Articular Cartilage Injury Information

Articular Cartilage Injury Information

Knee cartilage damage is often confusing for those not versed in anatomy, mainly because there are two types of cartilage in the knee. Often times damage to the meniscus fibrocartilage in the knee is simply termed “torn cartilage.” However, there is another type of cartilage that is very different from a fibrocartilage injury. This cartilage is called articular cartilage. While articular cartilage and fibrocartilage are found along side each other in the knee, each has distinct features and functions.

 

What is Articular Cartilage?

This cartilage, also called hyaline cartilage, is smooth, shiny, slippery, and strong. It’s mostly made up of the protein collagen and water. It has distinctive five layers, but is most often medically described in three zones - the superficial zone, transitional zone, and deep zone. In the knee, articular cartilage covers the ends of the femur and femoral grove, the top end of the tibia, and the underside of the patella (kneecap). Articular cartilage is what allows the bones in the knee joint to smoothly slide over one another without actually rubbing bone against bone, thereby keeping pressure and friction to a minimum. Articular cartilage is extravascular, meaning it doesn’t have a direct blood supply. It also doesn’t have a nerve supply or lymph nodes.

How Is The Articular Cartilage Injured In The Knee?

Medically, injured areas are often referred to as lesions. These lesions may be caused by a traumatic forceful impact just under the knee, such as when a football player is tackled from the side with his foot planted firmly on the ground. The lesions may also be caused be gradual wear and tear (degenerative process) on the knee joint, repetitive stress on the knee joint, overuse of the knee joint, or genetic defects in the cartilage or joint alignment.

Articular cartilage injuries are also often seen in conjunction with other knee injuries, such as anterior cruciate ligament injuries, posterior cruciate ligament injuries, and dislocations of the knee.

Articular cartilage damage is graded on a surgical scale of one though four as follows:

Grade I - soft spots in the cartilage.
Grade II - minor lesions to the most superficial layer of cartilage.
Grade III - a tear through multiple layers of cartilage that may be diagnostically seen as a deep hole or crevice in the cartilage.
Grade IV- a full-thickness lesion through all five layers of cartilage to the underlying bone.

What Are The Symptoms Of A Knee Articular Cartilage Injury?

Often, the injury isn’t painful when only the most superficial layer of cartilage is injured. However, as lesions worsen, holes and rough areas may produce symptoms of pain, lack of joint mobility, and inflammation as the design and function of the joint is disrupted. General symptoms include the following:

* localized pain, swelling, heat, redness at the knee joint
* bruising may occur in direct trauma causes
* there may be an audible clicking in the knee joint upon movement
* the joint may be stiff
* range of motion may be limited
* the knee may lock-up or give away

Key Points About A Knee Articular Cartilage Injury

* The knee is considered arthritic (osteoarthritis) when a significant amount of articular cartilage is lost.

* Since articular cartilage doesn’t have a nerve supply, the pain from the injury isn’t actually caused by the cartilage itself. The pain results from the insufficient amount of articular cartilage protecting the bone from stress, friction, and pressure.

* Since articular cartilage doesn’t have a direct blood supply, cartilage is very slow to heal by itself. Deep enough injuries may tap into the blood supply from the bone for nourishment, but the articular cartilage is often “filled in” or replaced with fibrocartilage scar tissue.

* A grade four lesion may involve a small piece of cartilage breaking off inside of the joint. This is referred to as a loose body. If this happens joint motion may be severely limited. The subchondral area of bone, which is the area of bone located just under the articular cartilage, may also fracture due to the articular cartilage no longer preventing bone to bone friction. This is referred to as osteochondritis dissecans.

 

Strengthening Exercises

These Articular Cartilage Injury Exercises are ideal to build strength and flexibility.

Massage Treatment

These Articular Cartilage Injury Massage Techniques are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms, especially when used alongside the Sinew Therapeutics liniments and soaks.

 

ACUTE STAGE SYMPTOMS AND TREATMENT

 

This stage is characterized by swelling, redness, pain, and possibly a local sensation of heat, indicating inflammation. If coolness makes your pain feel better, then the Acute Stage Treatment is recommended.

 

ACUTE STAGE SYMPTOMS:

 

The acute stage starts the moment an injury occurs and lasts until the swelling and inflammation are gone. The swelling is the result of the blockage of blood, tissue fluids and circulation in the knee because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating; blood and fluids back up behind the injured knee, causing pain, inflammation, lumps and swelling.

The sensation of heat is due to the warming action of the blood and fluids overheating in the injured knee as they back up and accumulate. Stiffness and decreased mobility are due to spasms in tendons and ligaments that have contracted reflexively beyond their normal range from the impact of the injury.

As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.

During the acute stage it is very important to restore normal circulation to the knee, break up clotted blood and stagnant fluids, reduce swelling, and reduce the redness and heat associated with inflammation. By restoring the flow of blood, fluids, and circulation in the knee, then pain is relieved, damaged tissues can regenerate with healthy functional tissue, and the knee can strengthen and regain it's mobility.

 

ACUTE STAGE TREATMENT:

 

1. Apply the Sinew Herbal Ice on your knee to reduce redness, swelling, and inflammation while dispersing accumulated blood and fluids to help restore normal circulation to the knee. This first-aid treatment is used in place of ice to significantly speed up the healing process. It reduces the swelling and inflammation more effectively than ice, allowing you to more quickly regain range of motion. Acute Sinew Liniment can be used in-between applications.

Ice is not recommended because it does not help repair damaged tissues and keeps everything in the injured area frozen, causing the stagnation of blood and fluids and the contraction of muscles, tendons and ligaments. In Chinese sports medicine ice is not used and is considered a culprit in injuries that donít heal well.

2. Massage your knee with Acute Sinew Liniment to relieve pain, reduce swelling and inflammation, break up clotted blood and stagnant fluids, and stimulate circulation of blood and fluids to help cells quickly repair damaged tissues. Sinew Herbal Ice can be used in-between applications.

3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.

 

 

CHRONIC STAGE SYMPTOMS AND TREATMENT

 

This stage begins once the swelling and inflammation are gone, but you still feel pain, stiffness, weakness, and/or sensitivity in cold and damp weather. If heat makes your pain feel better, then the Chronic Stage Treatment is recommended.


CHRONIC STAGE SYMPTOMS:

 

The chronic stage begins once the swelling and inflammation are gone, but you still feel aching pain and stiffness. This is because there are still accumulations of stagnant blood and fluids in the knee that are blocking circulation and blood supply to damaged tissues, creating residual pain, stiffness and weakness. You may actually feel hard nodules like sand in the tissue, indicating accumulation, calcification, and adhesions, which all cause pain, stiffness, and joint instability.

Your knee may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. When you move your knee you may hear a clicking or popping sound from the tendons and ligaments slipping very slightly in and out of their natural alignment indicating weakness and joint instability, causing chronic pain and a cycle of reinjury. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.

Increasing circulation and blood supply to the damaged tissues is very important in treating chronic injuries because tendons and ligaments do not have an extensive direct supply of blood. That is why chronic injuries can be slow to heal. Increasing local circulation also prevents cold and dampness from penetrating the injured area, preventing pain and stiffness.

During the chronic stage it is very important to break up remaining accumulations of blood and fluids, and increase circulation and blood supply to the damaged tissues. By increasing circulation and blood flow in the knee, then pain and stiffness is relieved, and the tendons and ligaments can strengthen to restore stability.


CHRONIC STAGE TREATMENT:

 

1. Massage your knee with Chronic Sinew Liniment to relieve pain and stiffness, strongly stimulate circulation and blood flow to damaged tissues, and promote the healing of overstretched tendons and ligaments. Sinew Injury Poultice and/or the Sinew Warming Soak can be used in-between applications.

2. Apply the Sinew Injury Poultice on your knee to relieve residual pain and stiffness, significantly stimulate circulation and blood flow to damaged tissues, and further promote the healing of overstretched tendons and ligaments. The Sinew Injury Poultice is particularly useful if your knee is more painful in cold and damp weather. Chronic Sinew Liniment and/or the Sinew Warming Soak can be used in-between applications.

3. Soak your knee with the Sinew Warming Soak to ease joint pain, increase range of motion, and strongly increase local circulation to drive coldness and dampness out of damaged tissues. The Sinew Warming Soak is particularly useful if your knee is more painful and sensitive to cold or hurts more in cold weather. The soak can be used by saturating a towel in the liquid and applying it to your knee. Chronic Sinew Liniment and/or the Sinew Injury Poultice can be used in-between applications.

4. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.