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WHAT ARE THE TREATMENT OPTIONS


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Joint Surface Damage (Minor Early Arthritis)

The surface of the bone inside your knee has a coating of gristle (articular cartilage is the medical term) forming the joint surface. This gristle is like firm rubber / plastic and provides a shock absorption mechanism, along with the ‘cartilages’ (meniscus is the medical term), which are made of a similar material. Hence you have three layers to your shock absorption mechanism. 

When the articular cartilage (gristle) surface is damaged by injury, it becomes roughened and wears away more quickly leading to arthritis. This process is worse if a cartilage has been partially or fully removed previously. 

You can take certain measures to slow down this wearing away process and delay (or even prevent) the onset of arthritis and the need for major arthritis surgery.

I call this situation "wear and tear" and retain the term "arthritis" for when the surfaces are completely worn through and are grinding bone on bone.

 

WHAT CAN YOU DO ? 

You can do a lot (!), but this damage often occurs in younger people who want to continue to be athletically active and they find our advice hard to accept. However here it is:

 

  1. You must limit those activities that cause your knee to swell and/or ache. Prolonged running and demanding sports such as football and netball are out of the question if the damage is between the main bones. Jumping, bending, stair and hill climbing are out if the damage is under the kneecap. 
  2. You must allow your knee to be a ‘barometer’. When it aches or swells, you have done too much. 
  3. If you are overweight, you must lose it. The excess load will wear the joint more quickly. It is often difficult to lose weight when activity is restricted. If you cannot diet well, we will recommend a dietician here at SPORTSMED·SA who can help you. 
  4. You should keep the muscles of your leg as strong and as flexible as possible.
  5. You will need to take anti-inflammatory tablets occasionally if you have a ‘flare up’ or a particularly busy time. Over-the-counter Nurofen is useful and other medications can be prescribed by us or your family doctor. You should not however take such tablets to enable you to do more than the knee normally allows and therefore accelerate the wear.
  6. You can take natural remedies that may help the knee feel better, or even try to delay arthritis. Big doses of Fish Oil (10,000 mg per day, 10 standard strength capsules, or 10 mls of the liquid, or 3-4 of the Blackmore's Joint Formula fish oil) can act as a mild anti-inflammatory. Glucosamine 1500 mg a day of the Sulphate, or its equivalent) has been shown statistically to slow down the development of arthritis, but it is unpredictable whether it will work for the individual, and particularly whether it will make the knee feel better. It may take 2-3 months to see if there is any benefit. Chondroitin  sulphate (shark cartilage) should have a similar, and maybe additive effect, but has not been scientifically proven.

       

      WHAT SORT OF PHYSICAL ACTIVITY IS OK ?

      • This depends on the degree of joint damage. 
      • If the damage is moderately advanced, activities such as cycling and swimming are ideal as there is little or no impact loading on the knee. 
      • Gym programs, social tennis and similar activities are permitted if the damage is minor.

      DOES SURGERY HAVE A ROLE ?

      • An arthroscopic ‘clean up‘ of the damaged surfaces can (in ~50% of cases) diminish the level of pain and may slow down the rate of progression by smoothing off rough edges and removing loose pieces in the joint. However, very occasionally (2 - 5%), this procedure can appear make the joint worse, and even end up with rapid acceleration of arthritis! 
      • More major surgery, such as tibial osteotomy, partial or total knee replacement, do not have a role in minor-moderate joint damage in younger people but may be necessary later.
      • There are different kinds of cartilage (gristle) repair operations, but the success of these depends on your age and the biochemisrty of the degenerative process within your knee. If you are young and the damage is well localised, and due to a traumatic episode, or a condition called Osteo-Chondritis Dissecans, you may be a good candidate for having some cartilage taken from your knee, cultured in a lab, and then re-implanted on a membrane (MACI graft; Matrix Autologous Chondrocyte Implantation). The recovery is long and slow, but the results can be very good. Alternatively, and especially if the area of damage is less than 2 sq cm, or if you are older with less healing potential, a more minor procedure involving drilling into the bone to allow some bleeding in order to stimulate some chondral (gristle) healing may well be worth a try. This is called Micro-Fracture technique. If the area affected is fairly large, you would be asked to stay on crutches for 6 weeks after this surgery. The results, at least in the short term, are symptomatically similar to MACI grafting. Your surgeon would discuss the pros and cons of these two procedures with you if it looked like you were a candidate for a chondral repair operation.