While we have cartilage tissue in numerous parts of our body, the cartilage tissue in our joints are crucial for us. Joint cartilage allows the bones that make up the joint to easily slide over each other. All of us know that 2 ice cubes can easily slide over each other. In a healthy joint, the friction on the cartilage tissues is 3 times less than the friction between 2 ice cubes! 80% of people older than 75 have problems related to cartilage, and the lucky 20% may never suffer problems related to cartilage in their lives.
The 2 fundamental elements that discomfort the cartilage the most are excessive use and over-load. These concepts include the sudden movements that cause excessive load to be burdened on the knees and the body weight. In our daily life, our knees take on a load that is 4 times our body weight. When doing sports, this load can rise up to 8 – 10 times of our body weight. Even though our cartilages are actually highly durable structures, as all elements in nature, they also have an endurance limit. Everybody has a physiological limit and capacity. The kinds of excessive loads that our bodies are not accustomed to can cause us to be unable to use our muscles in a controlled manner and can harm our cartilages. Sports must be performed regularly and constantly in our lives but we also must abstain from repetitive and excessive load burdening. We must know our physiological limits well. Sports must be a part of our lives in a conscious manner.
When we look at the histological structure of the cartilage structure, we know that the cartilage structure, the thickness of which is 2-3 mm, actually consists of 4 layers, the borders of which are not very definite. The cartilage on the layer that is closest to the surface is the layer, the collagen fibers within which is parallel to the surface. This is the part that constitutes 10% - 20% of the cartilage thickness. This part ensures the durability of the joint as well as its brightness and lubricity. As we move towards the deep layers, the collagen fibers first take on an oblique and then a complex situation. The cartilage tissue is a special tissue that is 2-3 mm thick, can absorb the shocks and highly lubricates the surfaces of the bones. In case they deteriorate, they cause rattling noises to come from the knees as well as pain, seizing and swelling.
All these problems limit the person's movements, make life tasteless and cause gaining weight. When weight is gained, load on the knees increases, knee pains become more severe, movement become more limited and more weight is gained. In short, a vicious cycle occurs. We know that, unfortunately, a problem in the cartilage always has the tendency to progress. Despite of all scientific studies and researches made, original cartilage tissue has not be obtained completely in today's world, yet.
If we mention about the degrees of the cartilage injuries, we can say that they are examined in 4 basic grades depending on the depth and characteristic of the damage.
Grade 1: Softening of the cartilage tissue
Grade 2: Damage on 50% of the surface of the cartilage tissue
Grade 3: Damage on more than 50% of the cartilage tissue
Grade 4: Exposing underlying bone
We can group currently known cartilage treatment methods as follows:
Debridement: It is the method applied arthroscopically for curing the pain and slowing down progression in surface cartilage lesions and cartilage injuries causing problems at the joint. This method does not create a new cartilage tissue.
Microfracture: It can be applied if the area of the damaged region is not more than 2cm² in deep Grade 3 and 4 cartilage damages. The purpose is to drill holes on the bonny tissue at cartilage base to ensure that multi potent cells penetrate into the are and to create a new cartilage tissue in that area. The cartilage tissue formed s fibrous cartilage tissue and it fills the gap. However, it does not have the biological and mechanical characteristics of the hyaline (original) cartilage tissue. Its endurance is lower. Microfracture surgery is made arthroscopically.
Mosaicplasty: It is the surgery concerning transferring cartilage and bonny cylindrical block from less active part of the knee to the more active part. It can be made either arthroscopically or open. It must be noted that, during mosaicplasty surgery, we create cartilage damage at one part of the knee while repairing the damage at another part. Mosaicplasty surgery is also preferred for the cartilage damages with the size of 1-2 cm2.
Autologous Chondrocyte Implantation: It is a 2 stage surgery made frequently today. Cartilage tissue with the size of 2 rice grains are taken from less actively used part of the knee arthroscopically and sent to the laboratory. Cells in this cartilage tissue are reproduced at the laboratory. Cells, which are generally placed into a "scaffold," are implanted to cartilage defect zone with open surgery technique. Although there are many ways of stem cell therapy made by means of injection, there is not a standard application method.
Stem Cell: Stem Cell is one of the cartilage generation methods that is persistently studies throughout the world. It has not been adopted as a classical application yet. The purpose is to create cartilage tissue from a stem cell. Long term effects are not known in both autologous chondrocyte implantation and stem cell studies.
Prosthesis surgery: If all cartilage treatment methods are tried or for the knees with severe cartilage problems, prosthesis surgery is made if necessary in order to better off human life. Basically, there are 3 types of prosthesis surgery: Mini prosthesis, unicondylar Prosthesis and Total Prosthesis. Prosthesis surgeries are made with open surgery.