Cartilage, specifically hyaline cartilage, is very difficult to heal. In this episode I'll cover cartilage anatomy, and we'll discuss how it is arranged to withstand tensile and compressive forces across joints. I'll cover what happens in a joint injury, and why healing is so challenging. we will also discuss the distinction between normal and abnormal wear from a surgeons perspective.
There are three types of cartilage in the human body, although the one we most commonly pay attention to is hyaline cartilage since this makes up the articulation between bones. The gliding and shock absorbing function of type 2 collagen makes hyaline cartilage particularly suited for absorbing force. It is arranged in a very specific manner to absorb forces and maintain structural integrity under load. When damage occurs to this tissue, the integrity becomes compromised, and similar to the laminated structure of a car tire, begins a disintegration process.
Delamination will occur in phases, and often correlates to the radiographic and clinical findings a patient will present with. As a surgeon, my job is to determine the origin of the degradation (whether normal age related or traumatically induced) and assume certain prognostic factors, like stage and rate of degradation that is likely and secondary or collateral effects of this degenerative process. There is no one-size-fits-all approach to joint degeneration. Since this is a slow process in most cases there is time for decisions related to interventions, whether conservative or surgical. When surgery is considered, there are joint sparing and joint eliminating procedures, the choice of which is highly dependent on the knowledge and skillset of the surgeon evaluating the condition.