Cartilage injury: What is it? Causes, Symptoms, Diagnosis, Therapy and Prognosis of A.Griguolo

Generality

Cartilage damage is an injury that can affect any cartilaginous tissue in the human body and which, in general, is the result of trauma or degenerative processes.

The most common sites of cartilaginous lesions are the joints - which present the so-called articular cartilage - the respiratory organs of the throat and thorax (larynx and trachea), and external anatomical structures, such as the nose or auricle.

Symptoms of cartilage injury vary depending on the location of the injury. For example, the lesion of an articular cartilage produces pain in the affected joint, associated with stiffness, swelling, motor difficulties, etc .; the lesion of the laryngeal or tracheal cartilage, on the other hand, is responsible for pain at the throat or chest and respiratory problems.

Cartilage is a tissue that almost never heals spontaneously; this implies that, in the presence of cartilage lesions, the treatment is mostly surgical.

Review of what Cartilage is

Also known as cartilage tissue, cartilage is a connective tissue with a supporting function and extreme flexibility and resistance.

Consisting of particular cells called chondrocytes and devoid of blood vessels, the cartilage of the human body is not all exactly the same, but has different characteristics, depending on the anatomical site and the specific tasks for which it is responsible. Here then is that, as a result of the aforementioned characteristics, the anatomists have thought of distinguishing the cartilage tissue in 3 major types:

Hyaline cartilage . Smooth, flexible and bluish-white in color, it is the type of cartilage most present in the human body. Examples of locations where it is possible to find it are: ribs, nose, trachea, bronchi, larynx and articular surfaces;
Elastic cartilage . Of an opaque yellow color, it is a type of cartilage that stands out above all for its elasticity. Examples of sites where it is possible to find it are: auricles, Eustachian tube and epiglottis;
The fibrous cartilage . Of whitish color, it is the type of cartilage most present in the articular level, as it is very resistant to mechanical stress. Examples of locations where it is possible to find it are: intervertebral discs, knee menisci and pubic symphysis.

What is a Cartilage Injury?

Cartilage injury is the expression that describes any damage to a cartilaginous tissue, whether it is hyaline, elastic or fibrous.

Cartilage lesions, therefore, are injuries that can involve many parts of the human body, from external anatomical structures such as the nose or the auricle of the ears to the joints or internal organs consisting of cartilaginous tissue.

Is it serious?

Normally, the cartilage is devoid of blood vessels, so there is no circulation of blood; this means that, if damaged, it can hardly heal spontaneously, as would happen in the case of damaged skin or broken bones.

A cartilage injury is all the more serious, the more damage is extended.

Most common locations of Cartilage Injury

The cartilage most prone to injury is, without doubt, the cartilage present in the joints, or the so-called articular cartilage ; to follow, we note the lesions of the cartilage belonging to the respiratory organs of the throat and thorax - in other words, larynx and trachea - and the lesions of the cartilage of the nose and ears ( auricle ).

Causes

The main causes of cartilage damage include trauma and degenerative diseases .

Cartilage trauma

From a trauma may depend:

Cartilage lesion of a joint (articular cartilage). The articular cartilages most subject to traumatic injuries are those of important joints, such as the knee, ankle, hip and shoulder.
In most cases, traumatic injuries of the articular cartilage are the result of sports injuries (the sports most at risk are football, rugby, American football and basketball) or injuries suffered during strenuous work, which undermine the integrity of the joints;

Cartilage lesion constituting throat and chest respiratory organs. Cartilages of organs such as the larynx or trachea can be damaged by violent blows to the throat or chest.
In most cases, traumatic lesions of the laryngeal and tracheal cartilages are the result of motor vehicle accidents or, again, of sports injuries;
The cartilage lesion that forms the nose or auricle. The nose cartilages and auricles can be damaged by repeated cuts and burns.

Degenerative Cartilage Diseases

Premise: a disease is degenerative, when it gradually alters the anatomy and then the function of an organ or tissue.

There are various degenerative diseases capable of producing cartilage lesions; as a rule, these degenerative diseases are joint affections, therefore the injuries in question concern the cartilage of the joints.

Among the most well-known and widespread degenerative diseases that cause damage to cartilage is arthrosis .

Also known as osteoarthritis, osteoarthritis is the inflammation of one or more joints, resulting from the progressive degeneration of articular cartilage (articular cartilage is the cartilage that covers the surface of the bones involved in a joint).

Symptoms and Complications

The symptoms of cartilage injury depend on the location of the injury.

For example:

When the site of the injury is a joint, the cartilage lesion is the cause of:

Pain, exacerbated by movement;
Sense of joint stiffness ( ankylosis );
Swelling ;
Redness and heat outside the affected joint;
Crunches with every movement of the joint involved;
Difficulty performing all those physical activities related to the movement of the damaged joint.

When the site of the injury is a throat or chest respiratory organ, cartilage injury produces respiratory problems and pain in the throat (if the affected organ is contained in the throat) or in the chest (if the organ involved is contained in the chest ).
When the site of the injury is a nose or auricle, the cartilage lesion is a cause of aesthetic problems .

Diagnosis

In cartilage lesions, diagnostic tests vary according to the location of the injury. For example, for the diagnosis of a cartilage lesion of the nose or auricle , observation of the anatomical structure involved is sufficient ; for the diagnosis a lesion of the articular cartilage or cartilage of a respiratory organ, instead, in addition to the objective examination and the anamnesis, more in-depth tests are needed, such as magnetic resonance, X-rays, diagnostic arthroscopy (for the joints ), endoscopic procedures (laryngoscopy, for the larynx, and tracheoscopy, for the trachea) etc.

Therapy

Remembering that cartilage is a tissue that almost never heals spontaneously, the therapy of cartilage injury depends on several factors, including: location of the injury, severity of the damage and cause .

Treatment of an articular cartilage lesion

In cartilage lesions of a joint, the therapeutic approach can be conservative, if the injury is very mild, or surgical, if the injury is moderate-severe.

CONSERVATIVE TREATMENT

The conservative treatment of an articular cartilage lesion may include:

Rest;
Taking non-steroidal anti-inflammatory drugs (NSAIDs);
Infiltrations of hyaluronic acid;
Targeted physiotherapy exercises.

SURGICAL TREATMENT

Surgery for cartilage lesions of a joint includes various treatment options, including:

The so-called joint cleansing . It is indicated when the damaged cartilage has sharp edges, which could damage adjacent joint structures.
Briefly, it may consist of smoothing or removing imperfections developed by the articular cartilage, following the injury;
Bone marrow stimulation . It consists of piercing the bone surface on which the damaged joint cartilage rests, up to the internal blood vessels; this drilling work, in fact, leads to the formation of blood clots inside the damaged cartilage, followed by the generation of new cartilage.
Unfortunately, the new cartilage obtained with this surgical technique has different characteristics from the original articular cartilage; specifically, it is less elastic;
Joint mosaicplasty . It is in fact an autologous cartilage transplant; in fact, it provides for the taking of a piece of healthy cartilage from another area of the patient's body and the application of this piece in place of the damaged cartilage.
Joint mosaicplasty is a good solution only when the cartilaginous lesions are small (eg: in the presence of arthrosis it is completely unsuitable);
The implantation of autologous chondrocytes . It consists in taking some chondrocytes from the damaged cartilage, cultivating them in the laboratory for 1-3 months in order to produce others and, finally, implant the result of cultivation where there is the cartilage lesion.

Treatment of a laryngeal or tracheal cartilage injury

In lesions to the laryngeal or tracheal cartilage, the therapy is only surgical and consists of an operation aimed at restoring the normal anatomy of the injured organ.

Treatment of a cartilage lesion of the nose or ears

In the case of lesions to the cartilage of the nose or ears (auricle), there is the possibility to intervene surgically, to restore the appearance of the area involved.