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Non-surgical Treatments for Cartilage Problems

03 July 2018/ Kategori : Health Corner /

Cartilage is a steady, flexible and vessel- and nerve-free connective tissue that is consisted of collagen and elastic fibers, softer than the bone and covers the joint surfaces to prevent the friction of the bones.

WHY DOES CARTILAGINOUS INJURY OCCUR?

1. Overweight or obesity:Since abnormally high body weight bears excess load on hip, knee and ankle, these joints wear and tear easier and quicker.If the underlying cause of obesity is a metabolic disease (such as diabetes mellitus), it should be eliminated.

2. Trauma:Cartilaginous damages can also be caused by injuries.The injury can, sometimes, be minor, but the forces that affect the joint may strengthen them over the time.The documented cartilaginous injuries should immediately be treated (PRP, microfracture, stem cell etc.).

3. Joint Instability: Since injury of an intra- or peri-articular ligament causes movement of the joint on a larger range and leads to friction, cartilaginous injury will potentially develop.When a ligament injury is detected, it should be managed with appropriate method, such as repair or reconstruction of ligament and PRP, in order to protect the cartilage.

4. Nutrition:Cartilage needs certain nutrients in order to be stronger and to repair the potential damages easily.Sufficient amount of protein (meat, egg, legumes), Vitamin C (orange, lemon, strawberry) and Vitamin E (corn, wheat, soy, almond, peanut) should be ingested every day.

5. Medications:It is reported that the long-term use of intra-articular or peroral corticosteroids has negative effects on the cartilage.Therefore, intra-articular injection of corticosteroids is not recommended the long-term oral corticosteroids should be supported by cartilage protecting drugs (glucosaemine and chondroitin sulphate) and nutrients (protein, Vitamin C and Vitamin E).

6. Arrangement Disorder:Congenital or acquired curvature in bones leads to arrangement disorder in the joints above and below the diseases bone.This arrangement disorder can cause impairment in the cartilage secondary to the overload.The arrangement disorder should appropriate be corrected to protect the cartilage.

7. Avascular Necrosis (AVN):The cartilage is not supply blood and therefore, it lyses due to obstruction of the blood vessels feeding the joint due to any reason whatsoever (trauma, corticosteroids, metabolic diseases, alcohol).It is necessary to use drugs that provides patency of the blood vessels and to vitalize the bone and the cartilage by drilling thereof, if required.

8.Genetic:Finally, age and genetic predisposition play a role.There is no solution for the genetic predisposition.As the person ages, cartilages wear and become more indurable.

NON-SURGICAL TREATMENT

For cartilaginous damages, the treatment intends a pain-free daily life and restoration of all functions in the joint.The decision of surgical or non-surgical treatment depends on the activity level and the age of the patient as well as the underlying cause and the severity of damage.

If the cartilaginous damage is mild, non-surgical treatment is preferred.This modality aims managing the pain.This treatment modalityincludes anti-edema agents (pain killers), cartilage protectors (glucosamine, chondroitin and omega-3), intra-articular injection for the knee joint (hyaluronic acid, PRP), weight loss and physiotherapy.

Hyaluronic Acid:

Hyaluronic acid (HA) is a viscoelastic substance and it has lubricating effect.The substance is specially manufactured in gel form and instilled into the knee joint with a syringe.It is administered in 3 doses at one week intervals or the new generation preparations can be administered in single dose.The procedure can be repeated semi-annually depending on the pain of the patient.Effects of HA are not recognized immediately.It is necessary to avoid excess activity for several days after the injection.

These injections pose certain risks, such as local swelling, allergy, infection and bleeding.

Glucosamine:

Glucosamine-chondroitin sulphate is a supportive treatment.Tablet preparations offers ease of use.Although there is no scientific data to evidence that the treatment prevents cartilaginous damage and calcium deposition, the patients, who receive this treatment, report alleviation of pain.

PRP (Platelet-Rich Plasma):

Whole blood is drawn from the patient and it is treated in a special machine to get a solution with high concentration of a particular blood cell, namely platelet.The separated cells are injected into the joint with a syringe.

PRP is very widely used, but the route of administration, amount and the indication are not substantially clarified.It is usually administered at dose of 2 to 8 ml at 1-, 2- or 3-week intervals.

Diabetes, systemic diseases, age and the medications used by the patient usually influence the efficiency of PRP.

Although it is widely used for intra-articular cartilaginous damages, muscle and tendon diseases and ligament injuries, there is no consensus on standardized treatment, as studies are conducted using different methods and on different patient groups.

Physiotherapy and Exercise:

Exercise is very useful, as strengthening the muscles around the joint will reduce to load born on the articular cartilage.Moreover, some life style modifications, such as walking stick, using elevator rather than stairs, losing weight, swimming or walking in the water, will alleviate the pain.Resting and cold compression helps the pain, while hot compression and stretching exercise will be useful in pain-free periods.

Stem Cell (Lipogems)

Adipose cells are collected from the abdomen or medial side of the upper leg and specially processed in order to obtain and inject the stem cells to the joint with cartilaginous damage for the repair and the structural support.The procedure is carried out 3 phases (collecting adipose tissue, special processing and injecting to the damaged tissue) in a single session under general or local anesthesia and it takes shorter than 1 hour.

It is reported that the modality offers good results especially in joints with Grade 3-4 cartilaginous damage.

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