Cartilage Injury / Chondral lesions

Pain when climbing up stairs

What is cartilage injury / chondral lesions?

Cartilage injury, also known as chondral injury, chondral lesions or ulcers, refers to damage to the cartilage that covers the ends of bones in a joint. Specifically, it involves the articular cartilage which provides cushioning and helps bones glide smoothly over each other in the joint. 

Chondral lesions are a specific type of cartilage injury that involves a focal loss of cartilage, usually due to mechanical wear and tear or traumatic injury. Knee cartilage or lesion could lead to further degeneration and joint damage if left untreated. Chondral knee injuries are particularly tricky due to the slow healing nature of cartilage as it has no blood supply. Additionally, cartilage injury/chondral lesions do not occur in isolation and are often accompanied by ACL injuries.

cartilage lesion
Cartilage lesions occur on the articular cartilage.

Cartilage injuries or chondral lesions are graded based on the severity of the damage to the cartilage, such as:

  • Grade 1: softening or swelling of the cartilage and superficial lesion also known as blisters. 
  • Grade 2: partial thickness or defect with fissures (cracks) that do not reach the subchondral bone. Cartilage appears “shredded”. 
  • Grade 3: full-thickness damage to the cartilage bulging over the lesion, and impact on the subchondral bone is present. 
  • Grade 4: exposed bone due to complete loss of the cartilage layer.

What causes cartilage injury / chondral lesions?

Cartilage injury or chondral lesions can be caused by a variety of factors including:

  • Trauma or injury to the knee joint
  • Continuous stress on the knee joint
  • Degenerative changes due to ageing or osteoarthritis
  • Malalignment or abnormal tracking of the patella (kneecap)
  • Inflammatory joint diseases like rheumatoid arthritis and osteoarthritis

What are the symptoms of cartilage injury / chondral lesions?

Some of the signs that you have a cartilage injury or chondral lesions include:

  • A “popping” or “grinding” sound when moving the affected joint
  • Swelling and stiffness
  • Instability or weakness in the joint
  • Limited range of motion
  • Severe pain in the affected joint with prolonged walking or climbing up stairs
  • Feeling a catching or locking sensation in the joint
  • Unable to bear weight on the affected area
chondral lesions pain
Chondral lesions result in pain specifically when climbing up stairs.
If you notice any of the symptoms, make an appointment with an orthopaedic specialist to get an accurate diagnosis and treatment.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

Is cartilage injury / chondral lesions painful?

Yes, cartilage injury/chondral lesions can be painful.

Pain may be felt during movement of the joint, and there may be swelling, stiffness, and a grinding or popping sensation in the joint. Pain may also be felt at rest, particularly in more advanced cases.

Who is at risk of cartilage injury / chondral lesions in Singapore?

Cartilage injury/chondral lesions can occur in anyone, but there are certain factors that can increase the likelihood of developing these conditions.

Risk factors include:

  • Age: as we age, the cartilage in our knees becomes more brittle and susceptible to damage.
  • Athletes / hobbyists: generally young people may be susceptible if they participate in activities which cause strain on the knee such as runners. 
  • Trauma: forceful impacts to the knee can damage the cartilage, which could lead to a chondral ulcer.
  • Genetics: some people are born predisposed to cartilage injuries due to their genetics.
  • Obesity: being overweight can put extra stress on the knees and increase the chances of developing cartilage injuries.
  • Medical history: people with misaligned knees or other joint conditions are more susceptible to developing cartilage injuries.
knee strain
Activities that put strain and pressure on your knees can result in cartilage injury or chondral lesions.

How is cartilage injury / chondral lesions diagnosed?

Cartilage injury/chondral lesions can be diagnosed in the following ways:

  • Physical examination and medical history: inform your orthopaedist of the potential activities that may have led to an injury such as trauma, exercise, or sports. Physically the area of injury will be examined and several motion tests will be conducted to review the injury.
  • Imaging tests: magnetic resonance imaging (MRI) or dynamic ultrasonography would be required to visualise the extent of the damage to the cartilage and to determine if there are other bony defects such as cysts or swelling of the bone. An x-ray may be conducted if osteoarthritis is suspected and to capture any narrowing of the joint. 
  • Diagnostic arthroscopy: arthroscopy, a minimally invasive procedure where a small camera is inserted into the knee joint to visualise the structures inside.

What are the treatment options for cartilage injury / chondral lesions in Singapore?

Depending on the severity and individual need, cartilage injuries / chondral lesions can be treated by:

  • Rest: you would be advised to observe complete rest, while icing the affected area, to relieve pain and reduce swelling.
  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers are commonly prescribed as the first course of treatment to reduce inflammation and manage pain.
  • Injections: corticosteroid injections may be used to manage pain associated with chondral lesions.
  • Brace: to reduce movement of the joint and allow the cartilage to heal.
  • Crutches: to limit placing weight on the affected knee.
  • Physiotherapy: upon discontinuation of the use of the brace, an active range of motion exercise would be administered via physiotherapy to regain mobility and strengthen muscle.
  • Surgery: surgery can vary from a microfracture to an osteoarticular allograft. The surgery employed will depend on the grade of the cartilage injury. 
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For emergency appointment, please call or Whatsapp us at (65) 8909 8877. We will arrange for a limousine to send you to our clinic.
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