Knee Cartilage

[Bligh]

After watching the doctor discuss Kimbo's knee injury, I was left with some questions regarding this condition.
Are some people just born with cartilage that will degrade over time?
Is it not a matter of genetics but more a factor of poor training practice?
Is it only really a result of traumatic injury?
Is there any medical procedure to repair this damage once it has been done?
If not, are cortizone injections the only way to temporarily deaden the pain to function for strenuous activity?

Thanks in advance for any help.

[Jujujason]

Hi, I'm a physician assistant that works in an arthritis based orthopedic practice here in LA. In response to your questions, cartilage is a spongy-material that cushions our joints. It will wear out to some degree or another in all individuals over time.

Some things will cause it to wear out more quickly over time (eg too much physical activity and pounding for all of us gym rats and obesity for the couch potatoes). Some things do appear to be protective (eg genetics, osteoarthritis does seem to run in some families more strongly than others and maybe nutrition, certain supplements like glucosamine, msm, hyaluronic acid and chondroitin may be restorative). Basically, human beings have an unhealthy hobby of collecting birthdays and the larger your collection gets, the chance of things like cartilage wearing out go up.

Now, all different types of injuries can occur in the knee joint and it's difficult to say what really happened to Kimbo's knee from the small segment that aired on tv, but I'll attempt to go over a few.

[Jujujason]

First, meniscal tears. These are usually diagnosed with mri's. A meniscus is a cartilage-like fibrous connective tissue that is poorly vascularized. Because of its poor circulation, it usually doesn't heal or heal well if injured and any little tear can act as a source of chronic inflammation and cause 'catching' or 'locking' sensations. Conservative treatment can include cortisone injections, antiinflammatories, rest, ice, bracing and physical therapy but the only definitive treatment is arthroscopic surgery. Both the tear and arthroscopic surgery can predispose the patient to further problems in the future that may require joint replacement surgery to fix.

[Jujujason]

Medial/lateral ligament sprains/tears. These can be diagnosed with history and physical exam skills alone and confirmed by an mri. These will usually respond well to conservative measures like rest, bracing, ice, antiinflammatories and physical therapy but it may take anywhere from 3-6 mos to feel normal again. I had a medial collateral ligament injury that healed perfectly with the above measures alone.

[Jujujason]

ACL/PCL sprains/ruptures. These too can usually be diagnosed with a combination of history and physical exam skills and confirmed with an mri. Because people can live without these ligaments, they are sometimes treated nonsurgically with conservative measures but it may mean giving up martial arts (Not acceptable to most of us on this forum.). Treating it surgically with an autograft (taken from the injured person's own body, like his patellar tendon or harvesting his gracillus tendon) or an allograft (donated by a dead person) can usually restore function but may require extensive physical therapy afterwards and may take upwards of a year to feel normal again.

[Jujujason]

Arthritis only gets worse over time and at this time, the only definitive cure is a joint replacement (posterior total hip replacement, anterior hip replacement, hip resurfacings, partial and total knee replacements). The rate at which it progresses is not constant, however, and can be highly unpredictable. The best one can hope for is a long period of quiescence in which the arthritis levels off and doesn't get any worse for awhile. Surgery should always be a last resort and conservative measures (antiinflammatories, narcotics, rest, ice, pt, bracing, injections) should be exhausted before going under the knife. Joint replacement surgery is not the end of one's athletic/martial arts career. Bill Wallace has two artificial hips and an artificial knee and is still very active. He even wrote about in an issue of Black Belt about a year ago.

[Da Pope]

There is alot of research currently being done in regenerating cartilage outside of the body for implant, checkout Institute of Medical and Biological Engineering at the University of Leeds who are currently doing alot of work in this area.