I have followed the advice on this site, Penn State research papers and numerous www.ncbi.nim.nih.gov articles. A man was diagnosed with osteoarthritis of the knee due to a severe motocross accident. I've attached his x-rays from before and after the plates were finally removed from his leg which was one year after his crash. I need advice. Does the second set of x-rays reveal a total healing, or are we just seeing the effects of numerous chondroprotective supplements which were given to him in the hopes of opening the space in his knee? I ask because it seems to soon to experience this level of healing. I've also attached the patient's supplement list with dosages and dates. Please understand that the supplement list was created for my benefit and not necessarily to be read by others. By this, I mean I was only attempting to keep my research straight.
Healing of cartilage can not be judged in a plain x-ray. I think the role of such nutritional supplements is overestimated - even though its always mentioned that they could at least prevent further progress.
On A/P radiograph measurements between the medial femoral condyle and the midpoint from medial tibial spine to medial border of the medial tibial condyle can provide Joint space measurements. Using the Baumgaertner score can help to determine clinical results with radiographs. (Bae et al J Korean Orthop Assoc 2008). However, if one is looking to determine cartilage healing, MRI, biopsy (histological assessment), arthroscopy, immunohistochemical staing and Western blotting test for type II collagen after microfracture can be used.
(Bae et al, J Arthroscop & Rel Surg 2006; Systematic Analysis microfracture technique, Mithoefer et al Amer J Sport Med, 2009). I hope this helps.
In order to really prove healing of cartilage, MR of the knee would need to be performed.
Numerous methods have been promoted to stimualte and repair cartilage or to restore the joint surface and to ameliorate or abolish symptoms (pain, swelling, impaired movement). Numerous operative methods for treating the damage joint cartilage have also been advanced. After the procedures, cartilage defects are filled with fibrous or fibrocartilaginous tissue, wich by far fails to reach the biomechanical properties of healthy cartilage and mostly leads to further tissue degeneration. MRI has been used widely in the evaluation of cartilage lesions and cartilage healing.
Fantastic to see the improvement in appearance. Long-leg WBing and semi-flexed WBing PA views (e.g. Rosenberg) before and after are the best way of assessing changes in alignment and joint space. MRI is required to evaluate cartilage depth and quality.
- MRI is required to determine the cartilage healing. Nutritional supplements with strengthening exercises stabilises the structures that support the knee. It can help to prevent further progressions of the cartilage condition. Manual mobilisation with movement along with strength training of the knee help to prevent cartilage destructions.
Shahnaz Hasan, do you have recommendations regarding the best way to strength train the knee? Any specific exercises? Also, what recommendations would you have regarding manual mobilization? Would this be a something a patient could perform on his/her own outside of the office?
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