Anatomy & Function

The cartilaginous covering of the respective joint partners (e.g. femoral condyle and tibial plateau) varies in thickness depending on the joint and localization. In the knee joint, the thickness varies from 1 mm at less stressed sites to > 1 cm behind the kneecap. Human cartilage is mainly nourished by the synovial fluid. It is created during embryonic development and thus also follows a genetic program.

Cartilage wear / abrasion is first of all not a "disease", but a completely natural process.

The term osteoarthritis is defined as "chronic disease of a joint due to wear andtear."

There are thus three therapeutic approaches in our concept:

  • Therapy of arthrosis due to symptoms (surgical/conservative)
  • Therapy of cartilage damage or its causes (in the case of corresponding symptoms or in individual cases also to prevent symptoms and progression).
  • Detailed information about the "normal course" of joint wear and supportive measures

Symptoms & Complaints

More information will follow shortly.

Causes

Local cartilage damage occurs both in young patients (traumatic, osteochondrosis dissecans, leg axis defects, etc.) and in older patients (local overload, trauma) and requires detailed analysis. The goal must be to understand the underlying mechanism. Only then can a targeted therapy be initiated. Depending on the duration and nature of the symptoms, localization, size and depth of the defect, as well as the age of the patient and concomitant pathology (ligament injuries? leg axis defects? bony form defects?), this ranges from conservative therapy to the surgical measures explained in the further course.

It is crucial that the treating physician has access to the entire spectrum of therapy options. Only then is he free to make decisions and can select the right procedure for you together with you. The certification as a knee surgeon of the German Society for Knee Surgery stands precisely for this specialization and competence.

Diagnosis

More information will follow shortly.

Treatment

Conservative therapy

The basis for the joint decision regarding the therapy of your complaints is the detailed anamnesis and extensive clinical examination of both the affected joint and the entire extremity including the spine. Muscular imbalances or blockages can often be the trigger of pain syndromes. These can be significantly alleviated by targeted, also equipment-supported physiotherapy as well as self-exercises. In parallel, X-ray diagnostics and often MRI diagnostics should be performed in order to obtain decisive information about the current condition of your joint cartilage.

Preparations such as hyaluronic acid or PRP are also referred to as "cartilage-building substances". This is so regrettably incorrect. Both substances, in similar form and with the correct indication, lead in up to 70-80% of cases to relief of symptoms and improved mobility, but not to an increase in cartilage substance. They do stimulate cartilage metabolism, but in all probability do not lead to growth. Used correctly (more likely in early and moderate osteoarthritis), they can provide relief for many years and delay surgical intervention. However, if there is no effect after the first infiltrations, appropriate resumption should be made. The infiltrations (usually 3-5) are performed under sterile conditions.

Hyaluronic acid is contained in high concentration in the body's own joint fluid. It serves as a lubricant and at the same time participates in cartilage nutrition. In the course of arthritic changes, there are also changes in the synovial fluid (viscosity, cartilage abrasion products). Thus, the injection of hyaluronic acid leads to a better sliding couple and promotes cartilage metabolism.

PRP (Platelet Rich Plasma) is produced directly in a centrifuge after a blood sample (the patient's own blood) has been taken and then injected into the site of the problem. In the case of muscle and tendon injuries, the mechanism of action is explained by the high proportion of platelets and growth factors in the prepared plasma, which accelerates healing. PRP is therefore used primarily in sports injuries with good results. The first very promising results have been seen in arthrosis therapy. The mechanism of action is not yet fully understood. The fact is, similar to hyaluronic acid, that it can lead to pain relief and improved mobility in the knee joint, but not to cartilage growth.

Surgical therapy

Depending on the extent of the cartilage damage (diameter, depth), different procedures are used. As a rule, local, symptomatic cartilage damage grade III to IV is treated surgically by means of replacement procedures.

>4 cm²: Cartilage cell transplantation (ACT)

Matrix-coupled autologous chondrocyte transplantation (M-ACT) represents one of the current therapeutic procedures for higher-grade symptomatic cartilage damage (grades 3 and 4) of a certain size. It shows very good long-term results. If cartilage damage is initially localized, the result is often progressive, extensive arthrosis and the threat of joint replacement. In order to slow down or even prevent the development of arthrosis, cartilage cells are removed from non-loaded areas of the knee joint (arthroscopically) in the first M-ACT procedure. The cells are cultivated and multiplied in a special laboratory. These matrix-coupled cartilage cells are then transplanted into the patient's cartilage defect in a second operation. If concomitant pathologies are present (e.g. rupture of the anterior cruciate ligament, axial malalignment or meniscus damage), these must usually also be addressed. The transplantation is followed by an intensive phase of physiotherapy according to a special post-treatment regimen, as well as regular check-ups in the consultation room. Alternatively, cartilage-stimulating procedures (microfracturing, AMIC) can be used for minor cartilage damage. In this regard, the MRI already provides the most important information before the operation.

< 2-2,5 cm²:  Mikrofrakturierung: Mittels Aale oder Bohrer wird der Knochen im Bereich des Defektes eröffnet. Freigesetzte Stammzellen bilden einen Regeneratknorpel (Defektauffüllung). Die Erfolgsquote kann durch maxtrixassoziierte Techniken (siehe AMIC) verbessert werden.

2-4 cm2: AMIC (autologous matrix-associated microfracturing): After microfracturing is performed, it is covered by an artificial, prefabricated collagen membrane. This form of cartilage therapy can be performed arthroscopically and in one procedure.

Aftercare

More information will follow shortly.

FAQs

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dr tarek schlehuber
  • Specialist for orthopedics and trauma surgery in Freiburg
  • Leitender Arzt Sportorthopädie Loretto Krankenhaus

  • Certified knee surgeon of the DKG
  • Certified arthroscopist of the AGA
  • Sports doctor of the GOTS
  • Manual medicine / chiropractic
  • Team doctor Bahlinger SC / Cooperation doctor EHC
dr dan potthoff
  • Specialist in orthopedics and trauma surgery
  • Schulter- und Kniechirurgie

  • Artificial joint replacement of knee and hip joints
  • Cartilage surgery
  • Arthroscopic surgery
  • Joint wear and tear (arthrosis), sports injuries
  • Conservative orthopaedics