Physical therapy for cartilage damage.

Cartilage has no blood supply of its own. And nutrients and oxygen reach cartilage through the synovial fluid in the joint. So because cartilage has no blood vessels of its own, cartilage is vulnerable to damage and cannot properly repair on its own. For this reason, rehabilitation of cartilage complaints is difficult and specialized physical therapy is necessary for lasting results.  

When you get an injury to cartilage, it often causes stiffness, pain and possibly reduced joint mobility. Normal daily things like climbing stairs, standing and walking for long periods of time can then cause symptoms. It also gives limitations in your athletic activities. The knee may also swell in some cases in response to exercise and movement. 

Athletes are more likely to be at risk for cartilage damage. This is because sports such as soccer, running and basketball, for example, put a lot of pressure on the joints. During these activities, the cartilage in the joints is often subjected to heavy stress, which can lead to damage during sudden movement. This damage occurs from repeated impact or as a result of an abrupt movement that causes damage. Athletes often find that their mobility and strength decrease due to this injury, which can hinder their performance.

Although cartilage damage and osteoarthritis are both complaints of cartilage, they are different conditions. Cartilage damage often results from a sudden injury or overuse and, in some cases, is repairable with surgery or proper rehabilitation. Osteoarthritis is a degenerative joint disease in which the cartilage gradually deteriorates in quality and causes symptoms often as a result of aging or long-term strain. 

How is cartilage injury diagnosed?

Only an orthopedist or surgeon can determine with certainty whether significant cartilage damage has occurred. In most cases, this is done by an MRI scan. In some cases, an ultrasound in our practice can also provide an indication of cartilage damage. These ultrasound images are an initial indication, but an MRI is necessary for a complete and accurate diagnosis. 

Cartilage damage is classified into five grades according to the International Cartilage Repair Society (ICRS):

• Grade I: A soft spot with less resistance than the surrounding healthy cartilage.
• Grade II: Superficial cracks or small defects affecting less than half of the total cartilage thickness.
• Grade III: Deeper cracks or fissures affecting more than half of the total cartilage thickness.
• Grade IV: A tear to the subchondral bone in which the entire thickness of the cartilage surface is affected.
• Grade V: Impairment of the total cartilage thickness with involvement of the subchondral bone, also called a full-thickness defect.

Sometimes, in addition to MRIs, X-rays are also taken to rule out loose bone fragments and detect signs of osteoarthritis. This complete review ensures that an effective and appropriate treatment plan for cartilage rehabilitation can be established.

The various options surgically for cartilage repair

Auto-cart Treats cartilage defects using the patient's own cartilage. In this process, cartilage particles are carefully removed, collected and mixed with platelet-rich plasma (PRP). This mixture is then inserted back into the defect and fixed with the body's own thrombin. This offers a durable solution for small cartilage defects and is performed at Bergman Clinics and others.

Microfracturing is suitable for smaller cartilage defects. This involves drilling tiny holes in the bone beneath the cartilage defect, which stimulates stem cells from the bone marrow to fill the defect. Patients often need six weeks of recovery time with crutches or a brace after the procedure to allow the new tissue to grow.

Hydrogel injection, developed at the University of Twente, fills cartilage defects with a special gel that completely covers the damaged surface after injection. This technique is still in the research phase, but promises cartilage repair for smaller defects without surgery. 

Autologous Chondrocyte Implantation, here cartilage cells are cultured and replaced to repair larger defects. After an initial keyhole surgery, in a second procedure, the cultured cells are applied to the damaged area as small spheres. This provides a permanent solution to extensive damage and is regularly performed at ETZ Tilburg, one of four cartilage centers in the Netherlands.

At Fysio Fitaal in Tilburg, you are in good hands for rehabilitation after cartilage surgery. We know all the ins and outs of the rehabilitation process and know how much impact it has on your daily life and sporting goals. Our specialized physical therapists make the recovery process understandable and manageable. Thanks to our experience with various surgical techniques such as the AutoCart procedure, microfracture, hydrogel and autologous chondrocyte implantation, we are fully equipped to support you at every stage of recovery. Together, we create a treatment plan that focuses on lasting results and restoration of strength, stability and mobility. Learn more at Cartilage rehabilitation - PhysioFitaal.

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