Chondral Injury

Localized injuries to the surface of joints are known as chondral injuries. In chondral injuries, the articular cartiledge sustains and injury. This may or may not involve the separation of the articular cartiledge from the bone. Chondral injuries do not involve an injury to the underlying bone. These injuries can occur in any joint; although, the knee joint is the most commonly injured, followed by the ankle, elbow, and shoulder. Chondral injuries occur most frequently in adolescent males. Chondral injuries are difficult to treat because cartilage has a limited ability to heal.

SYMPTOMS

  • Pain, swelling, or pain or tenderness in the affected joint.

  • Giving way, locking, or catching of the joint.

  • Feeling of a free-floating piece of cartilage in the joint.

  • A crackling sound (crepitation) within the joint with motion.

  • Often, injuries to other structures within the joint (ligament tears or meniscus injury).

CAUSES

Direct trauma (impaction, avulsion, or shearing or rotational forces) to the joint.

RISK INCREASES WITH:

  • Participation in contact sports or sports in which playing on and falling on hard surfaces may occur.

  • Adolescence.

  • Other knee injury (anterior cruciate ligament (ACL) or meniscus tear).

  • Poor physical strength and flexibility of the joint.

PREVENTION

  • Wear protective equipment (knee, elbow, or shoulder pads) to soften direct trauma.

  • Wear appropriate-length footwear (cleats for field sorts) for playing surface.

  • Warm up and stretch properly before physical activity.

  • Maintain appropriate physical fitness:

  • Flexibility, strength, and endurance of muscles around joints.

  • Cardiovascular fitness

PROGNOSIS

The prognosis of chondral injuries is dependent on the size of the lesion (injury). Small chondral lesions may not cause problems. Large and/or deep chondral lesions are more problematic, because cartilage does not have the ability to heal. Chondral injuries may go on to develop arthritis of the joint. Usually the symptoms resolve with appropriate treatment, which can include removal of or fixing loose pieces of cartilage.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms, resulting in chronic pain and swelling.

  • Arthritis of the affected joint.

  • Loose bodies that cause locking of affected joint.

TREATMENT

Treatment initially consists of taking medication and applying ice to reduce pain and inflammation of the affected joint. For injuries to the joints of the leg (knee or ankle), walking with crutches (still allow weight to be placed on the leg) until you walk without a limp is often recommended. You may be asked to perform range-of-motion, stretching, and strengthening exercises. These exercises may be carried out at home, although you may be given a referral to a therapist. Occasionally it may be recommend that you wear a brace, cast, or crutches (for the knee or ankle) to protect or immobilize the joint. If pain persists despite conservative treatment or if loose fragments are present within the joint, surgery is usually recommended. The surgery is typically performed arthroscopically to remove the loose fragments or to re-attach the fragment (if large enough and not deformed). After immobilization or surgery it is important to stretch and strengthen the weakened joint and surrounding muscles (due to the injury, surgery, or the immobilization). This may be done with or without the assistance of a therapist.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Symptoms worsen or do not improve in 2 weeks despite treatment.

  • Any of the following occur after surgery:

  • Signs of infection: fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • Pain, numbness, or coldness in the foot or hand.

  • Blue, gray, or dark color appears in the toenails or fingernails.

  • New, unexplained symptoms develop (this may be due to side affects of the drugs used in treatment).