Chondropathy: Causes, Symptoms & Treatment

Chondropathy is thus a generic term for pathological changes of the articular cartilage, which can occur traumatically, degeneratively or in the context of inflammation. Thus, the symptoms and treatment of chondropathy also depend on the corresponding clinical picture.

What is chondropathy?

Chondropathy is a term from orthopedics that is rarely used in this form: chondros is the cartilage, a -pathie always refers to a condition, a disease; a cartilage damage could therefore also be said. You hear this term more often in the field of sports, where cartilage damage is one of the more common injuries and wear and tear. Even in the context of “normal” osteoarthritis, that is, without sports injuries, chondropathy is part of the usual history of the condition.

Causes

Basically, all joints in our body are covered by cartilage. In contrast to bone, which provides stability, the substance cartilage is somewhat softer and elastic to pressure and bending. This is important for its function. It buffers, so to speak, the bones articulating with each other and, together with the synovial fluid produced by special cells in the synovial membrane, enables the joint surfaces to slide smoothly along each other. To ensure that this functions as smoothly as possible, the articular cartilage consists only of connective and supporting tissue cells and usually no longer contains any blood vessels at the crucial points. It is therefore nourished only by diffusion. This becomes even more problematic in the pathogenesis of chondropathy: If the joint is under abnormal permanent load or if the cartilage surface is interrupted by an injury, the supply of nutrients may also be jeopardized and the cartilage that depends on it suffers further damage. At the same time, the poor supply situation also severely limits the ability of the cartilage to heal itself compared to other body tissues. Small substance defects, which easily develop once, can therefore persist over a long period of time and grow into larger cartilage damage over the years. Furthermore, such defects do not initially cause any symptoms: After all, nerve tracts are just as absent in the joint as the blood supply. Only when the defect deepens and affects the bone under the cartilage are nerve endings irritated, resulting in joint pain, especially during movement. A healing process is initiated starting from the subchondral bone tissue, which, however, does not lead to the formation of new undamaged articular cartilage, but to the formation of a type of replacement cartilage called fibrocartilage.

Symptoms, complaints, and signs

In many cases, chondropathy does not cause any particular discomfort or symptoms at the beginning of the disease. For this reason, the disease often remains undetected for a long time, so that it comes only to a delayed diagnosis and thus also to a delayed treatment. Those affected suffer from pain in the joints in the respective region and often also from a feeling of pressure. The pain can also spread to neighboring regions and cause discomfort there. Furthermore, nocturnal pain is usually associated with insomnia and thus with irritability or psychological upsets. The pain is intensified when the patient moves, resulting in restricted movement and thus limitations in the patient’s everyday life. Most patients also suffer from bruising of the joints. The pain can occur primarily in the form of a start-up pain and thus has a very negative effect on the quality of life. As a rule, the pain continues to intensify if no treatment of the chondropathy is initiated. In the further course, the muscles of the affected person are also permanently damaged.

Diagnosis and progression

If the cartilage is arroded and roughened over a long period of time, osteoarthritis forms as a form of chondropathy. This is primarily a disease of older age and is caused by permanently increased stress on the joint, but also by genetic influencing factors. Hip and knee are the most frequently affected joints of this degenerative disease. In the beginning, there are usually complaints during stress, such as the typical start-up pain, later, often after years, permanent pain occurs in the affected joint. Due to injuries, cartilage damage can also occur at a young age and cause enormous arthrosis-like symptoms.In the case of knee joint injuries, these are then often accompanied by major damage to the ligamentous apparatus and a joint effusion, but can also occur in isolation and cause recurring complaints over a longer period of time. Prolonged immobilization of a joint after injury, for example by means of a cast, can also lead to cartilage damage. Chondropathy can be guessed by X-ray on the basis of the width of the visible joint space and other typical changes, but it is only clearly shown in MRI (magnetic resonance imaging). Various degrees of severity are classified here on the basis of the extent and severity of the cartilage tears. Diagnostic arthroscopy is also an effective means of detecting chondropathy.

Complications

The complications of chondropathy depend greatly on the cause of the disease and, in the process, also lead to different symptoms. Usually, the articular cartilages change, leading to pain. The pain can occur both during movement and as pain at rest. Due to the movement pain, the affected person is severely restricted in his actions, so that the quality of life decreases. There is usually also a feeling of pressure at the joints. Elderly people in particular are affected by pain on onset and have difficulty getting up and moving around. They are then dependent on walking aids. In many cases, it is possible to limit the chondropathy in the short term and combat the symptoms. However, the treatment does not last long. In this case, no further complications occur. In severe cases, surgical intervention is also possible. The joint can also be replaced with a prosthesis if it is completely damaged, and surgery is also required. This allows the patient to perform movements without pain and restrictions for an unlimited period of time and thus is no longer limited in his everyday life. Chondropathy does not usually result in a reduced life expectancy.

When should you see a doctor?

When the typical symptoms of chondropathy appear, a doctor should be consulted. For example, if knee pain occurs repeatedly with severe knee flexion, this indicates a serious underlying condition that needs to be clarified and, if necessary, treated. Another sign is pain at rest at night. A visit to the doctor is indicated at the latest if these complaints lead to muscle tension or poor posture. If the chondropathy remains untreated, patellar arthrosis may develop in the further course. If warning signs of such a joint disease are noticed, a doctor must be consulted immediately. People who regularly perform kneeling activities (e.g. tile setters or building cleaners) are particularly at risk. But also a general overloading of the tendons (for example with the tennis or stair climbing) can promote the pain syndrome in some cases still. Anyone who belongs to these risk groups should talk to their family doctor at the first signs of chondropathy. Other contacts are the orthopedist or a knee specialist. If symptoms are severe and make it impossible to see a doctor independently, emergency outpatient services should be contacted.

Treatment and therapy

In the same session of the arthroscopy, excess and disturbing scar tissue can then be removed at the same time, thus performing a kind of “joint toilet”. This procedure can improve the symptoms in the short term, but unfortunately the relief usually does not last long. Physiotherapeutic stabilization through muscle building is another important component of therapy for chondropathy. If major damage is detectable, it can sometimes be removed in major surgical procedures. In the case of osteoarthritis, joint replacement by prosthesis remains a last but very effective means of therapy.

Outlook and prognosis

Because cartilage damage cannot be cured with current medical options by rebuilding the removed cartilage, an unfavorable prognosis results. Despite all efforts, the disease cannot be completely stopped in its progress. The treatment leads to an alleviation of the symptoms. At the same time, the progress of the disease is slowed down, but it cannot be prevented. In addition, there is a natural degradation of the cartilage over the lifespan, which cannot be changed. Ultimately, in the worst case, the only option is to replace the damaged joint.Since this cannot be equated with the functional capability of a natural joint despite all the advantages and relief of existing complaints, impairment remains. Nevertheless, the prognosis of chondropathy has improved significantly due to medical progress. The quality of life could be optimized for the patient with the existing treatment methods. In addition, various therapeutic methods succeed in delaying the progression of cartilage degradation. The patient’s behavior additionally contributes to an improvement of his situation. Intensive and joint-stressing sports should be avoided. If there is little cartilage damage, there should be sufficient exercise. This improves blood circulation and triggers better circulation of the synovium. This nutrient-containing substance has a positive effect on the joint.

Prevention

Not proven, by the way, is the often imputed cartilage damage caused by overloading, for example, when jogging. Rather, studies have shown that articular cartilage, provided it has not yet been damaged by injury or osteoarthritis, has enormous regenerative potential and is able to adapt permanently to stress. To prevent chondropathies, it is therefore important not to increase sporting activity “from zero to one hundred”, but to introduce the cartilage slowly to the stresses and to plan sufficient breaks for regeneration. Furthermore, running on forest paths or boggy ground is naturally far gentler on the joint than constant locomotion on asphalt-covered roads.

Aftercare

Chondropathy can be gradually healed by physiotherapy following treatment with medication or surgery. In this process, exercises strengthen the muscles and compensate for any deficits that may exist. Aftercare also involves correcting malpositions and avoiding incorrect stresses. Physiotherapy exercises are also available for this purpose. After instruction by professional physiotherapists, patients can also perform these training sessions at home. In the first phase of aftercare, relieving the strain on the affected joints plays an important role. In this way, corrective losses can be avoided. Only after bony consolidation has been restored is more intensive training permitted. Especially in the case of “runners knee”, which often occurs in athletes, load adjustment in combination with physiotherapy is used. It is advisable not to put excessive strain on the weak spot and, for example, to avoid climbing stairs when the knee is in pain. Otherwise, patients must expect the condition with the associated pain to recur after a short time. Depending on the personal constitution, reducing body weight may help to combat the symptoms. For more mobility, the doctor recommends stretching exercises and strengthening the muscles.

What you can do yourself

The physiological processes that typically lead to chondropathy, a pathological change or wear of a joint cartilage, are not (yet) all understood. Depending on the progress of the disease, the symptoms range from hardly noticeable to very painful arthrosis with sometimes considerable movement restrictions. Adjustments in everyday behavior and the use of self-help measures can slow or even stop and reverse the progression of chondropathy. In order to provide the joint cartilage affected by chondropathy with the best possible supply of nutrients and building materials, it is very important to move the joint without placing it under heavy strain, because the cartilage is supplied with nutrients via the synovial fluid located in the joint space and not via the capillary blood vessel system. The necessary movements can be achieved within the framework of a suitable sport or through individually composed gymnastics. Unfavorable effects on the articular cartilages are caused by abrupt changes in load, such as those that occur at irregular intervals and changing strength in many ball sports. Ball sports such as soccer, handball, tennis and many others therefore tend to have an unfavorable effect on incipient chondropathy, while sports such as hiking, Nordic walking, biking and even jogging generally have a favorable influence on the course of the disease. Movement analyses of the affected joints are also important in order to identify any incorrect stresses and to avoid them in the future by training new movement patterns.