Hyaline cartilage (also known as lining cartilage) is one of nature’s wonder substances – a material that’s simultaneously tough, shock-absorbent and very slippery.
This is important because it provides the foundations for pain-free movement in our bodies. Lining cartilage on the surface of bone endings allows our joints to glide freely against each other – even when we’re putting them under the considerable stresses and strains of regular, day-to-day life.
But like every other part of our bodies, cartilage isn’t indestructible. We can also damage it. This can happen in a huge variety of ways, but the most common reasons are trauma (an accident or injury) or degeneration (usually wear-and-tear arthritis). Excessive pressure on lining cartilage can cause it to deteriorate, fray and break into ‘loose bodies’ – tiny fragments that float in the joint fluid, causing pain, inflammation and even mobility problems (for instance, if a fragment catches in the joint).
Serious cartilage damage often requires surgery. Again, there are lots of different procedures available depending on the context, and the underlying reason for the damage. One of the most common and effective first-line operations, however, is something called debridement – often followed by microfracture. If you’re suffering from knee pain as a result of cartilage damage, it may be an option to discuss with you. Both procedures are performed using keyhole surgery (arthroscopy), under general anaesthetic. Here’s how they work.
Debridement comes from an old term meaning “remove the bridle”. The aim of the procedure is to locate the pieces of frayed or loose cartilage and remove them from the joint. First, we use an arthroscope (a thin tube) to access the joint. We then deploy a miniature camera to assess the damage. A tiny shaving instrument is inserted into the joint to trim and smooth back the surrounding lining cartilage, particularly if there are ‘chondral flaps’ (loose edges). We can also introduce a saline liquid to clean the area and wash out debris – this is known as ‘lavage’.
Microfracture is a procedure that is often performed alongside a debridement. It’s sometimes also known as ‘marrow stimulation’, because the idea is to release a small amount of bone marrow into the damaged area to promote healing. Bone marrow contains stem cells, which are capable of generating new fibrocartilage; while fibrocartilage doesn’t have quite the same properties as hyaline cartilage, it’s essentially the next best thing. To do this, we use an instrument called a microfracture pick to make a series of tiny holes in the bone surface below the defective cartilage. These holes release small amounts of marrow, which forms into clots that build fibrocartilage. The rebuilding process can take some time: usually between six weeks and three months.
Debridement and microfracture aren’t right for every cartilage problem. If the damage is being caused by osteoarthritis or an issue with the alignment of your bones, for instance, we’ll need to explore other avenues of treatment. As a first-aid-style treatment for certain types of injury and damage, however, it often turns out to be really effective.
Interested in finding out more about debridement, lavage and microfracture? Please feel free to get in touch and make an appointment. We’ll be very happy to take a look and see if the procedures might be right for you. Just hop over to our quick-book facility on the website – or call Mr Bailey’s assistant, Cheryl, on 01962 826107.