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Damage to the joint cartilage can be from an injury or from osteoarthritis and it can happen in those young and the old. 

It can cause a catching or clicking sensation and is often associated with knee swelling. You are likely to need an MRI scan which will show us where the damage is and if it needs surgery or can be managed through physical therapy.  The scan will also show any other injury to the meniscal cartilage or ligaments that needs treatment. 

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Our knee joint cartilage spreads the load going through our knees during activities, allowing our knee joint to move smoothly and without pain. It is protected by the menisci which act as shock absorbers 

The ends of our thigh bone (femur), shinbone (tibia) and kneecap (patella) are covered in joint cartilage to allow for smooth, pain-free movement. This cartilage is very tough as it has to last our lifetime and does not repair itself when damaged.

Injury to the joint cartilage can be confused with an injury to the meniscus which is often called a 'torn cartilage'. It is not a common knee injury in younger people, mainly affecting those with unstable knee caps or following a larger knee injury such as an ACL rupture. It is important for our surgeons to see a younger person with a suspected piece of loose cartilage as soon as possible (in our Urgent Knee Clinic) as it may be possible to fix it back. 

However, as we get older, our joint cartilage gradually becomes more brittle and prone to wearing away or tearing with less force. We tend to see middle-aged and older patients who have worn out their knee cartilage (osteoarthritis) which may have been stirred up by a mild injury.

If you have suffered an acute injury to the knee which damages the joint cartilage, you may feel a catching sensation or a deep aching pain. It can be painful in the early stages but this pain may be from other injuries such as a dislocated patella. There is often some swelling which is usually at its worst within a few hours of the injury. If the injury has created a loose piece of cartilage within the knee, this can get trapped between the joints causing a catching or clicking sensation. Occasionally the tear can cause the knee to 'Lock'. This is where it is not possible to fully straighten the knee. Sometimes it can be ‘unlocked’ by wiggling and twisting the leg although often it needs surgery to remove or repair the loose piece of cartilage. 

If your knee joint cartilage damage is from wear and tear arthritis, you would usually experience an aching pain on that side of the knee, usually the inner (medial) side of the kneecap (patella). This is usually worse with exercise such as walking and can also be painful at night. The knee will often click and catch.

Joint cartilage damage can be diagnosed by your GP, physiotherapist or specialist through careful questioning about your injury, an examination of your knee and in most cases, an MRI scan. The scan will not only tell us if you have damage but also whether it is repairable and whether there is any other injury to the meniscus or ligaments that needs treatment. 

If your knee is locked or there is a loose piece of cartilage from a recent injury, then urgent surgery may well be indicated. Nearly all other patients with a meniscal tear will benefit from a range of non-operative treatments before going for surgery.

First, we help you to settle your knee down so that it can be used for day-to-day activities again without pain. This involves using anti-inflammatories such as ibuprofen, diclofenac, or meloxicam for a short course of 1 to 2 weeks. This helps to reduce any swelling and pain in the knee. **(Please check with your doctor or specialist that these medicines are safe for you first.) 

It is important to reduce the impact going through your knee while it is recovering with running and jumping being the highest impact. Some compression bandaging or bracing can be useful as can ice packs. 

The next stage is to have a thorough assessment by a physiotherapist of the strength and function of your legs, not just in the knees but also in the stabilising muscles of your hips and core. They can then direct your exercise program which will reduce the load going through your knees, balance that load to reduce your risk of re-injury, and strengthen you to help improve your speed, your endurance, or your distance with the driver off the first tee. 

The exercise program can take 2-3 months to make a difference but it works in the majority of simple meniscal tears. If the meniscal tear is still causing problems despite all the above then it is time to consider surgery. 

The surgical treatment for joint cartilage damage ranges from an arthroscopy or keyhole procedure to remove loose pieces to more invasive procedures to repair loose fragments or in the case of arthritis, knee replacement surgery. Please make an appointment with the surgeon to discuss what is most appropriate for you.

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