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S FREESTYLE SPORTS PSYCHOLOGY
PORTS MEDICINE CARTILAGE REPAIR KNEE ARTICULAR
CARTILAGE REPAIR AND ATHLETES
This article presents an overview of the latest articular cartilage surgical techniques and cartilage repair rehabilitation principles and their practical implementation. A return to pre-injury performance levels is not guaranteed, and for some athletes articular cartilage injuries may be career-ending. In such cases, the role of the healthcare professional switches to considering how to keep the athlete exercising when they retire from competition.
BY KAREN HAMBLY BSC (HONS) MCSP INTRODUCTION
Articular cartilage injuries are not a new problem. As far back as the mid- eighteenth century it was identified that damaged articular cartilage does not heal once injured. Over the past 50 years scientists and surgeons have been increasingly challenged to develop a biological alternative to the traditional knee replacement that can offer a more cost-effective, durable and acceptable alternative for the millions of people with osteoarthritis worldwide. With over two million articular cartilage defects being diagnosed each year in Europe and the USA, interest in cartilage repair has escalated. This article sets out to give up-to- date information regarding cartilage repair surgery and rehabilitation and discusses why cartilage repair remains so troublesome to the athletic population.
HOW DO CHONDRAL INJURIES OCCUR? Articular cartilage damage can result from: n Acute trauma (blunt or shear) n Chronic repetitive trauma (excessive
focal mechanical overload) n Osteochondritis dissecans. Focal grade IV chondral defects
can occur within a year of acute knee trauma or surgery (usually ACL or meniscal) (1). Articular cartilage damage should be considered if an athlete experiences pain at rest, has had recent ligament or meniscal injury, and/ or has chronic knee pain and other diagnoses have been excluded and/or conservative treatment has failed.
RELEVANCE TO ATHLETES Articular cartilage defects are one of the most common causes of permanent disability in athletes (2). Excessive stress on a joint with an articular cartilage defect may accelerate further degenerative changes and predispose the athlete to a higher risk of osteoarthritis. One important study showed that, although 75% of young athletes with severe chondral damage returned to pre-injury sport levels, 14 years later 43% showed radiographic joint space narrowing (3). Athletes require an articulating cartilage surface that can withstand the high mechanical joint stresses generated
during their specific sports activity. Articular cartilage is avascular and does not have the natural healing ability of other tissues, and this often leads to the need for surgical intervention. Management of an athlete with articular cartilage damage is consequently a significant challenge to healthcare professionals (Fig. 1).
CARTILAGE REPAIR At present we are unable to regenerate hyaline articular cartilage, but the articulating surface can be repaired with a functional tissue. In order to implement optimal rehabilitation for an athlete, it is important to be familiar with articular cartilage repair techniques. The three current categories of cartilage repair techniques are described below.
Marrow-stimulating: microfracture
The microfracture technique, as pioneered by Dr Richard Steadman, involves removing the damaged cartilage to expose the underlying bone. The subchondral bone is then penetrated with an awl to expose the
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