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Cartilage damage Content Supplied by NHS Choices
Introduction

Cartilage damage is a relatively common type of injury. It often involves the knees, although joints such as the hips, ankles and elbows can also be affected.

Cartilage is a tough, flexible tissue found throughout the body. It covers the surface of joints, acting as a shock absorber and allowing bones to slide over one another.

It can become damaged as a result of a sudden injury, such as a sports injury, or gradual wear and tear (osteoarthritis).

Minor cartilage injuries may get better on their own within a few weeks, but more severe cartilage damage may eventually require surgery.

This page covers:

Symptoms

When to get medical advice

Treatments

Symptoms of cartilage damage

Symptoms of cartilage damage in a joint include:

  • joint pain - this may continue even when resting and worsen when you put weight on the joint
  • swelling - this may not develop for a few hours or days
  • stiffness
  • a clicking or grinding sensation
  • the joint locking, catching or giving way

It can sometimes be difficult to tell a cartilage injury apart from other common joint injuries, such as sprains, as the symptoms are similar.

When to get medical advice

If you've injured your joint, it's a good idea to try self-care measures first. Sprains and minor cartilage damage may get better on their own within a few days or weeks.

More severe cartilage damage probably won't improve on its own and if left untreated, can eventually wear down the joint.

Visit your GP or a minor injuries unit (MIU) if:

  • you can't move the joint properly
  • you can't control the pain with ordinary painkillers
  • you can't put any weight on the injured limb or it gives way when you try to use it
  • the injured area looks crooked or has unusual lumps or bumps (other than swelling)
  • you have numbness, discolouration or coldness in any part of the injured area
  • your symptoms haven't started to improve within a few days of self-treatment

Your GP may need to refer you for tests such as an X-ray, magnetic resonance imaging (MRI) scan or arthroscopy (a type of keyhole surgery used to look inside joints) to find out if your cartilage is damaged.

Treatments for cartilage damage

Self-care measures are usually recommended as the first treatment for minor joint injuries. For the first few days:

Get medical advice if your symptoms are severe or don't improve after a few days. You may need professional treatment such as physiotherapy, or possibly surgery.

A number of surgical techniques can be used, including:

  • encouraging the growth of new cartilage by drilling small holes in the nearby bone
  • replacing the damaged cartilage with healthy cartilage taken from another part of the joint
  • replacing the entire joint with an artificial one, such as a knee replacement or hip replacement - this is usually only necessary in the most severe cases

Read more about how cartilage damage is treated.

Treatment

Minor cartilage damage may improve on its own within a few weeks, but more severe damage will often require surgery.

This page covers:

Initial treatment and self-care

Physiotherapy

Surgery

Less common surgical procedures

Initial treatment and self-care

If you've injured your joint and your symptoms aren't too severe - for example, you're still able to put weight on and move the joint - you can often look after yourself using "PRICE therapy".

PRICE stands for:

  • Protection - protect the affected area from further injury by using a support, such as a knee brace.
  • Rest - rest the affected joint as much as possible during the first two or three days (crutches may help if you've injured your knee or ankle). Then try gradually returning to light activity over the next few days and weeks.
  • Ice - apply an ice pack or bag of frozen vegetables wrapped in a towel to the injured area for 15 to 20 minutes every two to three hours during the first two or three days.
  • Compression - compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a simple elastic bandage or an elasticated tubular bandage available from a pharmacy.
  • Elevation - keep the injured area raised and supported on a pillow whenever you can to help reduce swelling.

If your joint is painful, take ordinary painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs).

Visit your GP if your symptoms haven't started to improve after a few days of PRICE therapy.

Physiotherapy

Physiotherapy can be helpful if you have difficulty moving the affected joint. Your GP may be able to refer you to a physiotherapist, or you may choose to pay for private treatment.

A physiotherapist can teach you exercises to help strengthen the muscles surrounding or supporting your joint. This may help to reduce pain and pressure on the joint.

Physiotherapy can also be useful when you're recovering from the surgical procedures described below.

Surgery

Severe cartilage damage doesn't tend to heal very well on its own, so surgery is often necessary in these cases.

Surgery is usually performed using arthroscopy - a type of "keyhole" surgery where special instruments are inserted into the joint through small cuts (incisions) - although sometimes larger incisions need to be made.

It's normally carried out under general anaesthetic (where you're asleep).

Some of the main procedures are:

  • Lavage and debridement - the joint is cleaned out to remove any loose tissue and the edges of the damaged area are trimmed to make them smooth. It may sometimes be possible to repair the damage at the same time.
  • Marrow stimulation (microfracture) - tiny holes are made in the bone beneath the damaged cartilage, which releases bone marrow into it. The marrow cells then begin to stimulate the production of new cartilage.
  • Mosaicplasty - small plugs of healthy cartilage from non-weightbearing areas of a joint, such as the side of the knee, are removed and used to replace small areas of damaged cartilage.
  • Osteotomy - the alignment of the leg is altered slightly to reduce pressure on the damaged area and improve pain. This usually involves adding or removing a wedge of bone from the shin or thigh bone. The bone is fixed with a plate until it heals.
  • Joint replacement - replacing the whole joint with an artificial one, such as a knee replacement or hip replacement, is occasionally necessary if the damage is particularly severe.

Talk to your surgeon about which type of surgery they think is best for you, what the possible risks are, and how long they expect it will take you to recover.

You'll usually need to take things easy for at least a few weeks after surgery, and you may not be able to return to strenuous activities and sports for several months.

Less common surgical procedures

There are also a number of alternative surgical techniques that are sometimes used to treat cartilage damage, including:

  • Allograft osteochondral transplantation (AOT) - similar to mosaicplasty, but the replacement cartilage is obtained from a recently deceased donor and is used to repair larger damaged areas.
  • Autologous chondrocyte implantation (ACI) - the surgeon first takes a small sample of cartilage cells from the joint. These are then used to grow more cells in a laboratory and the new cells are used to replace the damaged cartilage.
  • Artificial scaffolds - a special patch or gel is used to repair the damaged cartilage. It may be used in combination with marrow stimulation or on its own.

However, these procedures are only carried out in a few hospitals in the UK and aren't routinely provided on the NHS. You may be able to pay for them privately, but they can be very expensive.

The National Institute for Health and Care Excellence (NICE) says there's too much uncertainty about ACI for it to be used on the NHS, unless it's being done as part of a clinical trial. But this will be reviewed again soon, so this recommendation may change.

For more information, see the NICE guidance on the use of autologous chondrocyte implantation for the treatment of cartilage defects in the knee joints.

 
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