“Cartilaginous pathologies in sport: the state of the art”: this is the title of the master lesson that Dr. Cristiano Sconza, specialist in orthopedic and neuromotor rehabilitation in Humanitas, held during a conference dedicated to Sports Medicine, held in Prato.
The work also involved Dr. Ilaria Marchetti, sports doctor, and Dr. Stefano Respizzi, Director of Rehabilitation and Functional Recovery Department at Humanitas.
“We first offered a picture of the properties of articular cartilage, explaining how it reacts to the load, for example in the case of a run or a walk,” explains Dr. Sconza.
Knee chondropathies
“We then focused on chondropathies, i.e. diseases affecting cartilage, with particular attention to those affecting the knee. A very current topic, since 90% of the athletes of the NBA have cartilage problems during magnetic resonances to the knee, perhaps carried out for other reasons. The most significant problem is that regeneration of cartilage is very difficult because it is a non-vascularized component.
We distinguish between two types of lesions: focal and diffuse. The former involve especially young people, are often a consequence of an acute trauma and in most cases require surgery. The latter, on the other hand, take place following repeated micro-traumas and mainly affect athletes over 30 or older patients”, the specialist specifies.
The role of conservative treatment
“Treatment may be conservative or surgical. Conservative treatment is indicated for a professional non-athlete patient who has a small focal cartilage lesion or an extended mild to medium degenerative picture. Surgical treatment is preferable in professional sportsmen and young people with high functional requirements.
The conservative treatment involves the use of various techniques: pain control, control of the weight of the patient (overweight in fact causes biomechanical overload on the knee), physiokinesitherapy, visco-supplementation with intrarticular infiltrations of hyaluronic acid, the use of slow acting drugs, and supplementing drugs that are taken orally. A topic of great interest is the use of local growth factors, always through intrarticular infiltration, among which the one that is currently best known is the PRP (plasma rich in platelets); in this field, called Regenerative Medicine, research is developing thanks to the studies of Professor Elizaveta Kon, one of the greatest experts on the subject and Head of Translational Orthopedics in Humanitas,” explains Dr. Sconza.
Post-surgical rehabilitation
“The physiatrist also takes care of the planning the rehabilitative treatment of the patient after surgery.
In this case, the recovery phases include: the control of inflammation, the recovery of mobility and muscle elasticity, the recovery of strength and endurance, proprioceptive recovery and neuromotor control and finally the gradual return to sport.
Recovery times vary from patient to patient, also depending on the surgical technique. It should also be noted that we are not based on time criteria, but on functional criteria. The patient will return to complete recovery only when he is able to perform with confidence every activity / function of his daily life and sports,” concludes Dr. Sconza.
