Cartilage Disorders

Introduction
Chondrocalcinosis
Chondromalacia patella
Costochondritis
Hip Labral Tear
Osteochondritis dissecans
Torn Mesniscus

Cartilage is a tough, semi transparent, elastic, flexible connective tissue consisting of cartilage cells (chondrocytes and chondroblasts) scattered through a lipoprotein material strengthen by collagen fibers. The exterior part of cartilage is covered by dense fibrous membrane called the perichondrium. There are no nerves or blood vessels in cartilage, and when damaged, it does not heal readily.

Cartilage has several functions. It covers the surface of joints, allowing bones to slide over one another, thus reducing friction and preventing damage; it also acts as a shock absorber. It forms part of the structure of the skeleton in the ribs, where it joins them to the breastbone (sternum). Cartilage is found in the tip of the nose, in the external ear, in the walls of the windpipe (trachea) and the voice box (larynx) where it provides support and shape. In an embryo, the skeleton is formed of cartilage which is gradually replaced by bone as the embryo grows.

Cartilage is known as elastic cartilage, fibrocartilage or hyaline cartilage, depending on its different physical properties.

	Elastic Cartilage is strong but supply cartilage containing proteins called elastin and collagen embedded in ground substance. Elastin gives it a distinctive yellow color. Elastin cartilage makes up the springy part of the outer ear, and also forms the epiglottis (the flap of tissue in the front that prevents food from entering the airways).
	Fibrocartilage contains large amounts of collagen, making it both resilient and able to with stand compression, it is found between the bones of the spinal column, hips and pelvis
	Hyaline cartilage is a tissue which contains collagen fibers. It forms the skeleton in the embryo and remains as a thin layer on the ends of bones which form joints. It also forms the end of the nose, and the stiff rings around the windpipe. It is on the ends of the ribs and supports the larynx.

Chondrocalcinosis is a condition characterized by deposits of calcium pyrophosphate dihydrate (CPPD) crystals in one or more joints that eventually results in damage to the affected joints. It most often affects the knee, wrist and pubic symphysis, the joint between the pubic bones in the front of the pelvis.

Some people with chondrocalcinosis have no signs or symptoms. Others may have:

• Redness, warmth and swelling over the affected joints
• Sudden, severe pain in the affected joint (pseudogout)

Chondrocalcinosis occurs most often in women older than age 50. It can be associated with:

• Overactive parathyroid gland (hyperparathyroidism)
• Too much iron in the body (hemochromatosis)
• An inherited metabolic bone disease (hypophosphatasia)
• Low blood levels of magnesium (hypomagnesemia)
• An inherited disease in which too much copper accumulates in the body (Wilson's disease)
• Osteoarthritis
• Diabetes

A doctor may confirm a diagnosis of chondrocalcinosis by X-rays of affected joints. Blood tests may also be done to rule out other diseases, such as osteoarthritis. Treatment depends on the severity of signs and symptoms but may include:

• Injections of corticosteroids directly into the joint
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others), naproxen (Aleve) or indomethacin (Indocin, others)
• Prednisone or colchicine for flares of pseudogout
• Surgery, in severe cases

You love to run. Climbing the hills on your usual route used to be a pleasant challenge. Now it hurts to even climb the stairs. What's going on?

Your knees may be telling you that it's time to take a break.

The cartilage under your kneecap (patella) is a natural shock absorber. But it doesn't come with a lifetime guarantee. Overuse, injury or other factors may lead to a condition known as chondromalacia patella - a general term that indicates damage to the cartilage under your kneecap. Chondromalacia patella is more accurately referred to as patellofemoral pain.

The most common symptom of patellofemoral pain is knee pain that increases when you walk up or down stairs. It also may hurt to kneel or squat. Simple treatments - such as rest and ice - often help, but sometimes more aggressive treatment is needed.

As the smooth cartilage under your patella rubs against the groove in the bottom of your femur (thighbone), you may feel dull pain in the front of your knee. The pain often increases when you walk up or down stairs. It also may hurt to kneel, squat or sit with your knee bent for long periods of time. You may notice a grating or grinding sensation when you extend your knee.

In adolescents and young adults, patellofemoral pain often is caused by overuse or injury. Sometimes an unusual alignment of the kneecap is responsible. For older adults, patellofemoral pain may be related to arthritis of the knee joint - which causes cartilage to lose its normal shock-absorbing ability. Weak thigh muscles or flat feet also may contribute to the pain.

Patellofemoral pain is most common in young adults, particularly runners and others who routinely do exercises involving the lower legs. The condition affects more women than men. People who've had a trauma to the kneecap - such as a dislocation or fracture - may be more likely to develop patellofemoral pain.

Diagnosis is based primarily on your symptoms and a physical exam. Tell your doctor about your typical activities and any recent changes to your routine. To gauge your knee's strength and alignment, your doctor may ask you to walk, jump or move your knee in certain ways. He or she may detect tenderness or feel a grinding sensation below your kneecap when you extend your knee.

Your doctor may recommend X-rays or other imaging tests to help determine the cause of your knee pain. If your symptoms are severe, a minor surgical procedure known as arthroscopy may be needed to confirm the diagnosis and treat the condition.

Treatment of patellofemoral pain often begins with simple measures. Rest your knee as much as possible. Avoid any activities that increase the pain, such as climbing stairs. If needed, take nonsteroidal anti-inflammatory pain relievers, such as aspirin or ibuprofen.

To speed your recovery, your doctor may recommend specific exercises or physical therapy to strengthen the muscles that support your knees, such as your quadriceps, hamstrings and the muscles around your hips. Sometimes physical therapy may include electrical stimulation to strengthen your muscles. In other cases, knee braces or arch supports are recommended.

When you exercise, choose activities that go easy on your knees, such as bicycling and swimming. Your physical therapist may show you how to tape your knee to reduce pain and enhance your ability to exercise.

If these measures aren't effective, surgery may be an option.

• Arthroscopy. During this procedure, the doctor inserts an arthroscope - a pencil-thin device equipped with a camera lens and light - into your knee through a tiny incision. Surgical instruments are passed through the arthroscope to remove fragments of damaged cartilage.
• Realignment. In more severe cases, a surgeon may need to open your knee to realign the angle of the kneecap or relieve pressure on the cartilage.

Sometimes knee pain just happens. But you can take steps to help prevent the pain.

• Lose excess pounds. If you're overweight, losing the extra weight relieves stress on your knees.
• Warm up. Before running or any other exercise, warm up with five to 10 minutes of light activity.
• Stretch. Promote flexibility with gentle stretching exercises.
• Increase intensity gradually. Avoid sudden changes in the intensity of your workouts.
• Practice shoe smarts. Make sure your shoes fit well and provide good shock absorption. If you have flat feet, consider shoe inserts.
• Think alignment and technique. Ask your doctor or physical therapist about flexibility and strength exercises to optimize your technique for jumping, running and pivoting - and to help the patella track properly in its groove.

It's also important to listen to your body. If your knee hurts, stop what you're doing. Pushing yourself may only lead to injury.

Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It causes sharp pain in the costosternal joint - where your ribs and breastbone are joined by rubbery cartilage. Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.

Costochondritis is the most common cause of chest pain originating in the chest wall. It occurs most often in women and people over age 40. However, costochondritis can affect anyone, including infants and children.

Your doctor might refer to costochondritis by other names, including chest wall pain, costosternal syndrome and costosternal chondrodynia. When the pain of costochondritis is accompanied by swelling it's referred to as Tietze's syndrome.

Most cases of costochondritis have no apparent cause, and most go away on their own. This makes it difficult to treat. When there's no obvious cause, treatment is aimed at easing your pain while you wait for costochondritis to resolve on its own.

Costochondritis causes pain and tenderness in the places where your ribs attach to your breastbone (costosternal joints). Often the pain is sharp, though it can also feel like a dull, gnawing pain. Pain associated with costochondritis occurs most often on the left side of your breastbone, though it can occur on either side of your chest.

Other signs and symptoms of costochondritis may include:

• Pain when taking deep breaths
• Pain when coughing
• Difficulty breathing

Doctors don't know what causes most cases of costochondritis. Only some cases of costochondritis have a clear cause. Those causes include:

• Injury. A blow to the chest could cause costochondritis.
• Infection. Infection can develop in the costosternal joint, causing pain.
• Fibromyalgia. Recurring costochondritis could be a symptom of fibromyalgia. People with fibromyalgia often have several tender spots. The upper part of the breastbone is a common tender spot.
• Pain from other areas of your body. Pain signals can sometimes be misinterpreted by your brain, causing pain in places far away from where the problem occurs. Your doctor might refer to this as "referred pain." Pain in your chest can sometimes be caused by problems with the bones in your spine compressing the nerves.

Your doctor will conduct a physical exam to diagnose costochondritis. He or she will ask you to describe your pain and what influences it. The pain of costochondritis can be very similar to the pain associated with heart disease, lung disease, gastrointestinal problems and osteoarthritis. Your doctor will feel along your breastbone for areas of tenderness or swelling.

Costochondritis generally can't be seen on chest X-rays or other imaging tests used to see inside your body. Sometimes your doctor orders these tests or others to rule out other conditions.

Costochondritis usually goes away on its own. The pain usually lasts a week or two and then resolves.

To ease your pain until it fades, your doctor may recommend:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve).
• Antidepressants, specifically a category of medicines called tricyclic antidepressants, if pain is making it difficult to sleep at night.
• Muscle relaxants, which can also help ease pain.

The socket of your hip joint (acetabulum) is lined by cartilage called your labrum. This cartilage provides stability and cushioning for your hip joint, allowing the ball of your thighbone (femur) to move smoothly and painlessly in the socket.

A tear in your labrum, known as a hip labral tear or acetabular labral tear, can result from injury, repetitive movements that cause wear-and-tear on your hip joint, or degeneration, such as from osteoarthritis.

In many cases, a hip labral tear causes no signs or symptoms and doesn't require treatment. Occasionally, however, a hip labral tear may cause pain or a "catching" sensation in the hip joint.

When treatment for a hip labral tear is necessary, it may consist of physical therapy, medications or a combination. Less frequently, surgery is necessary to treat a hip labral tear.

Many hip labral tears cause no signs or symptoms. Occasionally, however, you may experience one or more of the following:

• A locking, clicking or catching sensation in your hip joint
• Pain in your hip or groin
• Stiffness or limited range of motion in your hip joint

The cause of a hip labral tear may be:

• Repetitive activities. Sports-related and other physical activities - including the sudden twisting or pivoting motions common in golf or softball - can lead to joint wear and tear that ultimately results in a hip labral tear.
• Trauma. Injury to or dislocation of the hip joint, such as from playing football, hockey and other contact sports, can cause a hip labral tear.
• Diseases or conditions that damage the labrum. These may include degenerative conditions such as osteoarthritis or femoroacetabular impingement (FAI), a condition in which the ball of your femur and your acetabulum rub together abnormally, causing friction in your hip joint.

Sometimes a hip labral tear has no known cause.

The following factors may increase your risk of a hip labral tear:

• Overuse. People who participate in sports or other activities that require repeated twisting or pivoting motions are more likely to experience a hip labral tear.
• Conditions that compromise the labrum. Having a condition such as osteoarthritis or femoroacetabular impingement (FAI), a condition in which there's too much friction in your hip joint, puts you at a greater risk of a hip labral tear.

Osteochondritis dissecans is a condition that results from a loss of blood supply to an area of bone beneath the surface of a joint. The knee is most commonly affected, although osteochondritis dissecans also can occur in other joints, including your elbow and ankle.

The affected bone and its covering of cartilage may stay in place and may not cause any symptoms. Or a fragment may gradually loosen and cause pain.

Most people diagnosed with osteochondritis dissecans are teenagers and young adults. The juvenile form affects growing bone, while the adult form affects mature bone. Osteochondritis dissecans is more common in males. Although osteochondritis dissecans is rare, it's becoming more common, particularly among girls and young women as their participation in youth and college sports increases.

Early diagnosis and treatment of osteochondritis dissecans are important to minimize your risk of long-term disability. Some people with osteochondritis dissecans eventually develop osteoarthritis. When the disorder is treated promptly, most people recover and return to their usual activities, including participation in sports.

Pain is the most common symptom of osteochondritis dissecans. The pain tends to be sharp or aching, and is usually triggered by physical activity - for example, knee pain that occurs while walking up stairs, climbing a hill or playing sports. Other signs and symptoms include:

• A clicking sound when you move your joint
• A "locking" of your joint - the joint "sticks" and won't move through its full range of motion
• A feeling that your joint is "giving way" or weakening
• Decreased joint movement - an inability to straighten your leg or arm fully, or a limited range of motion
• Limping
• Swelling and tenderness of the skin over your joint
• Stiffness after resting

Doctors are unsure of the cause of osteochondritis dissecans. However, a number of factors may contribute to the disorder.

High on the list is repetitive force (trauma or stress) to the affected joint, particularly if you're very active. You may experience small, multiple episodes of minor unrecognized injury that, over time, cause a tiny fracture that damages the overlying cartilage of a joint. Researchers have reported a relationship between osteochondritis dissecans of the elbow and particular sports motions, such as baseball pitching.

An impaired blood supply to the bone (vascular insufficiency) also may play a role in the condition. The impaired supply is due to a slight blockage of a small artery and gradually can cause a breaking down or death of bone tissue (avascular necrosis).

Some family groups appear to have a genetic tendency to develop osteochondritis dissecans, although this is not believed to be a major factor in most cases.

Regular physical activity - particularly when it involves repetitive impact movement, such as jumping - may put stress on your joints and place you at increased risk of osteochondritis dissecans.

The largest group of people affected by the condition is active boys and men in the 10- to 20-year age group who are participating in organized sports. While pitchers in baseball may be at particular risk, those in other sports may be vulnerable as well, including athletes in tennis, gymnastics, shot put, golf and wrestling.

To make the diagnosis of osteochondritis dissecans, your doctor begins by taking a thorough medical history - asking about your symptoms, including pain, and whether you've had joint problems in the past.

Your doctor will ask about whether you've experienced an injury to the affected joint and when it occurred. In addition, your doctor will ask about your exercise routines, whether they involve any throwing movements (if the pain is in your elbow), and whether the discomfort has increased in recent weeks and months.

Then your doctor will likely conduct a physical examination, checking the stability of the joint and whether there is a clicking or locking when you move the joint.

Imaging tests
Your doctor may ask you to undergo one or more imaging procedures to help diagnose and determine the severity of the disorder. X-rays of your joint from various angles could show abnormalities in the surface of your joint. Your doctor may recommend that both joints be X-rayed (both the right and left knee, for example) to compare them.

Although the diagnosis can often be made with X-rays alone, X-rays cannot show breaks or cracks in the cartilage, nor the stability of the joint. Other imaging techniques may be used to analyze the cartilage and provide other information to help make the diagnosis:

• Computerized tomography (CT) provides computer-enhanced images of the joint structures. It can also detect any bone and cartilage fragments and pinpoint their location, including whether they have settled in the joint space.
• Magnetic resonance imaging (MRI) uses magnetic fields to create detailed pictures of your joint, which will provide information about its structure, the accumulation of fluid in the area and the visualization of loose fragments. Doctors frequently use MRI to help decide whether healing will occur with conservative treatment or whether surgery is necessary.
• Bone scans involve injecting dye into your bloodstream, and then taking images of your bones.

Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and to relieve pain, as well as reduce the risk of osteoarthritis. No single treatment, however, is effective for everybody.

Initially, your doctor will likely recommend conservative measures, which are effective in most cases. They may include:

• Resting your joint. Refrain from impact activities such as jumping and from cut-pivot activities in which you can put strain on your knee as you rotate the joint.
• Immobilizing your joint. This may involve using a hinged brace or crutches if your knee or ankle is affected.
• Using nonsteroidal anti-inflammatory medications. These include aspirin, ibuprofen (Motrin, Advil, others) and naproxen sodium (Aleve, Naprosyn).
• Avoiding competitive sports and intense physical activity. These may put a strain on your affected joint and cause pain. At least six to eight weeks of limited activity are helpful for most people.
• Adopting low-intensity physical therapy. Most often, this therapy includes stretching and range-of-motion exercises, and conditioning exercises to strengthen the muscles that support the involved joint. Low-impact aerobic conditioning, such as use of a stationary bicycle, helps to maintain cardiovascular fitness.

When surgery is an option
Although most people see improvement with conservative measures, surgery is an option when problems persist for at least three to six months. Adults have a greater likelihood of requiring an operation, but they also have a lower chance of successful post-surgical results than adolescents have.

Surgery called arthroscopy is minimally invasive. It begins when your surgeon inserts a thin scope into the joint space to visualize the area on a television monitor, determine the location of the damage and decide upon the best type of surgical procedure.

Then tiny surgical instruments are inserted into small incisions, and loose bone fragments may be reattached or removed. When cartilage fragments are still attached to the bone, they can be tightly secured with pins or screws. The goal of this surgery is to restore normal blood flow and improve joint function.

Physical therapy after surgery is necessary to optimize strength, stability and function.

Although most people with osteochondritis dissecans are free of symptoms after appropriate treatment, in some cases doctors may recommend restrictions on daily activities. For example, while young athletes may be able to return to playing sports, doctors may ask that they limit participation initially to light workouts, and then gradually work back into competition.

You may be able to prevent osteochondritis dissecans by limiting the overuse of your joints. That may require reducing the time spent in certain athletic activities that place stress on your joints. Stretching and strengthening exercises also may help prevent osteochondritis dissecans.

Adolescents participating in organized sports can benefit from education on the risks to their joints associated with overuse, with emphasis on the proper mechanics and techniques of their sport, which can reduce the chances of injury.

The knee is a complicated joint consisting of various structures, including bones, tendons and ligaments. Two C-shaped pieces of cartilage known as the menisci (plural of meniscus) curve around the inside and outside of the knee to stabilize and cushion the joint.

Any activity that causes you to forcefully twist or rotate your knee can lead to a torn meniscus. In older adults, degenerative changes of the knee may contribute to a torn meniscus.

Conservative treatment - such as rest, ice and medication - is sometimes enough to relieve the pain of a torn meniscus. In other cases, however, a torn meniscus requires surgical repair.

The meniscus may tear in various directions. Occasionally, a lengthwise tear flips into the knee joint instead of staying around the joint's edge - an injury called a bucket-handle tear. Less often, the meniscus may split in two directions.

The first symptom of a torn meniscus might be a popping sensation in the knee. Within 24 to 48 hours, you may notice knee swelling and pain. In some cases, a flap of the torn cartilage "locks" the knee joint. You may have trouble walking or bearing weight on your knee.

A torn meniscus can result from any activity that causes you to forcefully twist or rotate your knee, such as aggressive pivoting or sudden stops and turns. Occasionally, kneeling, squatting or lifting something heavy leads to a torn meniscus. In older adults, degenerative changes of the knee may contribute to a torn meniscus.

In athletes, a torn meniscus may accompany other injuries, such as a torn anterior cruciate ligament - one of two ligaments that cross in the middle of the knee.

Anyone at risk of twisting the knee is at risk of a torn meniscus. The risk is particularly high for athletes - especially those who participate in contact sports, such as football, or activities that involve pivoting, such as tennis. The risk of a torn meniscus also increases as you get older, due to years of wear and tear on the knee.

Often, a torn meniscus can be identified during a physical exam. Your doctor may bend your knee and ask you to move your foot in various directions. Your doctor may use an X-ray of the knee or magnetic resonance imaging (MRI) - a technique that uses a magnetic field and radio waves to create cross-sectional images of your knee - to confirm the diagnosis or study the extent of the tear.

In some cases, your doctor may use an instrument known as an arthroscope to study the inside of your knee. The arthroscope is inserted through a tiny incision near your knee. The device contains a light and a small camera, which projects an enlarged image of the inside of your knee onto a monitor. If necessary, surgical instruments can be inserted through the arthroscope or through additional small incisions in your knee.

Treatment for a torn meniscus often begins conservatively. Your doctor may recommend:

• Rest. Avoid activities that aggravate your knee pain. You might want to use crutches to take pressure off your knee and promote healing.
• Ice. Ice can reduce knee pain and swelling. Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for 15 to 20 minutes at a time. Do this every couple of hours the first day or two, and then as often as needed.
• Medication. Over-the-counter pain relievers also can help ease knee pain.
• Knee exercises. Physical therapy can help you strengthen and stabilize the muscles around your knee and in your legs.
• Orthotic devices. Arch supports or other shoe inserts can help to distribute force more evenly around your knee or decrease stress on certain areas of your knee.

If your knee remains painful, stiff or locked, surgery may be recommended. For younger adults, it's sometimes possible to repair a torn meniscus. In other cases, the meniscus is trimmed. Surgery is often done through an arthroscope.

During arthroscopic surgery, the doctor inserts an instrument called an arthroscope through a tiny incision near your knee. The arthroscope contains a light and a small camera, which projects an enlarged image of the inside of your knee onto a monitor. Surgical instruments can be inserted through the arthroscope or through additional small incisions in your knee.

Recovery from knee arthroscopy is much faster than is recovery from traditional knee surgery. You can often go home the same day. Full recovery may take weeks or months, however.

If the meniscus has degenerated, your doctor may recommend a knee joint replacement.

Regular exercise, including strength training, can help you strengthen and protect your knees. Start slowly, and increase your intensity gradually. Use proper form and protective gear for your given sport.