Cartilage is a strong, flexible connective tissue providing structural support and shock absorption throughout the body. It covers bone ends in joints, allowing smooth, frictionless movement.
Understanding Cartilage Tears
Two types of cartilage are most commonly associated with joint tears: hyaline cartilage and fibrocartilage. Hyaline cartilage, also known as articular cartilage, is the most common type. It coats the ends of bones within movable joints, such as the knee, hip, shoulder, and ankle. This smooth tissue reduces friction and allows bones to move freely.
Fibrocartilage is a tougher, more fibrous cartilage containing dense collagen fibers. It is found in areas requiring significant shock absorption and structural support. Common locations for fibrocartilage tears include the menisci in the knee, the intervertebral discs in the spine, and the labrum in the shoulder and hip joints.
Common Causes of Tears
Cartilage tears often result from specific mechanical actions or degenerative processes. Sudden, forceful movements, such as twisting the knee while the foot is planted, can lead to a tear in the meniscus. Direct impacts, like those sustained during falls or sports injuries, can also damage cartilage. High-impact sports, including football and basketball, commonly contribute to such injuries.
Repetitive stress on a joint over time can also cause cartilage to wear down, especially in weight-bearing joints. This gradual breakdown can occur due to chronic overuse or conditions like arthritis. Additionally, age-related degeneration makes cartilage more brittle and susceptible to tears, meaning older individuals may experience tears from less significant incidents.
Recognizing Symptoms
When cartilage tears, symptoms vary by location and severity. Pain in the affected joint is common, persisting at rest and worsening with movement or weight-bearing. Swelling can develop within hours or days.
Stiffness and a reduced range of motion make it difficult to fully straighten or bend the joint. A noticeable popping, clicking, or grinding sensation may occur during joint movement. In some instances, the joint might feel as though it is catching, locking, or giving way, indicating that a piece of torn cartilage may be interfering with normal joint mechanics.
Medical Diagnosis and Care
Diagnosis begins with a medical history and physical examination. A healthcare professional will inquire about symptoms, previous injuries, and physical activities. They will then observe the joint’s movement, checking for pain, swelling, and range of motion. Specific physical tests, such as bending and rotating the joint, help evaluate its stability.
Imaging tests are necessary to confirm diagnosis and assess damage. While X-rays can rule out bone fractures or significant arthritis, they do not show cartilage directly. A magnetic resonance imaging (MRI) scan provides detailed images of soft tissues, including cartilage, and can identify the size and depth of a tear. In some cases, an arthroscopy, a minimally invasive surgical procedure where a small camera is inserted into the joint, may be performed for both diagnosis and treatment.
Conservative treatments are often the first approach, including rest, ice, elevation, and over-the-counter anti-inflammatory medications. Physical therapy strengthens muscles around the joint to improve stability and restore range of motion. Injections, such as corticosteroids for inflammation or hyaluronic acid for lubrication, may also be considered.
For severe or persistent tears, surgical interventions may be necessary. Many procedures are performed arthroscopically, using small incisions and instruments guided by a camera. Surgical options include:
Debridement: Smoothing damaged cartilage and removing loose fragments.
Microfracture: Drilling small holes into the bone to stimulate new cartilage growth.
Cartilage repair: Reattaching torn pieces.
Cartilage transplantation (autograft or allograft): Transferring healthy cartilage to the damaged area.
Autologous chondrocyte implantation (ACI): Harvesting a patient’s own cartilage cells, growing them in a lab, and then implanting them.
Recovery and Rehabilitation
Recovery from a cartilage tear involves a structured rehabilitation process. The initial phase focuses on managing pain and swelling, often involving rest and limiting weight-bearing activities. Depending on the type of surgery, individuals may need to use crutches for several weeks or months.
Physical therapy plays a central role in regaining joint function. Therapists guide patients through exercises designed to restore mobility, improve flexibility, and strengthen the muscles surrounding the injured joint. This progressive program helps to stabilize the joint and reduce stress on the healing cartilage.
The timeline for recovery can vary widely, from several weeks for minor tears or less invasive procedures to 6 to 9 months for more extensive surgical repairs. Full return to high-impact activities or sports can take even longer, potentially up to 18 months, as the new cartilage needs time to mature and gain durability. Adherence to the rehabilitation plan is important for optimizing outcomes and preventing further complications.