cartilage injuries
In addition to cartilage smoothing, localised 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 years of experience in the entire spectrum of cartilage surgery.
The hip surgery and sports orthopedics 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 and arrange an individual consultation.
Hyaline cartilage – articular cartilage
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 networked cartilage fibers of the extracellular matrix. Articular cartilage is chemically composed of proteins, carbohydrates and water.
Hyaline cartilage is very elastic under pressure and serves 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 nutrition from the synovial fluid.
cartilage damage / cartilage defect
Diagnosis of cartilage defects initially involves a detailed anamnesis (questioning) and a thorough examination.
Joint pain is usually present. Joint swelling and/or joint effusion, pain when exerting or at rest often occur. Signs of entrapment, blockages of the joint with a lack of movement are often described.
For a more precise assessment, an ultrasound of the joint, X-ray and magnetic resonance imaging (MRI) are usually necessary. X-rays can be used in particular to assess 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 in the early stages usually goes undetected.
However, if left untreated, major cartilage damage leads to increasing wear and tear of a joint
Pure damage to the cartilage rarely shows any healing, especially no spontaneous healing. 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 with, for example, 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 carried out as an arthroscopy, as this is a minimally invasive and very gentle surgical method.
Cartilage damage can occur due to wear and tear from 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 takes place in the same surgical procedure.
The aim of a cartilage operation is to form high-quality cartilage tissue in the defect area. In addition, the adjacent existing cartilage should be preserved for as long as possible and subsequent damage should be avoided.
Common cartilage treatments
Non-surgical – 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 using a syringe (double-chamber syringe) after centrifugation. Here, too, several infiltrations can be performed.
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 from 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.
