Brief overview
- Symptoms: Joint pain, which in advanced stages leads to restricted movement and joint effusions.
- Treatment: Depends on type, severity and cause; rest, physiotherapy, medicinal pain treatment, surgery, joint replacement
- Causes and risk factors: Varies; often excessive/one-sided stress from sports or work, inflammation, congenital joint deformities; overweight
- Course of disease and prognosis: joint cartilage has limited healing capacity; prognosis depends on age and type of cartilage damage; joint-sparing exercise improves prognosis
What is chondropathy?
Since the cartilage covering of the joint surfaces in particular has to withstand strong mechanical stresses and the repair processes here are very slow, cartilage damage occurs relatively often there. The hip, shoulder and ankle are increasingly affected by this, but the knee in particular. In principle, however, it is possible for chondropathy to develop in any type of cartilage.
Cartilage damage in the knee
Cartilage damage behind the kneecap (patella), known as retropatellar chondropathy, is therefore a common orthopedic diagnosis. Sometimes chondropathy also occurs in the part of the joint located between the thigh bone (femur) and the shin bone (tibia). In this case, the term is “femorotibial chondropathy”.
As a result, this section of bone dies along with the overlying cartilage. Often, the dead bone-cartilage fragment detaches from the remaining bone and then floats freely in the joint (joint mouse, free joint body).
Cartilage damage to the hip
Cartilage damage to the shoulder and ankle joint
Not only wear and tear, but also acute injuries and chronic incorrect loading of the joints often lead to cartilage damage. The ankle and shoulder are particularly at risk, especially in people who are active in sports. If you twist your ankle, for example, you often not only injure ligaments and bones, but also increase the risk of cartilage damage.
Intensive weight training, for example bench pressing or weight lifting, also poses a certain risk to the shoulder cartilage. Especially if you perform the exercises incorrectly or train on one side. As in tennis or swimming, strength training should also train the muscles on the opposite side of the joint.
Special forms of chondropathy
Medical research is also not yet clear about the exact triggers of polychondritis. However, it is suspected that the body’s own immune system mistakenly attacks the cartilage. This form of chondropathy does not only affect the joint cartilages, but it is possible that all cartilage tissues of the body become inflamed, for example also the auricles and the nasal cartilage.
How do you describe the extent of cartilage damage?
- Chondropathy grade 0: The cartilage is healthy and undamaged, i.e. there is no damage to the cartilage.
- Chondropathy Grade 1: The cartilage is complete and smooth, but is softened in places, especially in the zones of intense pressure.
- Chondropathy grade 2: The cartilage is roughened, and small cracks appear in places.
- Chondropathy grade 3: There are cracks and holes in the cartilage, but these do not yet extend to the bone.
Whether a degree of disability (GdB) is determined or a disability is recognized in people with chondropathy depends to a large extent on how pronounced the chondropathy is, whether it restricts everyday life and joint function, and what other conditions exist.
What are the symptoms of chondropathy?
- In the early stage, an indeterminate feeling of pressure at the affected joints
- As the damage progresses, pain, initially on movement, later also at rest
- Pain when pressure is applied to the affected joint or the kneecap
- Restricted movement due to the pain
- Possibly joint effusions with swelling
A typical phenomenon in chondropathy is the so-called start-up pain. Patients experience pain here primarily at the beginning of an activity. For example, start-up pain occurs after prolonged sitting or standing, when the patient stands up or begins to walk. With continued exertion, the pain decreases again and often even temporarily disappears completely.
How is chondropathy treated?
The therapy of a chondropathy depends on the respective type and cause of the cartilage damage. Thus, treatment of the underlying disease or avoidance of mechanical triggers is often required.
Operations
If chondropathy is severe and there is no chance that the cartilage will regenerate, surgery is often necessary. Within the framework of a joint endoscopy (arthroscopy), it is possible to perform a whole range of interventions in a minimally invasive way: Cartilage smoothing, microfracturing, removing free joint bodies, gluing shearing or cracks in the cartilage.
Newer procedures also allow cartilage tissue to be transplanted, either from the patient’s own body or artificially grown in a test tube.
If the destruction of a cartilage surface is already far advanced, sometimes only a total joint replacement can be considered. A typical example of this is total hip arthroplasty (hip TEP) as the last option in the case of extensive cartilage damage.
Hyaluronic acid injections
Knee treatment
Chondropathy: Causes and risk factors
There are a variety of possible causes for the different forms of chondropathy. Very often, wear and tear on the joint cartilage is the trigger. Such signs of wear and tear sometimes develop over years and occur more frequently, especially with increasing age. In addition to individual physical strain and age, overweight is another risk factor.
Skeletal anomalies are often the reason for retropatellar cartilage damage. The patella and the knee joint relate to each other like a sled and its track: The patella slides over the knee joint within a fixed track when the lower leg is bent and extended.
Another reason for chondropathy is inflammation of the joint, for example in rheumatoid diseases or due to bacterial infections. This changes the composition of the synovial fluid. This then attacks the cartilage substance instead of protecting and nourishing the cartilage.
Those who engage in sports with a high and one-sided load on the joints or frequently perform work that involves a high weight load or extreme movements of the joints therefore have a higher risk of developing chondropathy. Finally, genetic conditions also play a role: some people have cartilage tissue that is less resilient due to their genetic makeup.
Examination and diagnosis
Instrument-assisted examinations are very important for the diagnosis of chondropathy. X-rays or computed tomography (CT) are used for some questions, but magnetic resonance imaging (MRI) in particular provides good information for assessing cartilage damage.
Course of the disease and prognosis
Chondropathy of the joints is often a one-way street. Particularly with increasing age, the articular cartilage hardly regenerates. In young people, acute, minor injuries to the cartilage tissue often heal on their own, so that it is usually sufficient to temporarily rest the affected joint.
The general rule is that in the case of minor articular cartilage damage, the best therapy is not rest but exercise. This is because it improves the circulation in the joint and ensures that the nutrient-rich joint water circulates better inside the joint. Even if chondropathy cannot always be prevented in this way, it helps to slow down its progression considerably.
