Cartilage injuries in Berlin (Mitte)

In addition to cartilage smoothing, localized cartilage damage can be treated with the usual cartilage repair measures.

Your sports orthopedist in Berlin (Mitte) uses all common cartilage replacement measures (cartilage refixation, bone marrow stimulating procedures, autologous matrix-associated chondrogenesis, cartilage cell transplantation) and has many years of experience in the complete spectrum of cartilage surgery.

The hip surgery and sports orthopedics department of Dr. Moser at the Friedrichshain Clinic is a center of the German Cartilage Register.

 

If you have any questions about cartilage surgery in Berlin (Mitte), call us at 030 / 22 60 53 000 und vereinbaren Sie einen individuellen Beratungstermin.

 

Hyaline cartilage – articular cartilage

The articular cartilage (hyaline cartilage) is a very important tissue for the human musculoskeletal system. It covers the pressure-loaded sliding surfaces of the joints and is exposed to strong mechanical stress.

 

Cartilage tissue is a tissue with very few cells. It consists of relatively few cartilage cells (chondrocytes) and intercellular substance (extracellular matrix). The cartilage cells form the strongly interconnected cartilage fibers of the extracellular matrix. The articular cartilage is chemically composed of proteins, carbohydrates and water.

Hyaline cartilage is very elastic under pressure and acts as a shock absorber in the joint. Articular cartilage has no blood supply of its own. Articular cartilage is avascular (without its own blood supply), alymphatic and anisotropic (very poor tendency to heal or grow). Articular cartilage is nourished exclusively by diffusion. This means that the articular cartilage receives its nourishment from the synovial fluid.

cartilage damage / cartilage defect

The diagnosis of cartilage defects initially includes a detailed anamnesis (questionnaire) and a thorough examination. 

 

Joint pain is usually present. Joint swelling and/or effusion, pain during exertion or pain at rest are common. Signs of entrapment and blockage of the joint with a lack of movement are frequently described. 

 

For a more precise assessment, an ultrasound of the joint, X-rays and magnetic resonance imaging (MRI) are usually necessary. X-rays can be used to determine whether generalized joint wear is already present. MRI is the gold standard for assessing cartilage defects. 

 

Articular cartilage has no innervation! Cartilage damage is often not painful at first. Therefore, cartilage damage usually goes undetected in the early stages.

However, if left untreated, major cartilage damage leads to increasing wear and tear of a joint 

 

Pure damage to the cartilage rarely heals, and in particular does not heal spontaneously. If the underlying bone is also injured (osteochondral injuries - vascularized subchondral bone is penetrated), spontaneous regeneration processes occur, albeit only to a small extent. However, healing then usually only takes place with inferior fibrinous cartilage tissue. 

 

Cartilage damage can occur for a variety of reasons. In many cases, conservative therapy, such as physiotherapy, physical therapy, acupuncture or local or joint-targeted infiltrations (joint injections) is sufficient for long-term relief of symptoms. In particular, hyaluronic acid infiltration supports the nutrition of the damaged cartilage from the extracellular matrix.

 

In some cases, however, there are more serious structural problems that must be corrected surgically to avoid lasting damage to the joint. 

The operation is usually performed as an arthroscopy, as this is a minimally invasive and very gentle surgical method. 

 

Cartilage damage can occur due to wear and tear caused by chronic overload, an accident (traumatic) or unfavorable anatomical conditions. 

 

During surgical cartilage treatment, anatomical causes of the cartilage lesion should always be treated at the same time. This usually happens during the same surgical procedure.

 

Das Ziel einer Knorpeloperation ist die Bildung von hochwertigen Knorpelgewebe im Defektbereich. Zudem sollte der angrenzende vorhandene Knorpel möglichst lange erhalten und Folgeschäden vermieden werden.

Common cartilage treatments

Non-operative – conservative measures

 

Hyaluronic acid: Hyaluronic acid therapy is performed on an outpatient basis during consultation hours. Hyaluronic acid is injected into the joint using a syringe. This can be done as a single dose or by means of several doses at intervals. 

 

ACP/PRP therapy: Here, a certain portion of the patient's blood is injected into the joint after centrifugation using a syringe (double-chamber syringe). Here, too, several infiltrations can be carried out.

Cortisone and/or local anesthetic: In cases of acute joint irritation, cortisone is a good way to reduce the irritation of the joint. In addition, the local anesthetic can provide immediate, short-term relief of symptoms.

Operativen Maßnahmen

Cartilage smoothing (mechanical/thermal)

As specialized doctors, we view this procedure very critically. Cartilage should only be removed if pieces of cartilage are loosely embedded in the joint space.

nanofracturing and microfracturing

The bony layer beneath the damaged cartilage is opened or drilled using very fine instruments so that stem cells from the bone marrow can reach the cartilage defect and lead to improved healing. The defect is filled with the body's own fibrocartilage. This procedure is only suitable for small cartilage defects.

cartilage-bone transplantation (OATS) 

A punch of healthy cartilage including the associated bone is taken from a non-loaded joint region and inserted into the defect region. Several punches can also be used ("mosaicplasty"). Nevertheless, this procedure is only used for small defects. The advantage of this procedure is that the bone damage underneath the defect is also treated. 

 

Autologous matrix-induced chondrogenesis (AMIC)

A matrix (solid or gel-like) is introduced into the specially prepared area of ​​the cartilage damage. Stem cells from the bone marrow collect in the matrix and stable cartilage replacement tissue forms in the defect.

 

Minced Cartilage

The body's own cartilage is taken from a region of the joint that is subject to less stress, finely chopped and inserted into the defect in a collagen matrix (usually gel-like, e.g. Chondrofiller©). A stable cartilage replacement tissue is formed from the cartilage pieces and the collagen matrix. The modern minced cartilage procedure is a very high-quality method of cartilage treatment. Especially when the body's own cartilage is combined with a particularly suitable collagen matrix. The advantage compared to cartilage cell transplantation is that the procedure is carried out in one go (only one operation is necessary) and the convalescence is therefore faster.

 

cartilage cell transplantation (ACT, autologous chondrocyte transplantation)

This therapy is a two-stage procedure, i.e. two operations are required. In the first operation, the causative pathology is usually treated. In addition, a small cartilage punch is taken, which is sent to the laboratory for cultivation.

After 6 weeks of cell cultivation, the second procedure takes place, in which the cultured cartilage cells are placed into the defect area in the joint. 

This procedure represents the most biologically valuable method of cartilage regeneration.

All common methods of modern conservative and surgical cartilage therapy are available to us. We will be happy to advise you on which treatment method is most suitable for you.