Featured Speaker Physiotherapy Now

Dr. Jas Chahal

MD, Orthopaedic Surgeon Toronto, ON

Dr. Jas Chahal, MD, MSc., FRCSC, Orthopaedic Surgeon, discusses the various treatment options available to treat knee pain associated with articular cartilage damage

BIO: Physiotherapy Now

Jas is a fellowship trained orthopaedic sports medicine surgeon at Women’s College Hospital and Toronto Western Hospital with an interest in shoulder, hip and knee arthroscopy, ligament reconstruction, and cartilage restoration. He completed his sports medicine fellowship at Rush University Medical Center with international experts in the field and worked as a fellow team physician for the Chicago Bulls and Chicago White Sox.  His research interests include clinical outcomes research in sports medicine, as well as, translational work on the use of biologics and mesenchymal stem cells in treating orthopaedic conditions.  Jas is also an orthopaedic consultant for the University of Toronto Varsity Blues.   Most recently, Jas has completed his Master of Business Administration at Rotman and at the University of St. Gallen which has given rise to his passion for innovation in the context of local and national healthcare delivery.  Therapia home physiotherapy is an example of a healthcare innovation initiative that has arisen from this endeavour. Orthopedics Now  featured speaker Now Health


Treatment Options For Knee Pain Associated to Articular Cartilage Damage

So when doctors contact patients with articular cartilage problems in the knee, usually what they hear about is swelling in the knee, pain, and limitations in function, and that can be in simple everyday activities, or it can be limitations in more advanced activities like sports and work-related function.

Each situation is unique and that’s important to remember, and a lot of what patients have to tell their physician relates to where they’re coming from in terms of their physiological age, their chronological age, their lifestyle, and what their expectations are, and where they want to return.

The treatment options for cartilage problems in the knee depends on various aspects. There’s patient specific factors that we talked about such as age, activity level, function, expectations, and there is actual cartilage defect specific factors that we consider; for example, how big is the cartilage lesion, where is the cartilage lesion location, and does the cartilage lesion occur by itself or in combination with other problems in the knee joint; for example, ligament problems, meniscus problems, and the overall alignment of the entire extremity.

You have to remember what happens in the knee is often a direct result of what happens both above and below. So above we have the hip, the pelvis, and the core muscles, and below we have the foot, and the ankle. So overall you have to consider the overall patient in terms of anatomy, in terms of a cartilage lesion, and in terms of where they’re coming from as an individual.

For the young patient with a lesion in the cartilage that limited to one area, and the rest of their knee is in relatively good shape, there’s actually a lot of options, and the options range anywhere from non-operative treatment that can include injections, such as cortisone, hyaluronic acid, and maybe even platelet rich plasma, all the way to more advanced option, such as unloader braces and physical therapy.

From the surgical side, you have micro fracture, you have other newer treatments like De Novo, which is an allograft or cartilage where donors who have passed away have donated their cartilage so recipients with the appropriate pathology can be treated.

Other alternatives include receiving other types of transplants or cartilage transplants, and in certain parts of the world you can be treated with your own cartilage cells where the cartilage is biopsied, it’s grown in the lab and re-implanted into your knee, and that procedure is called autologous chondrocyte transplantation.

We don’t have that in Canada, but in the United States and Europe it’s widely available. If you’re an individual who has cartilage disease either spread out through the entire knee or a very advanced disease that’s very large and involved both sides of the joint, focal cartilage treatments, such as the ones I’ve talked about may not be appropriate for you. In your situation, you may be better managed with injections.

Once again, in the various types we’ve talked about: braces, physical therapy, and more invasive surgical alternatives, and these include things, such as an osteotomy of your knee, a partial knee replacement, or even a total knee replacement. So ultimately decide what treatment is best for you, and where you fall into the spectrum of cartilage pathology, you need to be evaluated by your local orthopedic surgeon.

If you think what we’ve talked about today applies to you, please contact your primary care physician for a referral to the appropriate specialist.

Presenter: Dr. Jas Chahal, Orthopaedic Surgeon, Toronto, ON

Local Practitioners: Orthopaedic Surgeon

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