The common arthritis pathway

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.

 

The common kind of arthritis in the knee is 'osteoarthritis'. Osteoarthritis in the knee may have several triggers, but once joint destruction sets the pattern of damage tends to be much the same irrespective of the original cause.

Often it is triggered by a mechanical problem setting off a sequence of local inflammation and joint surface softening, followed by local joint surface destruction. This process is accompanied by release of chemical substances into the injured joint, which then in turn sets off a greater destructive process in the joint as a whole. So, it doesn't very much matter what disorder one starts with - insufficient or inappropriate treatment may lead everyone down the same common arthritis pathway!

This list shows how different conditions in the knee may all end up in 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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Author

Dr Sheila Strover

Clinical Editor

Dr Sheila Strover is the founder and Clinical Editor of the KNEEguru website.

Her medical studies were completed at the University of the Witwatersrand in South Africa - BSc(...read more

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