Abstract
Chondral injuries represent a spectrum of disorders that include both partial and full-thickness defects. The natural history of full-thickness cartilage lesions remains unclear. Repair or regeneration of normal functioning hyaline cartilage, in the mature adult, has yet to be confirmed following known cartilage restoration procedures and treatments. As such, the initial management of these lesions is largely nonoperative.
Those nonoperative treatment modalities that are available to clinicians include physical therapy, activity modification, bracing, patient education, topical medications, systemic medications, and intra-articular medications. However, it is important to consider that patient responses to these initial treatment modalities are often unpredictable and idiosyncratic. Evidence-based treatment protocols and reliable predictors for identifying efficacious treatment strategies have yet to be established in this group of patients. Given this lack of data, the goals of therapy should be focused on reducing pain and inflammation, increasing flexibility, increasing strength, and optimizing function for a timely return to activities of daily living. This chapter discusses each of these interventions in detail. Current literature and controversies are explored. Ultimately, nonoperative modalities can be effective at relieving pain and improving function in affected patients and as such should be a first-line approach in the management of these lesions.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Minas T, Nehrer S. Current concepts in the treatment of articular cartilage defects. Orthopedics 1997;20:525–538.
Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997;13:456–460.
Shelbourne KD, Jari S, Gray T. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg Am 2003;85A(suppl 2):8–16.
Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 1998;80:1276–1284.
Falconer J, Hayes KW, Chang RW. Effect of ultrasound on mobility in osteoarthritis of the knee. A randomized clinical trial. Arthritis Care Res 1992;5:29–35.
Keating EM, Faris PM, Ritter MA, Kane J. Use of lateral heel and sole wedges in the treatment of medial osteoarthritis of the knee. Orthop Rev 1993;22:921–924.
Lindenfeld TN, Hewett TE, Andriacchi TP. Joint loading with valgus bracing in patients with varus gonarthrosis. Clin Orthop 1997:290–297.
Matsuno H, Kadowaki KM, Tsuji H. Generation II knee bracing for severe medial compartment osteoarthritis of the knee. Arch Phys Med Rehabil 1997;78:745–749.
Smith EM, Juvinall RC, Corell EB, Nyboer VJ. Bracing the unstable arthritic knee. Arch Phys Med Rehabil 1970;51:22–28 passim.
Weinberger M, Tierney WM, Booher P, Katz BP. Can the provision of information to patients with osteoarthritis improve functional status? A randomized, controlled trial. Arthritis Rheum 1989;32:1577–1583.
Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402–407.
Buckwalter JA. Effects of early motion on healing of musculoskeletal tissues. Hand Clin 1996; 12:13–24.
Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am 1980;62: 1232–1251.
Rubak JM, Poussa M, Ritsila V. Effects of joint motion on the repair of articular cartilage with free periosteal grafts. Acta Orthop Scand 1982;53:187–191.
Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med 1991;325:87–91.
Ytterberg SR, Mahowald ML, Woods SR. Codeine and oxycodone use in patients with chronic rheumatic disease pain. Arthritis Rheum 1998;41:1603–1612.
Cohen DB, Kawamura S, Ehteshami JR, Rodeo SA. Indomethacin and celecoxib impair rotator cuff tendon-to-bone healing. Am J Sports Med 2006;34:362–369.
Griffin MR, Ray WA, Schaffner W. Nonsteroidal anti-inflammatory drug use and death from peptic ulcer in elderly persons. Ann Intern Med 1988; 109:359–363.
Lanza FL. A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol 1998;93:2037–2046.
Roden L, Koerner T, Olson C, Schwartz NB. Mechanisms of chain initiation in the biosynthesis of connective tissue polysaccharides. Fed Proc 1985;44(2):373–380.
Lippiello L, Woodward J, Karpman R, Hammad TA. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Clin Orthop 2000:229–240.
Brief AA, Maurer SG, Di Cesare PE. Use of glucosamine and chondroitin sulfate in the management of osteoarthritis. J Am Acad Orthop Surg 2001;9:71–78.
McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000;283: 1469–1475.
Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-yr, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162:2113–2123.
Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001; 357: 251–256.
Tanveer E, Anastassiades T. Glucosamine and chondroitin for treating symptoms of osteoarthritis: evidence is widely touted but incomplete. JAMA 2000;283:1483–1484.
Verbruggen G, Goemaere S, Veys EM. Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA. Osteoarthritis Cartilage 1998;6(suppl A):37–38.
Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: a doubleblind trial. Clin Ther 1991;13:383–395.
Dieppe PA, Sathapatayavongs B, Jones HE, Bacon PA, Ring EF. Intra-articular steroids in osteoarthritis. Rheumatol Rehabil 1980; 19:212–217.
Marshall KW. Viscosupplementation for osteoarthritis: current status, unresolved issues, and future directions. J Rheumatol 1998;25:2056–2058.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Drakos, M.C., Allen, A.A. (2007). Nonoperative Treatment Options for Symptomatic Cartilage Lesions. In: Williams, R.J. (eds) Cartilage Repair Strategies. Humana Press. https://doi.org/10.1007/978-1-59745-343-1_5
Download citation
DOI: https://doi.org/10.1007/978-1-59745-343-1_5
Publisher Name: Humana Press
Print ISBN: 978-1-58829-629-0
Online ISBN: 978-1-59745-343-1
eBook Packages: MedicineMedicine (R0)