Arthritis can trigger from an injury, poor knee mechanics, weight issues and many other causes, but if the pattern is not interrupted the end-stage is the same.
Page updated July 2023 by Dr Sheila Strover (Clinical Editor)
This Primer explains how joint (articular) cartilage damage can lead to osteoarthritis in the knee.
- Introduction to arthritis
- Types of arthritis
-
The common arthritis pathway
- How knee arthritis progresses
- What's special about hyaline (articular) cartilage?
- Arthritis cysts and spurs
- Joint injections for knee arthritis
- The concept of arthritis compartments
- Classifying the amount of cartilage damage
- Knee X-rays and arthritis
How maltracking of the kneecap can end up in osteoarthritis
When a kneecap tracks badly, the one side of it contacts the femur bone with too much pressure, while the other side contacts it with too little pressure. The kneecap needs a certain amount of contact pressure to 'pump' the nourishment from the joint fluid. When the pressures are wrong the joint cartilage softens and swells (chondromalacia), then blisters or fissures, then the blister or fissure breaks into fibrils, and these later break off and float into the joint. This destructive processs releases enzymes into the joint, and these cause destruction elsewhere in the joint.
How a catching plica can end up in osteoarthritis
At the point of contact of the abnormal plica with the underlying bone, the plica becomes reddened, traumatised and thickened. Catching is aggravated and the underlying joint surface becomes softened and undergoes the same destructive cycle described above, while the damaged plica releases the same destructive enzymes which spread the damage elsewhere in the joint.
How a bucket handle tear of the meniscus can end up in osteoarthritis
When the integrity of the meniscal shock-absorber is badly disrupted the joint is unstable in addition to the joint surface being insufficiently buffered from shocks. Also the flap of loose meniscus can twist over and lock the joint, further damaging the surface. The joint cartilage undergoes the same softening/fibrillation cycle, with the enzyme damage spreading the destruction.
How a torn cruciate ligament can end up in osteoarthritis
When the cruciate is torn, it is usually the result of a significant injury, and meniscus and joint surface are often damaged at the same time. But even when this is not the case the instability of the joint introduces forces which eventually do stress both the meniscus and the joint cartilage, and the softening/fibrillation/enzyme cycle is triggered once more.
Note that osteoarthritis of the knee can arise without a mechanical trigger, but our point is that it is very often the end result of long term problems in the knee - a torn meniscus, a maltracking patella, a fracture, or even inappropriate or over-enthusiastic surgery!
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