Healing of the knee joint

Dr Marisol Vazquez
(BIOSI2, vazquezm1@cardiff.ac.uk)
Learning outcomes

• Describe the processes that differ from the general principles of cutaneous
wound healing of:
• Bone
• Cartilage
• Ligaments
• Synovium
• Factors that affect tissue healing
Lecture structure

• Brief introduction/recap on knee joint gross anatomy

• Focus on main tissues of knee joint (bone, cartilage, ligaments, synovium)
• Recap on tissue type/structure (microanatomy sessions)
• Common injuries
• Healing of the tissue
• Factors affecting tissue healing
The knee joint
• Synovial joint (hinge)
• Function can be impaired (hyperextension*)
• 3 articulations:
• 2 femorotibial (lateral and medial) – between femoral and tibial condyles*
• 1 femoropatellar (intermediate) – between femur and patella

*Hyperextension: extension beyond normal range of motion

*Condyles: rounded protuberance in bones forming articulations with other bones
Components of the knee joint
BONES
Femur

Patella

Tibia

NOTE: Fibula not part of the knee joint

Components of the knee joint
CARTILAGE

Articular

Medial Lateral
meniscus meniscus
Components of the knee joint
LIGAMENTS

• 5 extracapsular
• Patellar Ligament
• Fibular Collateral Ligament (FCL)
• Tibial Collateral Ligament (TCL)
• Oblique Popliteal Ligament (OPL)
• Arcuate Popliteal Ligament (APL)
• 2 intracapsular
• Anterior Cruciate Ligament (ACL)
• Posterior Cruciate Ligament (PCL)
• Coronary Ligament
• Transverse ligament
Components of the knee joint
SYNOVIAL MEMBRANE BURSAE
QUIZ!
Healing of the knee joint

• Focus on main tissues:

• Bone
• Cartilage
• Ligaments
• Synovium

• Tissue composition (recap from

microanatomy), common injuries, OSTEOARTHRITIC KNEE

healing of the tissue

Bone
Bone
• 3 main cell types:

• osteoblasts - make bone

• osteoclasts - dissolve bone
• osteocytes - maintain bone

OSTEOBLASTS OSTEOCLASTS OSTEOCYTES

www.cytochemistry.net www.asbmr.com www.brs.co.uk

Bone healing
• Most common injury: FRACTURES
• Unlikely in knee injuries unless e.g. car accident

STEP 1 STEP 2 STEP 3 STEP 4

Diagram from ‘Fundamentals of Anatomy and Physiology by Martini

Cartilage
• 2 types within knee joint:
• Fibrocartilage (menisci)
• Hyaline cartilage (articular cartilage)

• 1 cell type:
• Chondrocytes – secrete cartilage matrix

FIBROCARTILAGE HYALINE CARTILAGE

Cartilage healing
• Common injuries
• Menisci: TEARS
• Articular cartilage: WEAR AND TEAR (OA)
• Avascular tissue
• Limited repair capabilities
• Long healing time MENISCAL TEAR

• Damaged hyaline cartilage replaced by

fibrocartilage
• Change in mechanical properties
• Development of bioengineering techniques
• Repair cartilage
• Generate new cartilage

OSTEOARTHRITIS (OA)
Ligament
• Dense regular connective tissue
• Same as tendons, different collagen composition
• Contain more elastic fibres than tendons

• Cells
• Fibroblasts

DENSE REGULAR C.T.

Ligament healing
• Most common injury: TEAR
• Healing may occur in 3 ways:
• Regeneration
• Scar repair
• Combination

• Poor vascularity
• Limited regeneration capacity

INFLAMMATION PROLIFERATION MATURATION

(1-4TH OR 7TH DAY) (7TH-21ST DAY) (3 WEEKS-1 YEAR)
• Accumulation of
• Clotting stimulation • ↓ fibroblasts
fibroblasts and
• Formation of formation of capillaries
temporary plug • ↓ matrix synthesis
• Extensive fibroblast
(fragile) proliferation and matrix
• Necrotic tissue and • ↓vascularisation
production
debris removal • Granulation tissue
• ↑tensile strength
formation
Synovium
• Soft tissue lining joint cavity
• Acts to control the joint environment
• Determines what can pass into the joint space
• Lubricates joint: synovial fluid
• Relatively acellular, 1-2 cells thickness
• Cells SYNOVIUM
• Fibroblasts (synoviocytes)
• Macrophages
Synovium healing
• Most common injury: SYNOVITIS
• Inflammation
• Can occur on its own
• Or as a result of rheumatoid arthritis or gout
• No specific healing process
• Treatment to reduce inflammation

RHEUMATOID ARTHRITIS
Factors affecting healing
• Individual basis
• Age
• Nutrition
• Systemic diseases
• Hormones
• Degree of trauma
• Infection
• Local pathologies
Summary
• Knee is a synovial joint composed of mainly bones, cartilage, ligaments and
synovium
• Bone fractures heal in a 4 step process and can regenerate tissue as the
original with same mechanical properties
• Cartilage lacks repair capabilities due to lack of blood supply and is
generally replaced by fibrocartilage, loss of mechanical properties
• Ligament tears heal in a 3 stage process (inflammation, proliferation,
maturation), but take a long time to heal. Loss of mechanical properties.
• Synovium inflammation does not have a specific healing process, generally
treatment to reduce inflammation
Any questions?