Arthritis from Injury to a Joint: Can It Be Prevented?

by Chris Centeno, MD /

arthritis from injury

Our entire medical-care system has been trained through decades of trying to control costs to simply ignore small injuries. However, here’s the thing: these small injuries can become big problems if left untreated. In fact, all severe arthritis likely starts with a small injury to the cartilage or ligaments that was ignored. I call these ACEs, which stands for arthritis-causing events. So which is it? Ignore the little injuries or pay attention? In my world, paying attention to the ACEs that can cause small amounts of instability could prevent an awful lot of fried joints.

Osteoarthritis Defined

Osteoarthritis (OA) is a progressive disease of the joints in which the cartilage, which cushions the bones and absorbs shock, wears down. Chronic pain, stiffness, and swelling are the most common symptoms (though the damaged cartilage isn’t necessarily the source of the pain), and in the most severe cases, patients can literally be left with bone on bone.

According to the CDC, over 30 million Americans suffer with OA, making it, by far, the most common type of arthritis in the U.S. While the risk for OA does increase as we age (though the paper below states that over half of knee OA patients are under the age of 65), nearly 20% (5.5 million) of Americans have arthritis from injury to a joint, or posttraumatic arthritis. For example, an 18-year-old soccer star with a joint injury, especially one who undergoes surgery, is at a high risk for developing arthritis by the age of 30.

Arthritis from injury to joints isn’t just reserved for athletes; anyone can experience a joint injury, especially if the person is at an increased risk, due to things such as obesity, repetitive stress, and even genetics.

What Is an ACE?

While our joints connect bone to bone, it’s important to understand that the joint isn’t just cartilage and bone. The joint consists of many other structures that work in harmony to provide controlled motion. These include muscles, ligaments and tendons, nerves, and, of course, the bone and cartilage. The joint is just the contact point where two parts of an interconnected musculoskeletal system come together.

An arthritis-causing event (ACE) happens when one of those structures get injured. Actual arthritis may happen much later. These include the following:

  1. A small area of damage to the cartilage
  2. Damage to the cushioning structures, like the meniscus or the labrum
  3. Damage to the ligaments

While we can treat all of these injuries earlier now with minimally invasive regenerative medicine procedures, today I’ll focus on the easiest to treat, which is the last one—the ligaments.

A Statement on Risk Factors for and Prevention of Arthritis from Injury to a Joint 

A paper recently published in the Journal of Athletic Training highlights how small joint injuries can be magnified by all sorts of factors to grow up to be full-blown arthritis. For example, a small ding in the otherwise smooth cartilage surface can lead to the bone swelling. This can then stretch the cartilage and place more pressure at that spot, leading to a hole in the cartilage. Or a ligament injury can happen, which causes the joint to be unstable. These extra wear-and-tear forces lead to cartilage loss and bone spurs. Add in extra weight to that equation and it all goes that much quicker.

In fact, the single biggest issue we see that can be easily fixed and likely prevent arthritis is instability. A ligament at some point gets stretched, but not broken. The area swells for a couple of days, but, eventually, the ligament heals in a loose position. The joint cracks and pops a bit more, but it mostly goes unnoticed. However, one or more decades of extra motion caused by the loose ligament causes arthritis. All of this could have been prevented if:

  1. the patient understood that a joint injury that leads to popping and cracking in a joint, but no pain, is a potential arthritis-causing event, or
  2. the patient had been checked out by a physician who understands subfailure instability.

Orthopedic Surgeons Generally Don’t Understand This Type of Instability

Every year, I see scores of patients who have been told their knee is stable by an orthopedic surgeon and then I show them on stress ultrasound that the joint is unstable. Why? To an orthopedic surgeon, stability is a binary concept—the ligament is broken and needs to be fixed surgically or it’s not and it needs to be left alone. However, ligament laxity is a spectrum disorder from normally tight to loose to broken. Hence, conceptualizing it as binary is bad for patients.

The upshot? How do you know if you’ve had an instability causing ACE? Regrettably, your average orthopedic surgeon is not likely the person from whom you’ll find that out. The simplest test is a stress ultrasound, in which the doctor takes the joint and stresses it while looking at the ligaments with ultrasound to rule out too much give. If you’ve had this type of injury, a precise injection of platelet rich plasma will usually help the ligament heal and tighten and provide better stability to the joint. So in conclusion, pay attention to the little dings, they may become big issues later!

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8 thoughts on “Arthritis from Injury to a Joint: Can It Be Prevented?

  1. Debbie

    Very interesting information. I enjoy your daily blogs.
    I suffered a knee injury in 2008 after slipping on black ice. Thanks to a PRP injection I had by a Regennex provider 3 years ago, my knee is like new.
    Thanks for all you do.

    1. Regenexx Team Post author

      Debbie,
      That’s great to hear! It’s about matching the right type of procedure to the right issue. Often stem cells are not needed.

  2. Mike Phillips

    So recently, my left PCL was stretched out of shape during strenuous hiking in Scotland. (I’m 71.) The orthopod extracted 30cc of fluid from the knee and sent me home with a cortisone shot. Take it easy, he said, it’ll heal quickly. I’m not so sure. Both my knees are prone to soreness, and I’m an active guy. I had a great experience with stem cell therapy healing a torn rotator cuff a year ago. Should I be looking at proactive stem cell or PRP therapy to keep my knees out of trouble?

    1. Regenexx Team Post author

      Mike,
      Importantly, avoid steroid shots as they breakdown cartilage, are lethal to the local stem cells working to heal the issue, and can damage tendons and ligaments! The 30cc of fluid extracted was there for a reason, so tracking down and treating that issue is needed. Going forward, what’s important is to treat small issues when they come up before they become bigger ones that take you out of commission. The Proactive Book has many assessments to identify problems before they can escalate. Please see: https://regenexx.com/blog/introducing-dr-centenos-latest-book-regenexx-proactive/

  3. Carol E Swick

    I have used almost all the cartilage in each knee. My Otho says due to my arthritis that if I try stem cell therapy, it would be a waste of money since whatever cartilage growth I would get would just be worn back off. He only recommends the knee replacement surgery. Right knee has no injury to it just no cartilage left. Left knee injury resulted from a fall that tore ligaments and tendons. I have been receiving Symbus shots in the left knee which has been helpful so far. I have just started them in the right knee also. I have not had any stress MRI views of either knee. I am looking at all possible solutions to having knee surgery!

    1. Regenexx Team Post author

      Carol E Swick,
      The hyper focus on cartilage is counter-productive as while the lack of cartilage is symptomatic of a problem, it’s unlikely to be the source of pain. Many patients have no cartilage and no pain,and many patients have all their cartilage and great pain. Please see: https://regenexx.com/blog/osteoarthritis-pain-not-related-to-structure-again/ and https://regenexx.com/blog/knee-arthritis-nerve-pain/. The one finding on the knee MRI of a knee with arthritis most commonly associated with pain are Bone Marrow Lesions. Please see: https://regenexx.com/blog/knee-bone-marrow-lesions-why-bmls-are-the-mri-lesion-nobody-has-ever-mentioned/ So rather than knee replacement which should always be the last resort, a better plan would be to determine what caused the cartilage loss and treat that (often tendon and ligament instability) and treat the arthritis with Regenerative treatment using your own stem cells and platelets. Please see: https://regenexx.com/blog/stem-cells-for-bone-on-bone/ If you’d like to see if you’d be a Candidate, please submit the Candidate form

  4. Karthik

    So what do the pops and cracks mean after a sprain? That the ligament is lax and allowing more wear and tear? I feel like pops and cracks are an ambiguous topic in physical medicine. Just got diagnosed with a grade 1 PCL sprain and I’m tryna do all the prevention possible.

    1. Regenexx Team

      Hi Kathrik,
      Please see: https://regenexx.com/blog/knee-popping-after-injury/ If you’d like to see if we can help, please submit the “Get Started” form here: https://regenexx.com/conditions-treated/knee/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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