Cartilage damage

Cartilage damage in the knee is one of the most common diseases in the knee joint. A distinction is made between locally limited cartilage damage and a general cartilage wear, the so-called knee arthrosis.

Typical symptoms of cartilage damage in the knee are load-dependent pain and swelling.

The treatment depends on the causes and severity of the cartilage damage. For this reason, we pay great attentionto a precise analysis of the cartilage damage and its cause during cartilage damage treatment so that we can initiate individualized cartilage damage therapy.

The size, location and extent of the cartilage damage in the knee and the involvement of the bone play a decisive role. In addition, we take into account the requirements and age of the patient and attach great importance to treating not only cartilage damage but also bone metabolism, gait, ligament instabilities or axial deformity simultaneously.

CARTILAGE DAMAGE THERAPY – WITHOUT OP, WITH CELL THERAPY

Cartilage damage therapy depends not only on the stage of cartilage damage, but also on the demands and habits of our patients.
Since the knee pain is due to local inflammation, it can be reduced by anti-inflammatory drugs. Medicines of first choice in cartilage damage therapy are drugs with strong pain and swelling relief, the so-called non-steroidal anti-inflammatory drugs (NSAIDs) and Coxibe. Dietary supplements such as the combination of glucosaminoglycan and chondroitin sulphate have also been shown to have a positive effect on healing cartilage damage.
Painlessness in cartilage damage is a prerequisite for improving the muscular situation with targetedphysiotherapy. The focus is on strengthening the muscles, mobilizing the joints and improving coordination.
In addition to cartilage treatment, physical measures such as heat or cold applications, electrotherapy or ultrasound can also be applied. Acupuncture treatment has also been proven to reduce pain.
In addition, we use orthopaedic aids such as special tape systems, bandages, splints and orthopaedic buffer heels for cartilage damage therapy.
The most common type of injection therapy used in cartilage treatment is the administration of cortisone directly into the joint. This reduces the local inflammation. Although the effect occurs promptly, which is why we like to use it in the acute case of cartilage therapy, it also subsides quickly and cannot be used too often due to the side effects. We at the Knee and Health Institute therefore use it in only acute pain situations.

HYALURON

Among other things, hyaluronic acid is responsible for storing water and thus strengthening cartilage and making it more resistant. At the same time, it is known that damaged cartilage has a low proportion of hyaluronic acid, which explains why the administration of high-molecular hyaluronic acid helps to build up and strengthen cartilage. Hyalurone/hyaluronic acid increases the viscosity of the synovial fluid, reduces joint stress and blocks phagocytosis, which leads to anti-inflammatory success. In addition, PRP blocks nitrogen oxides, which are associated with the development of osteoarthritis and represent a strain on the joint. Current studies show that cartilage therapy with hyaluronic acid can reduce pain by improving cartilage properties and even delay the onset of cartilage surgery. For us, hyaluronic acid is the first choice for early cartilage damage therapy in order to rebuild it adequately and avoid cartilage surgery.

We recommend the injection of hyaluronic acid for chronic, mild cartilage damage in one of the three knee compartments. We give 3 injections at intervals of approx. and recommend as the combination of PRP and hyaluronic acid or the use of stem cells from the patient’s own body fat for cartilage damage treatment at the knee.

PRP

In PRP therapy, growth factors and exosomes are extracted from the patient’s own blood and degranulated after injection into the affected region, releasing various growth factors. These vascular, endothelial and insulin-like growth factors have enormous regenerative powers. More importantly, they can prevent inflammatory processes and their negative and toxic influence on cartilage. In addition, PRP treatment also reduces nitric oxide and thus oxidative stress on a joint. Furthermore, PRP therapy at the knee increases the effect of hyaluronic acid and reduces the metal proteinase, which is responsible for cartilage degradation.

This explains the healing potential and pain reduction in PRP and ACP therapy of cartilage damage and osteoarthritis. Since PRP is obtained from autologous blood and this therapy is based on the body’s own mechanisms, in contrast to cortisone therapy there are NO side effects.

Since it is known that hyaluronic acid also has a cartilage healing effect, we prefer the combination therapy of hyaluronic acid AND PRP. Depending on the extent of the cartilage damage, this therapy is injected 3-4 times into the affected joint. Between the individual injections at least 2 and not more than 10 days should pass in order to achieve an optimal result. After an injection, swelling can occur for a short time due to the increase in volume, but this is normally not painful and disappears very quickly on the same day. Relief or immobilization is not necessary.

STEM CELLS

Furthermore, due to the complex interaction between the Hoffa body, inflammation, degeneration and remodeling processes, we rely on stem cell therapy derived from our own fatty tissue for cartilage therapy at the knee. Since 2013, Prof. Schoettle has had extensive knowledge about the use of adult stem cells and their precursors in orthopaedics. In Munich, we currently use a procedure that has already been used in more than 10,000 cases worldwide for the treatment of gonarthrosis and is also accepted by the FDA.

Stem cells are the firemen and at the same time the maintenance team of our body and become active when they are attracted by dying cells or inflammations. They not only have a maximum anti-inflammatory effect, but also the possibility to multiply themselves and differentiate into the damaged tissue and thus achieve regeneration. They can also form new blood vessels to nourish the dead cartilage and support regeneration. When stem cells from the same “family” are brought into an affected area, they have a multimodal effect because they inhibit inflammation, ensure nutrition through the formation of new blood vessels and can replicate the affected tissue.

And since Prof. Schoettle’s method uses the body’s own fat, there are no side effects.

The procedure can be performed either in isolation or in combination with other procedures. Under light anaesthesia, 60-100 cc of fat are extracted from the abdomen, mechanically processed with the cells contained in the fat and applied to the affected region under light anaesthesia after almost an hour. Our patients can leave the clinic immediately afterwards. In the liposuction region, an abdominal belt should be worn for 48 hours. We also recommend the use of crutches for 2 weeks in order to fully develop cartilage healing. No sporting activities should be carried out during this time.

Inform yourself about these possibilities during our special consultation hours.

CARTILAGE DAMAGE - THERAPY WITH MICROFRACTURING

If there is extensive cartilage damage in the knee and residual cartilage is still present, we use what is known as microfracturing as cartilage therapy to stimulate stem cell production from the underlying bone. The bone is minimally opened arthroscopically so that bone marrow cells and stem cells can be deposited in the cartilage defect.

Thus, a fibrous replacement cartilage (fibrous cartilage) can develop from this cartilage op, which does not have the mechanical properties of the original cartilage, but can lead to a significant pain relief. Here too, we strongly recommend the support of a combination of PRP and hyaluronic acid.

TRANSPLANTATION OF CULTIVATED CARTILAGE

For more than ten years, the transplantation of our own cultivated cartilage cells (ACT) has been successfully used to replace and reconstruct missing or injured cartilage in cartilage damage – especially in traumatic and superficial defects without bone involvement. The indication for cartilage therapy with ACT must therefore be very carefully considered and has its limits, which we will discuss with you in individual cases.

For this form of cartilage surgery always two operations are necessary: In the first procedure, during an arthroscopy, we remove a minimal amount of cartilage cells from an unloaded part of the knee joint, which are then multiplied in a certified laboratory and reimplanted after approx. 3-6 weeks.

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Prof. Dr. med. Philip Schoettle
KNEE AND HEALTH INSTITUTE
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