process of restoring or treating damaged articular cartilage, which is the smooth, shiny tissue covering the ends of bones in joints. This repair can involve various surgical or non-surgical techniques aimed at promoting healing and improving joint function. 

Damage to the articular cartilage can occur due to factors such as injury, aging, or degenerative conditions, leading to symptoms like pain, swelling, and limited joint movement. The goal of articular cartilage repair is to alleviate symptoms, enhance joint mobility, and prevent further degeneration, ultimately improving the individual's quality of life.

Surgical vs. non-surgical articular cartilage repairs

• Surgical options:

  • Microfracture: A minimally invasive procedure where small holes are made in the bone beneath the damaged cartilage to stimulate new cartilage growth.

  • Autologous Chondrocyte Implantation (ACI): Involves taking healthy cartilage cells from the patient's own body, growing them in a lab, and then implanting them into the damaged area.

  • Osteochondral Autograft Transplantation (OAT): Involves transplanting healthy cartilage and bone from a non-weight-bearing area of the joint to the damaged area.

  • Osteochondral Allograft Transplantation: Similar to OAT but involves using donor tissue instead of tissue from the patient's own body.

• Non-surgical options:

  • Physical therapy: Involves exercises and stretches to improve joint mobility, strengthen surrounding muscles, and reduce pain.

  • Platelet-Rich Plasma (PRP) Therapy: Involves injecting a concentration of the patient's own platelets into the damaged area to promote healing.

  • Hyaluronic acid injections: Involves injecting a gel-like substance into the joint to provide lubrication and reduce pain.

  • Nutritional supplements: Some supplements like glucosamine and chondroitin sulfate may help support cartilage health and reduce symptoms.

These options can vary in effectiveness depending on the severity and location of the cartilage damage, as well as individual factors such as age and overall health. It's important to consult with a St. Luke’s Health orthopedic expert to determine the most appropriate treatment plan for your specific situation.

What is the recovery process after articular cartilage repair?

Recovery after articular cartilage repair typically involves several stages and may vary depending on the type of procedure performed and individual factors. Here's a general overview of the recovery process:

• Immediate Post-Operative Period:

  • Following surgery, patients are often monitored in a recovery area to ensure stability and manage pain.

  • Depending on the procedure, patients may need to use crutches or braces to protect the joint and aid mobility.

• Early Rehabilitation Phase (0-6 weeks):

  • Physical therapy begins soon after surgery to promote joint mobility, reduce swelling, and prevent stiffness.

  • Patients gradually increase weight-bearing activities under the guidance of a therapist or surgeon.

  • Pain management strategies, such as medications or ice therapy, are utilized as needed.

• Intermediate Rehabilitation Phase (6 weeks - 3 months):

  • Physical therapy focuses on strengthening the muscles around the joint to provide support and stability.

  • Functional exercises are introduced to improve balance, coordination, and range of motion.

  • Patients may start low-impact activities like stationary biking or swimming to further enhance joint function.

• Advanced Rehabilitation Phase (3 months - 6 months):

  • Rehabilitation intensity increases to improve joint proprioception and restore functional abilities.

  • Higher-impact activities, such as jogging or agility drills, may be incorporated gradually.

  • Continued monitoring of symptoms and progress guides the customization of the rehabilitation program.

• Long-Term Recovery (6 months - 1 year and beyond):

  • Patients continue to progress in physical therapy while gradually returning to their desired activities and sports.

  • Ongoing monitoring by healthcare providers ensures proper healing and identifies any potential issues.

  • Maintenance exercises and lifestyle modifications may be recommended to preserve joint health and prevent future injury.

Physical therapy exercises after articular cartilage repair

After articular cartilage repair, physical therapy plays a crucial role in promoting healing, restoring joint function, and preventing complications. Here are some common physical therapy exercises often recommended after articular cartilage repair:

• Range of motion exercises:

  • Ankle Pumps: Flex and extend your ankles to improve blood circulation and reduce swelling.

  • Quadriceps Sets: Tighten your thigh muscles while sitting or lying down to strengthen the muscles around the knee joint.

  • Heel Slides: Bend and straighten your knee while lying on your back to increase knee flexion and extension.

• Strengthening exercises:

  • Straight Leg Raises: Lift your leg while lying on your back, keeping the knee straight, to strengthen the quadriceps muscles.

  • Mini Squats: Perform partial squats while keeping proper alignment of the knees and hips to strengthen the thigh and gluteal muscles.

  • Step-Ups: Step onto a low platform with the operated leg, then step down, focusing on controlled movement and balance.

• Balance and proprioception exercises:

  • Single Leg Balance: Stand on one leg while maintaining balance and stability, progressing to unstable surfaces like foam pads.

  • Bosu Ball Exercises: Perform various exercises on a Bosu ball to challenge balance and proprioception while strengthening leg muscles.

  • Agility Drills: Incorporate multidirectional movements and quick changes in direction to improve agility and joint control.

• Functional exercises:

  • Sit-to-Stand: Practice transitioning from sitting to standing position, emphasizing proper alignment and weight distribution.

  • Stair Climbing: Ascend and descend stairs with proper technique, using handrails for support if necessary.

  • Gait Training: Focus on walking with a normal stride length and pattern, gradually increasing speed and distance as tolerated.

• Cardiovascular conditioning:

  • Stationary Cycling: Start with low resistance and gradually increase intensity to improve cardiovascular fitness without excessive stress on the joints.

  • Pool Exercises: Perform water-based activities like swimming or water walking to enhance cardiovascular endurance while minimizing joint impact.