Poor Quality of Life for Patients with Knee Cartilage DefectsCracks, holes, or other defects in the knee joint cartilage can be painful and limit function. Heath-related quality of life goes down as these patients are prevented by their symptoms from engaging in recreational and sports activities. In fact, they can be as crippled as older adults who have knee osteoarthritis that is severe enough to need a knee joint replacement.
Some experts have wondered if patients with cartilage lesions that severe should just go ahead and have the knee joint replaced. But the problem with that is that these patients are usually much younger than patients in need of a knee replacement for arthritis. Joint replacements don't last a lifetime -- they are usually good for 10 to 15 years. So that treatment option isn't really realistic for younger adults. If that's the case, then what's the best treatment for cartilage defects that will yield the highest patient satisfaction?
That's a question researchers have been trying to answer for quite a while now. So far, there hasn't been enough agreement to support the use of one technique over another. And -- too many patients end up with knee problems after treatment. In fact, some studies show that knee problems persist in both groups (those who have had treatment and those who haven't).
We can say that younger patients with one single defect in the cartilage who have only had symptoms a short time (less than two years) seem to have the best results when autologous chondrocyte implantation (ACI) is the treatment used. Autologous means the cartilage used to repair the damage comes directly from the patient having the treatment. The cells are harvested from a place in the joint surface where there is minimal weight-bearing and where removing the cells won't affect the load-bearing surface. Chondrocyte is another word for cartilage cell.
In order to measure patient quality of life after treatment for cartilage lesions, the authors of this study used a well-known tool called the Knee Injury and Osteoarthritis Outcome Score or KOOS. This test measures pain, symptoms, activities of living, participation in sports and recreation, and quality of life. The KOOS scales makes it possible to compare complaints for patient with different types of knee problems.
To see how patients with cartilage defects compared to other patients with knee problems, they compared three groups: patients with cartilage lesions, patients with anterior cruciate ligament (ACL) ruptures, and patients with severe osteoarthritis. The thing that made the patients in all three groups so unique was the fact that they were all scheduled for surgery. Their pain and symptoms made it impossible to cope with daily life. That places a different slant on the research study because it doesn't include patients with mild-to-moderate cases of these three diagnoses who manage without surgery. And that's okay -- we just have to keep in mind when looking at the results that this is a specific group of patients based on severity of symptoms and doesn't include everyone with these problems.
According to the results from the KOOS test, the patients with ACL tears were the ones most distressed by their inability to participate in physical activities. Their quality of life was more influenced by that factor than the older adults who couldn't get around because of pain from knee arthritis. Patients with cartilage defects reported that their quality of life was affected equally by pain, inability to get around to do their daily activities, and the inability to participate in sports and recreational activities. This was true no matter what type of surgery they had to repair the cartilage.
The authors suggest that the poor results after surgical treatment for cartilage defects are made clearer when comparing these patients to those with other types of knee problems. Patients with cartilage lesions suffer ongoing pain and loss of function despite treatment. The fact that the KOOS scores were the worst for the patients with cartilage defects repaired surgically tells us that more work is needed to find better ways to treat this condition.
Stig Heir, MD, et al. Focal Cartilage Defects in the Knee Impair Quality of Life as Much as Severe Osteoarthritis. In The American Journal of Sports Medicine. February 2010. Vol. 38. No. 2. Pp. 231-237.
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