Clinical Review

Treating articular cartilage injuries of the knee in young people

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c998 (Published 05 March 2010) Cite this as: BMJ 2010;340:c998
  1. Simon Macmull, clinical research fellow,
  2. J A Skinner, consultant orthopaedic surgeon,
  3. G Bentley, professor of orthopaedics,
  4. R W J Carrington, consultant orthopaedic surgeon,
  5. T W R Briggs, consultant orthopaedic surgeon
  1. 1Royal National Orthopaedic Hospital, Stanmore HA7 4LP
  1. Correspondence to: S Macmull simonmacmull{at}hotmail.com

    Summary points

    • Articular cartilage injuries of the knee are common in people aged under 35 years

    • If symptomatic they can be debilitating and may progress to osteoarthritis

    • Early appropriate treatment of symptomatic lesions may prevent the onset of osteoarthritis and is cost effective

    Articular chondral and osteochondral injuries of the knee are common in people aged under 35 years, and symptomatic lesions left untreated may lead to chronic pain and disability. Patients with articular chondral injuries often have a poorer function score than those awaiting surgery for other knee disorders, such as osteoarthritis or a ruptured anterior cruciate ligament.1 Patients with articular cartilage injuries may go on to develop early onset osteoarthritis with long term morbidity and consequent high use of health service resources; successful early treatment of these lesions would probably be cost effective.

    Chondral and osteochondral lesions may not be diagnosed or may present late because patients will often give a history of an apparent insignificant trauma and doctors may fail to understand the importance of an effusion in the knee joint, which always indicates joint disease.2 Radiographs of the knee may be poorly interpreted. This review discusses the diagnosis and management (conservative and surgical) of injuries to the articular cartilage of the knee and draws on published research articles and the authors’ own experience.

    Methods

    We searched the Cochrane database, PubMed, and Google Scholar up to December 2009. We analysed randomised controlled trials and comparison trials, as well as articles on operative technique and case series.

    How are articular chondral injuries of the knee classified?

    Long bone articular surfaces are covered with hyaline cartilage. Damage to this hyaline cartilage is known as a chondral injury or, if the underlying bone is also fractured, an osteochondral injury.

    Articular cartilage is avascular and aneural, so pain would not be expected. Yet some patients with chondral lesions do present with …

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