chondropathy

Chondropathy: description

“Chondropathy” describes various types of diseases of the cartilage tissue in the human body. The term “cartilage damage” is also used synonymously. It can also occur after a youthful sports injury as well as in advanced arthrosis. Often, however, not only the cartilage tissue is affected, but also the adjacent bone. This is called osteochondropathy.

What types of chondropathy are there?

Chondropathy can occur in any type of cartilage. Since often high mechanical loads act on the cartilage coating of the joint surfaces and its repair processes take place very slowly, cartilage damage relatively often develops there. The hip, shoulder and ankle are increasingly affected, but especially the knee.

Cartilage damage to the knee

The knee joint is heavily stressed in everyday life and is therefore particularly at risk for wear on its cartilage surfaces. It affects not only the contact surfaces between the upper and lower leg bones, but also the back surface of the kneecap, which has to transfer strong tensile forces of the thigh muscles to the lower leg when the leg is stretched. Retropatellar chondropathy, ie cartilage damage behind the kneecap, is therefore a common orthopedic diagnosis.

A retropatellar cartilage damage often occurs in younger years, sometimes even children are affected. In addition, the knee joint, especially in physically active children relatively frequently affected by the osteochondritis dissecans, in which, for reasons yet uncleared, the circulation of a bone area below the articular cartilage is disturbed. It is believed that short impact loads such as stopping steps in tennis or football have an influence.

As a result, this section of bone dies together with the overlying cartilage. Often, the dead bone-cartilage piece separates from the remaining bone and then floats freely in the joint (joint mouse, free joint body).

Cartilage damage on the hip

Also, the hip joint must withstand high loads during life. In addition, it is only covered with a relatively thin cartilage layer. This is why cartilage damage is particularly common in older people at advanced age. The result – a so-called hip joint arthrosis, is already considered a widespread disease.

A special form of chondropathy on the hip joint is the epiphysiolysis capitis femoris, also called juvenile hip-joint solution. The uppermost part of the femur separates from the underlying bone along the growth joint (epiphysis) and slips off. Without medical treatment, the detached bone piece dies together with the cartilage. The adolescent hip-joint solution occurs mainly in male adolescents in puberty, often in conjunction with obesity.

Cartilage damage to shoulder and ankle

Not only wear, but also acute injuries and chronic stress on the joints often lead to cartilage damage. The ankle and shoulder are particularly at risk, especially for physically active people. For example, those who bend over their feet often not only contract injuries to ligaments and bones but can also injure their cartilage.

In some sports such as tennis or swimming, the shoulders are constantly loaded only in a certain direction of movement. This creates a muscular imbalance and the humeral head shifts out of the center of the shoulder joint socket. The burden is then no longer distributed evenly on the cartilage, the result may be a chondropathy on the shoulder joint. Even intense strength training, such as bench press or weight lifting, can hurt the shoulders. Especially if you perform the exercises incorrectly or do not pay attention to train the muscles on the opposite side of the joint also

Special forms of chondropathy

In addition to the classic chondropathies on the articular cartilage, there are some special variants such as the Tietze syndrome. In the process, the costal cartilages ignite at the connection to the sternum and cause pain and swelling. How exactly the Tietze syndrome arises, is not yet clear.

Even the triggers of polychondritis are not yet clear in medical research. In this form of chondropathy, all the cartilage of the body can be inflamed. This usually affects the articular cartilage, but there are also cases where the auricles or the nasal cartilage are affected.

How to describe the extent of cartilage damage?

How pronounced a chondropathy of articular cartilage is, doctors describe with the help of a special division of Outerbridge from cartilage damage grade 0 to cartilage damage grade 4:

• Chondropathy grade 0: The cartilage is healthy and undamaged, so there is no damage to the cartilage.
• Chondropathy grade 1: The cartilage is completely present and smooth, but is partially softened, especially in the zones of intense pressure.
• Chondropathy grade 2: The cartilage is roughened and there are sometimes small cracks
• Chondropathy grade 3: There are cracks and holes in the cartilage, but these do not reach the bone.
• Chondropathy grade 4: In places, the cartilage layer is completely destroyed and the underlying bone is exposed.

Chondropathy: symptoms

The discomfort of a cartilage damage depends on whether it has arisen suddenly, such as an accident, or whether it develops creeping like a wear and tear. In addition, the localization of damage plays a role. General symptoms of chondropathy of the articular cartilage are:

• in the early stage an indefinite pressure feeling on the affected joints
• Pain progresses as the injury progresses, first during exercise, later at rest
• Pain on pressure on the affected joint or kneecap
• Movement restrictions due to the pain
• possibly joint effusions with swelling

The articular cartilage itself has no nerves, so cartilage damage does not cause any pain. In the case of a slowly progressing chondropathy, therefore, the affected persons often initially have no complaints at the joints. However, if the cartilage damage extends all the way down to the sensitive periosteum, this can be very painful.

A typical phenomenon in chondropathy is the so-called onset pain. The patients feel pain especially at the beginning of an activity. For example, the onset of pain occurs after sitting or standing for a long time, when you get up or start running. With continued loading, the pain decreases again and may even temporarily disappear altogether.

Typical are the retropatellar cartilage damage. Knee symptoms when walking downhill or downhill, squatting and sitting for longer, while walking on the floor often causes no discomfort.

Chondropathy: causes and risk factors

There are a variety of possible causes for the different forms of chondropathy. Abrasions on the articular cartilages are very often the trigger. Such signs of wear develop partly over years and are more common especially with increasing age. In addition to being in the individual physical stress and the age is overweight is another risk factor.

Abrasion of the articular cartilage can also occur in young people and take a much faster course. Then usually a malposition or malformation (dysplasia) of the corresponding joint is to blame.

Skeletal anomalies are also often the cause of retropatellar cartilage damage. Kneecap and knee joint behave like a sledge and its channel: the kneecap slides over the knee joint during flexion and extension of the lower leg within a fixed lane. If the distribution of forces at the knee changes as a result of leg malpositions or the weakness of certain muscle components, the kneecap may be pulled laterally out of its “gutter” and the cartilage may be damaged on its back surface.

Another cause of chondropathy is inflammation of the joint, for example in rheumatoid diseases or bacterial infections. This changes the composition of the synovial fluid. It then attacks the cartilage instead of protecting and nourishing the cartilage.

Causes of acute chondropathy are usually sports injuries or work-related accidents. Thus, a hard shock or twist load can tear the cartilage. But even a permanent overload harms the cartilage tissue at the joints. For example, excessive walking can trigger retropatellar chondropathy (Runner’s Knee).

Therefore, those who do sports with high and one-sided joint strain, or who often carry out work that involves a high weight load or extreme radii of movement of the joints, has a higher risk of developing chondropathy. Finally, genetic conditions also play a role: some people have a less durable cartilage due to their condition.

Chondropathy: examination and diagnosis

In the preliminary discussion, the so-called anamnesis, the doctor first asks what symptoms occur and in which situations they are noticeable. Do they only occur during certain movements or permanently? As a start-up, as a constant or increasing stress pain? Did the problems come suddenly or slowly? Are you worse in the morning than during the day or at night?

This is followed by a physical examination, during which the doctor checks the degree of mobility of the joints, and feels whether under his or her hand certain movements cause rubbing or popping, or whether pressure can provoke pain. If, for example, the patient has pain when the kneecap is pushed down under light pressure and then asked to tense the thigh muscle, this may be a sign of a retropatellar chondropathy (signs of a tooth).

Very important for the diagnosis of chondropathy are device-assisted examinations. For some questions, X-rays or computed tomography (CT) are used, but especially magnetic resonance imaging (MRI) provides good information for assessing cartilage damage. After all, the examiner can also perform a joint scan (arthroscopy), using a camera to directly examine the cartilage tissue and possibly even treat it the same way.

Chondropathy: treatment

The therapy of a chondropathy depends on the particular type and cause of cartilage damage. So often a treatment of the underlying disease or avoidance of mechanical triggers is required. Special medications relieve the pain and counteract inflammation. Also a physiotherapy can help. For example, certain exercises can compensate for muscular deficits and correct incorrect or incorrect joints.

However, if chondropathy is severe and there is no chance of cartilage regeneration, surgery may be required. For example, in case of a joint mirroring, the cartilage can also be smoothed, rinsed, if necessary, removed, free joint bodies are removed, and shingles or cracks are stuck in the cartilage.

If congenital misalignments of the joints are the cause of chondropathy, they may be remedied by surgery that better aligns the joint.

Recent methods also allow for the transplantation of cartilage tissue, either from the patient’s own body or artificially grown in the test tube.

If the destruction of a cartilage surface is already very advanced, sometimes only a complete joint replacement comes into question. A typical example of this is total hip arthroplasty (hip TEP) as the last option for severe cartilage damage.

Knee Treatment

If a retropatellar cartilage damage has been caused by an overload on the knee joint, you should first protect the joint. However, it is important to move the affected knee as early as possible and to, as too long immobilization can lead to permanent movement restrictions and to a reduction of the thigh muscles. This, in turn, can interfere with the balance of forces at the knee joint and patella and even aggravate retropatellar chondropathy.

Chondropathy: disease course and prognosis

Chondropathy of the joints is often a one-way street. Especially with increasing age, the articular cartilage can hardly regenerate. In young people, acute, minor injuries to the cartilaginous tissue often heal themselves, so that it is usually sufficient to temporarily protect the affected joint.

However, one can reduce the risk of cartilage damage if one refrains from particularly joint-straining sports, practices joint-gentle exercise techniques and prevents obesity.

The basic rule is: In the case of low-grade articular cartilage damage, it is not sparing but movement that is the best therapy. Because it improves the circulation in the joint and ensures that the nutrient-rich synovium circulates better in the interior of the joint. A chondropathy So you may not always be able to prevent it, but slow down the course.