The cartilage smoothing

What is cartilage flattening?

The cartilage forms a stable supporting tissue on the joint surfaces in the joints. Damage to this surface can occur as a result of incorrect or overstressing or as part of osteoarthritis. Patients often report pain and restricted mobility in the knee.

Cartilage smoothing can be used as a therapeutic measure to remove cartilage damage from the surface and avoid any consequences. However, its use has so far been controversial by experts, since it only removes parts of the cartilage, but does not restore the cartilage or treat the cause.

How can you smooth cartilage?

Cartilage smoothing is usually carried out arthroscopically, i.e. small skin incisions are made on the knee joint and the camera and instruments are inserted through these accesses. This procedure is also known as a knee mirror. The advantage of such a procedure is that it is less complicated than an open operation. As a rule, it is performed under general anesthesia, in rare cases or, if the patient so desires, under regional anesthesia.

During cartilage smoothing, fluid is first introduced into the knee joint in order to get a better view of the entire knee joint.This is followed by an assessment of the damaged cartilage surface for superficial and deep damage as well as loose fragments. Fragments are then removed using special electrical or mechanical instruments and the surface smoothed. The instrument can be thought of as something like a razor that shaves the rough surface of the cartilage.
This is followed by rinsing with water and cleaning of the joint to remove any remaining cartilage, the instruments are removed and the skin incisions sutured. In the case of heavier bleeding, a drain is placed, a vessel that collects blood or fluid from the wound or joint via a tube.

For more information, read on: Arthroscopy of the knee joint.

What results can be expected?

By smoothing the cartilage, surface roughening and cartilage residues can be removed. This is important because loose fragments of the body block the joints and can lead to pain and restricted mobility. An irregular surface of the cartilage leads to less gliding ability of the knee joint, which also reduces the pressure relief from the body on the knee. This can lead to osteoarthritis in the long term.

By smoothing the cartilage, further harmful developments in the cartilage and consequences can be prevented, but it does not fight the cause. The human cartilage is not supplied with nutrients by blood vessels, which means that it has little regenerative capacity. The smoothing therefore only removes the damaged cartilage, but does not restore it. Cartilage smoothing can provide temporary relief from the symptoms, but if the cause is not combated, cartilage damage can soon occur again.
The process of cartilage smoothing only works with superficial damage, with deeper cartilage damage it can be combined with a so-called abrasion if necessary.

Find out all about the topic here: Osteoarthritis therapy.

The benefits of cartilage smoothing

Arthroscopic cartilage smoothing is usually a very low-complication procedure, as it is not an open operation and therefore the risk of infection or injury is lower. Smoothing the cartilage can provide short-term relief from the symptoms and improve joint function.

One advantage of this procedure is the relatively quick recovery time after surgery. The patients are usually able to walk again shortly after the operation; the knee can be fully loaded after 2-4 weeks. However, the chances of healing with cartilage smoothing alone are not always ideal. Therefore, depending on the extent of the cartilage damage, a combination with a microfracture or bone drilling is performed. This process creates new cartilage which, compared to the original cartilage, is often less resistant but stable.

The disadvantages of cartilage smoothing

Even if cartilage smoothing as an arthroscopic procedure is considered to have very few complications, complications can occur in rare cases, which should always be clarified by the doctor before the procedure.
The ablation can lead to injuries to deeper layers in the cartilage, which can lead to joint effusion and swelling of the knee joint. It can also lead to infections, wound healing disorders and injuries to the menisci or other components of the knee joint. The removal of the cartilage can result in scars which can later lead to knee problems again, so that further cartilage smoothing or something similar is necessary. Furthermore, nerve damage and sensitivity disorders can occur. The risks of general anesthesia or regional anesthesia should also be pointed out here.

The therapeutic value of cartilage smoothing is still controversial, as only damaged tissue is removed, but no new cartilage is created due to the low regenerative capacity. If the cause of the cartilage damage is not treated, damage can occur again and again, which in turn would require cartilage smoothing. In the long run, the thickness of the cartilage would be very small, so that it would no longer be able to perform its pressure relief function. Therefore, experts recommend from the beginning to use procedures in which new cartilage is formed, for example with stem cells as part of a microfracture.

I.Find out all about the topic here: Causes of Osteoarthritis.

The sick leave after cartilage smoothing

After cartilage smoothing, patients are usually able to walk again within a short time. Forearm crutches may be needed for 1-2 weeks to relieve the knee and thus accelerate recovery. Even if it takes 2-4 weeks to fully exercise, work can be resumed after a short time.
The individual sensation lies with the patient; work should not be started if the knee is still painful or swollen. After a doctor's assessment has been carried out, the length of the sick leave can be decided.

When can you do sports again?

As a rule, the knee can be fully and symptom-free after 2-4 weeks. However, it depends on the patient, his muscles and the individual condition. Sports with steady movements, such as swimming or cycling, are advisable to start with, while irregular sports such as tennis or soccer should only be resumed after full recovery.

However, before starting an intensive exercise, a doctor should be consulted who will examine the knee again. Physiotherapy may also be advisable for support and faster recovery, also in order to avoid any improper strain that led to the cartilage damage in the future.

Read more about the topic here: Exercise for osteoarthritis.

Pain after cartilage flattening

Since the cartilage smoothing directly removes the triggering damage to the cartilage, the symptoms can be alleviated immediately after the procedure. A short time after the operation, you may experience knee pain as a result of the procedure. This is mostly due to the introduction of fluids and the procedure itself, but it should recede after a few days.
In rare cases, pain and swelling in the knee can occur for longer days. If there is also reddening and the knee becomes warm, a doctor should be consulted.