Therapy

The appropriate therapy as well as the success of the therapy for cartilage damage in the knee joint depends crucially on the given circumstances. For example, complaints that arise during puberty due to a growth spurt usually subside of their own accord after some time. This is not necessarily the case for symptoms that are due to massive overloading.

It is clear that certain strains, which occur mainly during sporting activities, must be avoided. Changes in training procedures in terms of duration, intensity and frequency should also be taken into account and usually reversed. Everyday movements that place a strain on the knee joint and the affected region should also be avoided.

These include frequent climbing stairs, carrying heavy loads and constant sitting or squatting. In some cases, it may be necessary to take painkilling medication to alleviate the symptoms of cartilage damage behind the kneecap. So-called NSAIDs are often used for this purpose, which include acetylsalicylic acid (aspirin), ibuprofen and diclofenac.

In addition to the analgesic component, these also have an anti-inflammatory effect on the affected area, which is additionally beneficial for successful healing. According to recent studies, physiotherapy and physical treatment methods have also been shown to be successful, which is why they are now included in the treatment. Physiotherapy is intended to relieve the joint of the “stiffness” that some patients with cartilage damage behind the kneecap complain about.Physical therapy approaches include ultrasound, cold and heat therapy and electrotherapy.

Treatments that the patient can carry out themselves also include physiotherapeutic exercises that can be shown to the patient by a physiotherapist or doctor and which can significantly improve the chances of recovery by regular performance. Women are also advised to wear shoes with flat heels in order not to put unnecessary strain on the cartilage. Special bandages can also provide relief in the case of longer lasting complaints.

The main purpose of these bandages is to restore the stability of the joint. Surgical intervention is only suggested in cases where there is no chance of recovery through non-surgical attempts at healing. Surgical intervention is therefore only recommended in certain cases.

Surgical intervention can be attempted to stimulate the cartilage to regenerate by means of a so-called Pridie drilling. In this procedure, holes are drilled through the kneecap, thus stimulating the tissue around the cartilage to form new cartilage (so-called replacement cartilage). The surgical procedure is also useful if the cause of the damage is due to increased pressure on the patella.

This pressure can be reduced by means of surgery, which leads to a better sliding movement of the patella. Other surgical approaches to treating cartilage damage behind the patella can include microfracturing, mosaicplasty and a cartilage transplant. Surgery is mainly performed in young patients with severe cartilage damage behind the patella to prevent further progression of the damage up to arthrosis.

Often an operation consists of smoothing the inner surface of the joint and “cleaning” the joint. This procedure is called debridement and is performed arthroscopically. This means that no open surgery is performed and the knee is cut open, but only small incisions of about 1 cm in length are made, where the surgical instruments and a camera are inserted.

In this method, any loose pieces of cartilage are removed and the joint mucosa is also smoothed to relieve the symptoms. In addition, there are a number of other surgical procedures that can be carried out behind the kneecap in case of cartilage damage. A so-called abrasion plasty is rarely performed and can only be used for minor cartilage damage.

In an arthroscopy, the remaining cartilage in the damaged cartilage area is milled away and bleeding from the bone marrow occurs. This allows so-called stem cells to enter the defect area and form new cartilage. However, this newly formed bone is not as strong and resilient as the original cartilage.

In mosaicplasty, the cartilage in the area of the defect is punched out and replaced by a cylinder punched out at another part of the body. The intact cartilage is taken from another part of the knee joint that is not so heavily loaded. Depending on the extent of the cartilage damage, one or more cylinders must be removed.

Osteochondral allografts are a similar procedure. Here, however, the newly inserted cylinder is synthetic and supports the cartilage and bone formation by absorbing the stem cells necessary for the new formation and degrading them in parallel with the new cartilage formation itself. Microfracturing is a very common procedure for the surgical treatment of cartilage damage behind the patella.

It can be performed arthroscopically, i.e. it is not an open operation but a minimally invasive procedure. It therefore involves comparatively few risks for the patient. The procedure consists of making small holes in the bone underneath the cartilage using certain instruments.

This leads to bleeding into the damaged joint from the bone marrow and certain cells that are in the blood attach themselves to the places where the holes are in order to form new cartilage substance there. This procedure is useful if there is cartilage damage to the tibia or femur. At the back of the kneecap, the pressure and friction are so great that the newly formed cartilage is quickly rubbed off again.

Another method is the so-called autologous cartilage cell transplantation (ACT). ACT is an open transplantation of cartilage cells that have previously been cultivated and inserted into the cartilage damage. Two procedures are necessary for this.

Both can nowadays be performed arthroscopically. In the first knee arthroscopy, cartilage cells are taken from a less heavily loaded area of the knee joint.These cartilage cells are then multiplied in the laboratory and after about 3 to 4 weeks the body’s own cartilage cells are introduced into the area of cartilage damage. How is the result The result of most operations is not very satisfactory, since the area behind the patella is very heavily loaded. Cartilage that has been stimulated to form new cartilage by the various surgical procedures wears off quickly. Often, only a cleaning of the joint is useful.