Cartilage Tears: Causes, Risk Factors, and Prevention

Mechanisms of Cartilage Injury

1. Acute Trauma

Direct impact, sudden twist, dislocation (sports, MVC, falls). Shear/compressive forces exceed tissue tolerance.

2. Repetitive Microtrauma

Cyclic loading (running, jumping, occupational) → fatigue failure. Common in weight-bearing joints (knee, hip, ankle).

3. Age-Related Degeneration

Collagen cross-linking ↓, proteoglycan loss → ↓ hydration, ↓ resilience. Fissures propagate.

4. Underlying Pathology

• Osteoarthritis (primary/secondary).
• Inflammatory arthritis (RA, gout, CPPD).
• Osteochondritis dissecans.
• Infection (septic arthritis).

5. Congenital/Developmental

• Dysplasia (hip), meniscal variants (discoid), ligamentous laxity.

Risk Modification

• Neuromuscular training (landing mechanics, proprioception).
• Strengthening (quadriceps, gluteals, core).
• Weight management (↓ joint load).
• Appropriate footwear, surfaces.
• Early treatment of joint injuries.

Treatment Spectrum

• Conservative: PT, NSAIDs, activity modification, injections (corticosteroid, HA, PRP).
• Surgical: Arthroscopic debridement, microfracture, OATS, MACI, osteotomy, arthroplasty.