Traumatogenic cartilage damage in younger patients
Generally as a result of a sporting accident (football, handball or similar) with associated sprain trauma, a small piece of cartilage (1-2 cm in diameter) can break off the otherwise intact cartilage layer. The surrounding edges are intact and of normal height, the underlying bone healthy and of good regenerative capacity. This type of injury responds well to the treatment options mentioned below.
Degenerative wear
Less favourable is the outlook for cartilage damage developed in the course of a life-time by years of monotonous stress alone or in conjunction with hindfoot malalignments; initially, this results in softening of cartilage (stage 1), followed by fissuring of the softened cartilage (stage 2). In stages 2-3, the cartilage layer is only half as thick as normal and extremely frayed; there may be detached or loose fragments of cartilage.
This stage can no longer be repaired by the body itself without outside intervention. These cases are classified as severe cartilage damage, even though pain levels may still be bearable and thus not perceived as warning signals by the patient. It is, however, at the early stage of cartilage degeneration that modern cartilage surgery has the greatest prospect of success.
Stage 3 degeneration with thinning of cartilaginous tissue
Terminal stage 4 with complete destruction of cartilage
At terminal stage 4, the cartilaginous tissue is completely destroyed, the "tyre profile" worn away. At this stage, even modern surgical interventions to restore the cartilaginous layer still only promise limited success. The basic principle is: once cartilage damage has begun, it is going to progress at increasing speed; without early therapeutic intervention, freedom from pain can only be achieved by implanting an artificial joint prosthesis.