1. Articular Cartilage Lesion – Chondral Defect

2. Normal Anatomy
Hyaline cartilage covering the articular surface of the tibia and femur
Function
Lower friction on gliding surfaces
Shock absorption
Average depth of 2 -4 mm
Avascular
65-80% is water, 10-20% is type II Collagen (Tensile Strength) and the other 10-20% is Proteoglycans (Compressive Strength)

3. Mechanism of Injury Traumatic Non Traumatic
Direction compaction injury
Rotational Injury- pivoting on a fixed foot
Normally associated with ACL tears, meniscal injuries, patellofemoral dislocation and subluxation
Non Traumatic
Degeneration of articular cartilage (OA)

4. Classification Grade 0: Normal cartilage Grade I:
Softening, blistering or swelling of the cartilage
Grade II:
Partial thickness fissures and clefts <1 cm diameter
Grade III:
Full thickness fissures, to subchondral bone >1 cm diameter
Grade IV:
Exposed subchondral bone

5. Associated Pathologies
ACL or other ligament tears
Menisci injury
Patellofemoral Dislocation or Subluxation
Osteochondritis Dissecans
Chondramalacia patella

6. Subjective Usually traumatic
Twisting/pivoting/rotational movement with a planted foot
Direct compaction injury
Localised pain around the joint line and pain on movement
Swelling and oedema
Locking may be present if loose body limits or blokes movement
Giving way
Can also get pain on prolonged inactivity such as sitting for long periods

7. Objective Significant swelling if acute Reduced range of movement
Pain on movement
Pain on closed chain loading activity such as squatting
Pain around joint line may be present.
Joint locking is a loose body is present
Quadriceps wasting may be present if gone undetected for a long period of time

8. Further Investigation
X-ray
MRI
Arthroscopy

9. Management
Conservative management has varying success depending on size of lesion
Surgical opinion is always recommended for early diagnosis and appropriate management plan
Injections can be used for pain relief and allow physiotherapy to continue

10. Conservative - Management
Progress weight bearing as able
Protect articular cartilage lesion as pain allows
Enough stress to stimulate a healing response
Too little stress – no healing response
Too much stress – increases injury
References contain in depth rehabilitation protocols

11. Conservative - Management
Restore Normal Range of Movement
Decrease inflammation if present with massage, ice, NSAID’s, rest from aggravating activities
Decrease tone of muscle spasm with soft tissue techniques (Soft Tissue Techniques)
Increase mobility of tibiofemoral and patellofemoral joint (Joint Mobilisations)
Regular joint motion to stimulate articular cartilage repair
Restore Normal Motor Control and Strength
Quadriceps
Hamstrings
Glutes
Abdominals
Restore Dynamic Stability
Exercises that challenge the stability of the entire lower limb kinetic chain in a pain free range
Return to sport/activity specific exercises

12. Surgical - Management 4 main options for surgical intervention
Arthroscopic Lavage and Debridement
Washing out the loose fragments
Removing flaps of damaged cartilage and removing loose bodies
Microfracture
Preferred in lesions >2cm due to its simplicity and cost effectiveness
Autolouge Chondrocyte Implantation
Usually used on full thickness chondral defects
Attempts to slow the progression of severe OA
2-3 biopsy's are taken form healthy cartilage from the lateral femoral condyle and then grown/cultivated
Osteochondral transplantation