SEMINAR ON

CARTILAGE AND JOINTS

STRUCTURE AND FUNCTIONS

PRESENTER:DR. SIDDIQUE HUSSANUL RANNA

PGT,ORTHOPAEDICS

MODERATOR:DR.CHAO ROCHEK BURAGOHAIN

ASST.PROF,ORTHOPAEDICS

10TH JUNE 2015

 INTRODUCTION
CARTILAGE

• Is an avascular, stiff, load bearing form of connective

tissue,

• consisting of extracellular fibers embedded in a

water filled ground substances.
 Peculiarities of cartilage
•Avascular and non nervous

•Receives nutrition by diffusion

•Posses some cartilage canals

•Canals help osteogenic cells and vessels to grow in ossific

centers.

•Posses low metabolic rate than bone cells

•Most bones in intrauterine life are cartilage.

 Peculiarities of cartilage cond..
•Chondrocytes are isolated in separate lacunae
•Has capacity of appositional and interstitial
growth
•Cartilaginous matrix has low antigenicity

•Homogenous transplantation is possible

•Repair of cartilage takes long time

 Structure of cartilage
Consists of
 Cells:
* chondrocytes
*cells appear in the lacunae or in cell nest
 Matrix
*collagen fibers & elastin fibers
 Ground substance(gel like)
*water,
*proteoglycans&glycosamineglycans
 Structure of ground substance
• Gel like substance rich in carbohydrate

• Consists mainly of water and dissolved salts

• meshwork of long proteoglycan molecules

• Proteoglycans consists of long polymers called

GAGS(glycosaminoglycans)
 Proteoglycans and GAGS
•Proteoglycans consists of long polymers called
GAGS(glycosaminoglycans)

•GAGS are covalently bound with “core protein”

•Core protein may bear more than 100 GAGS

sideways.

•Several PG molecules bound along huge

Hyaluronate molecules to form aggregates.
 Proteoglycans and GAGS,cont..
•Weak inter molecular forces hold aggregates in 3D
network with large water filled space between.
•GAGS posses acidic groups
•GAGS repel each other thus standing out stiffy
from core protein.

•PG aggregates appear to be compressed and posses

repulsion chains and subunits.

•PG may act as a minute spring, conferring elasticity.

 Proteoglycans and GAGS,cont..

•Some GAGS found in PG aggregans are

condroitin-4 sulfate,condroitin-6 sulfate,dermatan
sulfate and keratan sulfate.

•Link protein and chondronectin,are important for

PG structure.
Proteoglycans and GAGS,cont..
Proteoglycans and GAGS,cont..
 Structure of collagen fiber
• Too small and thin
• Characteristic cross
banding and 3D
structure
• Tropocollagen posses
triple helices of
polypeptide
• Tensile strength
properties
 Function of cartilage
• Supportive: soft tissue support
• Mechanical:response to
friction,compression,shear and tensile
loading
• Lubrication:lubricin plays major role in
biolubrication and protection of joints.
• Viscoelastic function: proteoglycans, GAGS
and elastic fiber
• Provides smooth gliding surface in joints
• Development and growth of bones
 Types of cartilage
mainly three types
1.Hyaline cartilage: most of
the cartilage in body are
hyaline cartilage
Distribution: articular
cartilage,costal,tracheobr
onchial,nose,and
laryngeal
cartilage(except
epiglotis,cuniform,cornic
ulate,apex of arytenoids)
Matrix: hour glass like,
Chondroitin sulfate
predominance,
Few collagen fiber
 Types of cartilage cont..
2.Elastic cartilage:
Matrix: contains collagen
fiber with large number
elastic fiber which
anastomose in all
direction except around
cartilage cells.
• Maintains shape of
cartilage.
Distribution:Pinna,eustachi
an,tubes,epiglottis,cornic
ulate,cuniform,apex of
arytenoids
 Types of cartilage cont..
3.Fibrocartilage:
Matrix:abundent amount of
collagen fiber, limited no.
of cells and ground
substance, collagen fiber
arranged in bundles, cells
present between bundles
Distribution:intervertibral
disc, interpubic disc,
articular disc of TM,
sternoclavicular and
inferior radio-ulnar
joints, menisci,
 JOINTS
• Joints are the region of
the skeleton where two
or more bones meet and
articulate.
• With the exception of the
hyoid bone, every bone
in the
body is connected to or
forms a joint.
• There are 230 joints in
the body.

• Study of joint called

ARTHOLOGY.
 Classification of joints
mainly of two types
1.Diarthroses or synovial joints:
*skeletal elements are separated by a
cavity
*free movements are possible
2.Synarthroses or solid joints:
*skeletal elements are held together by
connective tissues or cartilage.

*allowed restricted little or no movements

 1.Diarthroses or synovial joints:
• Characteristic feature:
1.articular cartilage
2.joint capsules-----formed
by fibrous tissue
3.joint cavity------enclosed
by fibrous capsule
4.synovial membrane
5.synovial fluid
6.accessory structure:
meniscus,labrum,articular
disc, fat
pads,tendon,ligament,burs
ae.
 1.ARTICULAR CARTILAGE
• hyaline cartilage
covering the
bone surfaces
• Posses ECM
enzymes: matrix
metalloproteinase
(MMPs) and
TIMPs.
 Functions of articular cartilages
• Extremely low
coefficient of friction

• Shock absorption

• Distribution of joint
loads

• Reduce contact stress

 Injury and healing of articular
cartilage
• Limited healing potential due to avascularity.

• Three types injury of articular cartilage:

Type 1: microscopic damage to cells and ECM

Type 2: chondral fracture or fissuring

Type 3: deeper injury,penetration to subchondral

bone
 Microscopic structure of articular
cartilage
• Four microscopic zones
1.Superficial or gliding
zone: 10—20%
2.Middle or transitional
zone : 40---60%
3.Deep or Radial zone:
30%
4. Calcified zone
 MENISCUS
• Meniscus is an
incomplete rim of
white fibrous cartilage
between articular
cartilages.
• Distribution: knee
joints, articular disc of
sternoclavicular and
acromioclavicular
joints,triangularfibroca
rtilage, labra in
hip&shoulder.
 Meniscus cont..
functions
• Tibiofemoral load transmission.
• Shock absorption
• Lubrication
• Prevent synovial impingement
• Distribute synovial fluid
• Contribute to joint stability, gliding motion.
 Composition of meniscus
CELLS ECM
• Primarily • Water-70%
fibrochondrocyte • Interlacing collagen
fibers.
• 95% type 1 collagen
• Responsible for
• Smaller amount type
synthesis and II,III,V,VI
maintenance of ECM • Elastin-0.06%
• Noncollagenous protein-
8-13%
 Ultra structure of meniscus
• Three collagen fiber layer.
• Which convert compressive
loads to circumferential or
hoop stress.
• Superficial layer: gliding
movements
• Circumferential layer: resist
stress during weight
bearing
• Radial layer: between
above two layer serve as
“ties”.
 Joint capsule
two layers:
• Outer fibrous membrane
• Complete enclose joints

• Interrupted by synovial
protrusion called bursae

• Bursae are routes for

spread of infection into
joints

• Form intrinsic ligaments.

 Inner synovial membrane

• Lines fibrous capsules

and covers articular
cartilage,
Intracapsular ligaments, bur
-sae,tendon sheaths.
• Forms synovial villi
• Composed of two layers:
1.Intima or cellular layer
2.Subintimal or fibro –
-vascular layer
 Synovial fluid
• Plasma transudate from synovial capillaries.

• Modified by secretory activities of type B

cells.

• Lack of fibrinogen

• Does not clot normally.

 Laboratory Testing: Macroscopic
• Volume-0.2-4ml

• Color and Clarity-colorless

and clear or transparent.

• Inclusions-rice
bodies,ochronotic shards

• Viscosity-string test

• Clotting

• Mucin Clot
 Laboratory Testing: Chemical
• Protein: 1-3 g/dl

• Glucose: no lower than

10mg/dl less than serum
glucose

• Uric Acid: 6 to 8 mg/dl

• Lactic Acid: less than 25

mg/dl

• Rheumatoid Factor:50% RA
+ve.
 Laboratory Testing: Microscopic
• Cell Counts: Normal values:
RBCs = none
WBCs = 0 – 150/cumm.
• Differential: Normal values:
– Neutrophils 7%
– Lymphocytes 24%
– Monocyte (Histocytes) 48%
– Macrophages 10%
– Synovial lining cells 4%
• Crystals: uric acid
crystals,CPPD,cholester--
ol,steroid induced,
apatite crystals.
 Laboratory Testing: Microbiology
• Infectious organisms
– Bacteria
– Fungi
– Mycobacteria
– Viruses
• Route of entry
– Bloodstream
– Penetrating wounds
– Osteomyelitis rupture
– Arthroscopy
– intra-articular steroid
injections
– prosthetic joint surgery
 TYPES OF SYNOVIAL JOINT
• Uniaxial joints:
 Hinge joints
 Pivot joints
 Bicondylar joints
• Biaxial joints:
 Ellipsoid or condyloid
joints
 Saddle joints:
• Triaxial or multiaxial joints:
 Plane or gliding joints
 Ball and socket joints
 Uniaxial joints:
• Hinge joints: allows • Pivot joints: Osseous
extension and pivot rotates in an
retraction.e.g. Humero- osteoligamentous
ulnar, IP joints ring,e.g.superior radio
ulnar joint,atlanto axial
joints.
 Uniaxial joints:
Bicondylar joints
• Predominantly uniaxial
• May posses very little
rotation about a axis
orthogonal to the first.
• Two convex condyles
articulate with concave
or flat surface.
• Example: knee joints,
TM joints
 Biaxial joints:
Ellipsoid or condyloid joints: Saddle joints:
• Oval convex surface • Opposing surface are
apposed to an elliptical reciprocally concavo-convex.
concavity e.g. radio-carpal • Flexion- Extension, Abduction-
and MP joints in wrist. Adduction, May combined as
circumduction.
 Triaxial or multiaxial joints
• Plane or gliding joints: • Ball and socket joints:
• Gliding movements only • Globular head into a cup
• Forms apposition of plane like cavity
surfaces. • Moves around more than
• E.g. some interCP, inter 3 axis which have a
MT,sterno-clavicular, AC common center.e.g hip
joints. &shoulder joints.
 SYNARTHROSES OR SOLID JOINTS
• FIBROUS JOINTS: • CARTILAGINOUS OR
skeletal elements are AMPHIARTHROSIS:
held together by • Bones are held together
connective tissues by cartilages
• Immovable joints • Allows restricted little
• Three subtypes movements
1.Sutur • Two subtypes:
2.Gomphosis 1.Primary or synchondrosis
3.Syndesmosis 2.Secondary or Symphysis
 FIBROUS JOINTS
• 1. Sutures or synostoses :are •
found between bones of the
skull. In fetal skulls the
sutures are wide to allow
slight movement during birth.•
They later become rigid
(synarthrodial).
2. Syndesmosis: are join directly
by ligaments or aponeurotic. e.g.
inferior tibio-fibular, posterior
part of sacroiliac joints.
moveable(amphiarthrodial), but
not to such degree as synovial
joints.
 FIBROUS JOINTS.cont..
3. Gomphosis: is a joint
between the root of a
tooth and the sockets
in the maxilla or
mandible.
• Two components
remain in contact by
collagen fiber of
periodontium.
 CARTILAGENOUS JOINTS:
• Primary cartilaginous or
synchondrosis joints :
• Bones are connected by
hyaline cartilage or
fibrocartilage.
• sometimes occurring
between ossification
centers.
• This cartilage may ossify
with age.
• These joints usually allow
no movement, or minimal
movement in the case of the
manubriosternal and first
manubriocostal joints.
 CARTILAGENOUS JOINTS.cont..
• Secondary
cartilaginous joints or
Symphysis:
• Connect the two bones
by fibrocartilage.
• E.g. Symphysis
pubis,vertibral bodies
connected by
Intervertibral disc.
 Movements and Mechanisms of Joints :-

• 1- Gliding movements.

• 2- Angular movements.

• 3- Rotation
movements.

• 4- Circumduction
movement.
 1- Gliding movement
• It is simple movement
that occurs in plane
joint.

• In this movement one

articular surface will
glides over the other.
 2- Angular movement :
increase or decrease of an angle between the articular
bones.

• A- Flexion & extension:

These movements occur around
transverse axis.

• B- Abduction & adduction:

Occur around antero-posterior
axis.
 3- Rotation movements :
• It is the movement in
which the bone rotates
around .
1. Axis inside the bone itself
e.g. rotation of humerus.
2. Axis outside the bone e.g.
rotation of radius around
ulna in pronation &
supination
3. Axis in another bone e.g.
rotation of atlas around
axis e.g. rotation of head.
 4- Circumduction
• It is a rotatory
movement of a limb
around a imaginary
cone.
• e.g. in circumduction of
upper limb the apex of
the imaginary cone lies
in axilla and hand
rotates around the
base of the cone
 Factors Affecting Stability of joints
• 1- Shape & fitting of
surfaces.

• 2- Thickness &
elasticity of capsule.

• 3- Ligaments.

• 4- Surrounding
muscles.
Factors Affecting Rang of Movements
• 1- Tension of ligaments
and capsule.

• 2- Contraction of
antagonistic muscles.

• 3- Contact of soft tissue.

• 4- Shape of articulating
bones.
THANK YOU
ALL