Targeted, physiotherapeutic strength training can eliminate imbalances in the joint. This does not heal cartilage damage, but healthy joint function significantly helps the body to compensate for damage and prevent further damage.
Inadequate musculature in certain areas is often a cause of cartilage pain, so this problem should always be addressed.
We are happy to advise our patients and create individual treatment plans.
Many injuries to the human body heal themselves. Behind these complex healing processes are growth factors from the blood.
During treatment with ACP, blood is taken from the patient with a small special syringe, similar to the way you would have a blood test at your GP.
This blood is then specially processed so that only the growth factors responsible for healing remain in a highly concentrated form.
The body's own active substance obtained in this way is then injected into the affected joint. The body's own healing process can thus be significantly supported.*
ACP is even used in professional soccer as a preventative measure against joint wear and tear. In animal experiments, it has even been shown to build up cartilage.
Hyaluronic acid is the most important component of synovial fluid. It acts in many ways in the knee - as a shock absorber, spacer and lubricant in the joint. It also helps to nourish the cartilage.
Cartilageis not supplied with blood, but is supplied passively by absorbing and releasing synovial fluid during movement. As an essential component of the synovial fluid, hyaluronic acid ensures the elasticity of the cartilage and thus its resistance as a shock absorber in the knee.
If a knee joint is injured or inflamed, the amount of hyaluronic acid and therefore the natural lubricant in the joint decreases. The joint surfaces rub more against each other and the inflammation and wear continue - a vicious cycle for the joint.
By injecting additional hyaluronic acid into the affected joint, the cycle is stopped, the joint is better lubricated again and runs "smoother" - swelling and pain are reduced.
In a few cases, hyaluronic acid can also be taken orally (in tablet form), especially if there is cartilage damage in several joints. The effect of the hyaluronic acid used is of course always significantly greater when injected into the affected joint than in tablet form. Depending on the patient's individual needs or reservations about injections, the best therapy for them will be discussed with them.
In cases of severe pain and severe swelling, a single cortisone infiltration can achieve a significant improvement. This can be repeated after a few weeks if necessary.
However, cortisone only combats the symptoms of cartilage damage. It is therefore only a small part of the conservative treatment options. The aim should always be to provide additional support for the cartilage.
Acupuncture can be used very effectively as supportive pain therapy to reduce swelling in the knee. We usually recommend two treatments per week over a period of ten weeks.
There are two main types of surgical cartilage therapy.
Cartilage refixation:
Fresh traumatic cartilage damage caused by accidents or sports injuries (e.g. soccer or skiing) should be treated as quickly as possible, as torn pieces of cartilage can often be successfully refixed.
Cartilage replacement therapies:
If this damage is recognized or treated too late, surgical cartilage replacement therapies are usually required. There are a variety of options here, including stimulating the body to heal itself and cultivating the body's own cartilage cells in the laboratory.
Cartilage is essentially responsible for the transmission of pressure in the knee joint. We now know from many studies that destroyed cartilage does not grow back in its normal form. In most cases, inferior replacement cartilage forms, so-called fibrocartilage, which does not have the function and resilience of healthy hyaline cartilage.
Damaged cartilage wears out very quickly if left untreated. The pressure in the joint can no longer be distributed evenly and premature osteoarthritis develops, which typically leads to initial pain or load-dependent pain and swelling in the joint.
Using modern arthroscopic techniques, larger cartilage fragments that have been freshly torn out of the cartilage can now be reattached using biological anchors.
The anchoring dissolves by itself and the cartilage grows back firmly.
This surgical method is chosen for acute accidents or sports injuries.
In this minimally invasive procedure (usually using the mini-open technique), the damaged cartilage is first removed. By opening the subchondral bone, multipotent cells (mesenchymal stromal and stem cells) migrate into the defect, where they promote the growth of new cartilage tissue. A small collagen membrane is inserted to cover the defect, which according to scientific evidence improves the quality of the cartilage replacement tissue compared to pure bone opening (microfracturing) and therefore leads to superior results.
In this minimally invasive procedure (usually using the mini-open technique), the damaged cartilage is first removed. Intact cartilage tissue is harvested from the edge of the defect (or from parts of the knee joint that are not under load), which is cut into very small pieces of cartilage (using a knife). These "cartilage chips" are then distributed in the defect area during the same operation without further processing and fixed in the defect with a matrix, a gel or with fibrin glue. In studies, this procedure has already shown comparable results to autologous chondrocyte transplantation in the short-term follow-up
In this procedure, which is performed arthroscopically, a round cartilage bone cylinder is first punched out in the area of the defect.
A cartilage bone cylinder of the same size is then punched out of an unloaded part of the knee joint and inserted into the defect area.
In this very demanding arthroscopic procedure, tiny pieces of cartilage are removed from unloaded areas of the knee joint in an initial operation and sent to a specialist laboratory for cultivation.
Using a newly developed, particularly gentle method, these cells are then combined into three-dimensional spheres. Each of these spheroids contains an average of 200,000 cartilage cells.
Using so-called adhesion proteins, these cartilage spheroids, which consist of the patient's own pure biological material, are stably attached to the cartilage defect and can thus produce a completely new, equivalent hyaline cartilage.
What follow-up treatment is necessary?
Afterthis cartilage transplant, it is important that the knee joint is relieved of partial weight-bearing for 6-8 weeks to allow the cartilage cells to completely fill the defect and form new, stable cartilage.
After the load has been relieved, careful, phased loading begins over a total of 12 months:
- Soft shoes for cushioning
- Cartilage massages, e.g. light cycling, help to nourish the cartilage and lead to faster healing.
- Shock loads and impact sports, such as soccer, should be avoided in the first year after the operation.
Under these conditions, very good results can be achieved, especially in younger patients. ACT patients have the highest long-term sports fitness rate of over 95%.
Depending on the procedure, the operation takes between 40 and 80 minutes
In most cases, these therapies are carried out on an inpatient basis.
After surgical cartilage therapy, partial relief of the joint on walking sticks is usually necessary for 6-10 weeks.
Typically, the patient is unable to work for around 6-8 weeks (whereby partial weight-bearing with forearm crutches must be maintained for 6 weeks after surgical cartilage regenerative therapy)
After the initial postoperative phase of partial weight-bearing and successive increases in weight-bearing under physiotherapy, relevant sporting activity can be resumed from around 4-6 months after cartilage regeneration surgery. Clearance for high-impact and contact sports is usually only given after 12 months and a follow-up MRI.
Even if you are not an athlete, surgical cartilage therapy may be necessary to prevent premature joint wear and the resulting threat of having to have an artificial joint fitted.
In the long term, this leads to painful restrictions in the movement of the joint, which can no longer withstand everyday stress and then has to be replaced by an artificial knee joint.
As with any operation, in the worst case an infection can occur which must then be treated with an antibiotic. However, this is extremely rare with today's minimally invasive arthroscopic operations and complications are extremely rare with today's special minimally invasive techniques. The worst and extremely rare complication would be a joint infection, which would then require additional antibiotics. It may be necessary to rinse the knee joint again.
Of course, it is also possible that even if cartilage therapy is carried out correctly, no corresponding load-bearing cartilage will grow back and despite cartilage treatment, further wear and tear may occur with a possible need for prosthetic treatment (artificial joint).
