CARTILAGE

Cartilage is a highly specialised connective

tissue.It is not as hard and rigid as bone, but
it is stiffer and less flexibile than muscle.
Its function is to provide smooth lubricated
surface for articulation.
Articular cartilage is devoid of blood vessels,
lymphatics and nerves and is subject to
harsh biomechanical enviornment.
It has a limited capacity for intrinsic healing
and repair.

 Cartilage is more flexible and compressible than bone

and often serves as an early skeletal framework .
Cartilage is produced by chondrocytes that come to
lie in a small lacunae surrounded by the matrix they
have secreted.
Cartilage clearly performs a mechanical function.It
provides a bearing surface with low friction and wear,
and because of its compliance, it helps to distribute
the loads between opposing bones in a synovial
joint.If cartilage were a stiff material like bone, the
contact stresses at at a joint would be much higher,
since the area of contact would be much smaller.

 As cartilage is not innervated and

therefore it relies on diffusion to
obtain nutrients. This causes it to
heal very slowly.
Normal articular cartilage is
white,and its surface is smooth and
glistening. Cartilage averages 2.21
mm in humans.
Injury to articular cartilage is
recognised as a cause of significant

 The unique and complex structure of

articular cartilage make treatment or
repair or restoration of the defects
challenging fpr the patient, surgeon
and the physical therapist.
The preservation of articular
cartilage is highly dependant on
maintaining its organised
archiecture.

STRUCTURE AND FUNCTIONS OF

CARTILAGE TISSUE
There are 3 different types of
cartilage that have slightly different
structures and functions.
HYALINE CARTILAGE.
FIBROCARTILAGE
ELASTIC CARTILAGE

 HYALINE CARTILAGEHyaline cartilage is the most abundunt of

the 3 types of cartilage.It is found in many
locations in the body including- bronchial
tubes, larynx, trachea.
Covering the surface of bones at joints
especially in areas where damage due to
wear may lead to osteoarthritis including
ends of long bones and the anterior ends of
ribs.

 STRUCTURE OF HYALINE CARTILAGEHyaline cartilage consists of bluish white, shiny

ground elastic material with a matrix of
chondroitin sulphate into which many fine
collagen fibrils are embedded.It contains
numerous chondrocytes.
FUNCTIONS OF HYALINE CARTILAGE TISSUEIt provides smooth surfaces, enabling tissues to
move/slide over each other eg facilitating
smooth movement at joints.It also provide
flexibility and support.

 FIBROCARTILAGEExamples include intervertebral disc,menisci,

pubic symphysis, also in the portions of the
tendons that insert into the cartilage tissue,
especially at the joints.
STRUCTURE OF FIBROCARTILAGE TISSUEFibrocartilage is a tough form of cartilage that
consists of chondrocytes scattered among
clearly visible dense bundles of collagen fibres
within the matrix. Fibrocartilage lacks a
perichondrium.

 FUNCTIONS OF FIBROCARTILAGE
TISSUEFibrocartilage tissue provides support
and rigidity to attached/surrounding
structures and is the strongest of the
three types of cartilage.

 ELASTIC CARTILAGEIn the body it is present in Auditory ( Eustachian

tubes)
External ear ( Auricle)
Epiglottis.
STRUCTURE OF ELASTIC CARTILAGE TISSUEIt is yellowish in colour, the cartilage cells are located
in a thread like network of elastic fibres within the
matrix of cartilage.A perichondrium is present.

 FUNCTIONS OF ELASTIC CARTILAGE

TISSUEElastic cartilage provides support to
surrounding structures and helps to
define and maintain the shape of the
area in which it is present.

COMPOSITION OF ARTICULAR
CARTILAGE
Articular cartilage is a living material
composed of a relatively small number of
cells known as chondrocytes surrounded by a
multicomponent matrix.
Mechanically, articular cartilage is composite
of material of widely differing properties.
Approx 70-80% of the weight of the whole
tissue is water. The remainder of the tissue is
composed primarily of proteoglycans,collagen
and relatively small amount of lipids.

STRUCTURE OF
PROTEOGLYCANS
Approximately 30% of dry weight of articular
cartilage is composed of proteoglycan.
Proteoglycan consists of a protein core to
which glycosaminoglycans ( chondroitin
sulphate and keratin sulphate) are attached
to form a bottle-brush like structure.
These proteoglycans can bind or aggregate
to a backbone of hyaluronic acid to form a
macromolecule with a weight upto
200million daltons.

 Proteoglycan concentration and water

content vary through the depth of the
tissue.
Near the articular surface,proteoglycan
concentration is relatively low, and the
water content is highest in the tissue.
In the deeper regions of the cartilage,near
the subchondral bone,the proteoglycan
concentration is the greatest,and the
water content is the lowest.

STRUCTURE OF COLLAGEN
Collagen is a fibrous protein that
makes upto 60%-70% of the dry
weight of the tissue.
Type II is the predominant collagen in
articular cartilage,although other
types are present in smaller
amounts.
Collagen architecture varies
according to the depth of the tissue.

ZONES OF ARTICULAR
CARTILAGE
There are 4 zones between the
articular surface and subchondral
bone.
Superficial tangential zone.
Intermediate or middle zone.
Deep or radiate zone.
Calcified zone.
The interface between the deep zone
and calcified cartilage is known as
TIDE MARK.

SPLIT LINES
Split lines are formed puncturing the cartilage
surface at multiple sites with a circular awl
The resulting holes are elliptical,not circular
and the load axes of the elipses are aligned in
what is called the split lines direction.
In the plane parallel to split line,the collagen
organised in broad layer or leaves, while in
plane orthagonal to the split lines the
structure has rigid pattern that interrupted as
the edges of the leaves.

 In the calcified and deep zones

collagen fibres collagen fibres are
oriented radially and arranged in
tightly pack bundles.The bundles are
linked to numerous fibrils.
From the upper deep zone into the
middle zone,the radial orientation
becomes less distinct, and collagen
fibrils forms a network that surrounds
the chondrocytes.

 In the superficial zone, the fibres are

finer than in the deeper zones, and
the collagen structure is organised
into several layers.
An amorphous layer that does not
appear to contain any fibres is found
on the articular surface.

 Scanning electron microscopy is also

used to investigate the structure of
osteoarthritic cartilage. These
investigations demonstrate two
primary structural changes
associated with degeneration
rolling of delaminated sheets into
fronds, and formation and
propogation of large cracks.

MECHANICAL BEHAVIOUR AND

MODELLING
The mechanical behaviour of
articular cartilage is determined by
the interaction of its predominant
components- collagen, proteoglycans
and interstitial fluid.
In an aqueous enviornment
proteoglycans are polyanionic,that is
the molecule has negatively charged
sites that arise from its sulphate and
carboxyl group.

 In solution, the mutual repulsion of these

negative charges causes an aggregated
proteoglycan molecule to spread out and
occupy a large volume .
In cartilage matrix, the volume occupied by
proteoglycan aggregates is limited by the
entangling collagen framework.
The swelling of the aggregated molecule
against the collagen framework is an essential
element in the mechanical response of the
cartilage.

 When cartilage is compressed, the negatively

charged sites on the aggregan are pushed closer
together,which increases their mutual repulsive
force and adds to the compressive stiffness of the
cartilage.
Nonaggregated proteoglycans would not be as
effective in resting compressive loads, since they
are not as easily trappedin the collagen matrix.
Damage to the collagen framework also reduces the
compressive stiffness of the tissue,since the
aggregated proteoglycans are contained less
efficiently.

 The mechanical response of the cartilage is

also strongly tied to the flow of fluid through
the tissue. When deformed fluid flows through
the cartilage and across articular surface.
If a pressure difference is applied across a
section of cartilage,fluid also flows through
the tissue.These observations suggest that
collagen behaves like a sponge albeit one that
doe not allow fluid to flow through it easily.

BIPHASIC MODEL OF
CARTILAGE
Fluid flow and deformation are
interdependant has lead to the modelling
of cartilage as a mixture of fluid and
solid components. This is referred to as
the BIPHASIC MODEL OF CARTILAGE.
In this modelling, all of the solid like
components of the cartilage,
proteoglycans collagen, cells and lipids
are lumped together to constitute the
solid phase of the mixture.

 The interstitial fluid that is free to move

through the matrix constitutes the fluid phase.
Typically, the solid phase is molded as an
incompressible elastic material, and the fluid
phase is molded as incompressible and
inviscid, that it has no viscosity.
Under impact load cartilage behaves as a
single-phase, incompressible elastic solid
there is simply no time for fluid to flow
through the solid matrix.

CLINICAL RELEVANCE
The Biphasic model shows that fluid
pressure sheilds the solid matrix from the
higher level of stress that it would
experience if cartilage were a simple elastic
material without significant interaction of its
fluid and solid components.
In osteoarthritic cartilage that is more
permeable than normal, stress sheilding by
fluid pressurisation is diminshed, and more
stress is transferred to the solid matrix.

MATERIAL PROPERTIES
A confined compression test is one of the
commonly used methods to determine material
properties of cartilage.
A disc of cartilage is cut from the joint and
placed in an impervious well. Confined
compression is used in either creep mode or
relaxation mode.
In creep mode a constant load is applied to a
cartilage through a porous plate, and the
displacement of the tissue is measured as a
function of time.

CONFINED COMPRESSION TEST OF

CARTILAGE

 In relaxation mode, a constant

displacement is applied to the tissue, and
the force needed to maintain the
displacement is measured.
In creep mode the displacement of cartilage
is a function of time, since the fluid cannot
escape from the matrix instantaneously.
Initially, the displacement is rapid.
This corresponds to a relatively large flow of
fluid out of the cartilage.

 As the rate of displacement slows

and the displacement approaches a
constant value, the flow of fluid
likewise slows.
At equilibrium the displacement is
constant and fluid flow has
stopped.In general it takes several
thousand seconds to reach the
equilibrium displacement.

 By fitting the Biphasic model to the

measured displacement, two
material properties of the cartilage
are determine.
Aggregate modulus
Permeability.
AGGREGATE MODULUS- is a measure of
stiffness of the tissue at equilibrium
when all fluid flow has ceased.The
higher the aggregate modulus , the less

 PERMEABILITY- The permeability of the

cartilage is also determined from a confined
compression test.The permeability indicates
the resistance to fluid flow through the
cartilage matrix.
Permeability was first introduced in the study
of flow through flow through soils.The average
fluid velocity through a porous sample ( Vave)
is proportional to the pressure gradient
( Vp).The constant of proportionality( k) is
called the PERMEABILITY.

DEVICE USED TO MEASURE PERMEABILITY OF

CARTILAG

 Permeability is not constant through the

tissue . The permeability of articular
cartilage is highest near the joint
surface ( making fluid flow relatively
easy) and lowest in the deep zone
( making fluid flow relatively difficult ).
Permeability also varies with the
deformation of the tissue .As cartilage is
compressed, its permeability decreases.

 Therefore, as a joint is loaded, most

of the fluid that crosses the articular
surface comes from the cartilage
closest to the joint surface.Under
increasing load, fluid flow will
decrease because of the derease in
permeability that accompaines
compression.

 An indentation test provides an alternative to

confined compression. Using an indentation
test , cartilage is tested in situ. Since disc of
cartilage are not removed from underlying
bone,as must be done when using confined
compression indentation may be use to test
cartilage from small joints.
In addition, three independent properties are
obtained from one indentation test but only
two are obtained from confined compression.

 Typically, an indentation test is

performed under a constant load.The
diameter of indenter varies depending in
the curvature of joint surface, but
generally no smaller than 0.8mm.
Under, a constant load the displacement
of the indenter resembles that for a
confined compression and require several
thousand seconds to reach equilibrium.

INDENTATION TEST ON ARTICULAR

CARTILAGE

 By fitting the biphasic model of the

test to the measured indentation,
following are determined.
Aggregate modulus
Poissons Ratio
Permeability
Poissons ratio is typically less than 0.4
and often approaches zero.

 This finding is significant departure from earlier

studies, which assumed that cartilage is
incompressible and therefore had a poissons ratio
of 0.5.This assumption was based on cartilage
being mostly water, and ater may often be molded
as an incompressible material.
However, when cartilage is loaded, fluid flows out
of the solid matrix, which reduces the volume of
the whole cartilage. Recognizing cartilage as a
mixture of solid and fluid leads to the whole tissue
behaving as compressible material,although its
components are incompressible.

 The PERMEABILITY influences the

rate of deformation.If the
permeability is high, fluid can flow
out of the matrix easily and the
equilibrium is reached relatively
quickly.
A lower permeability causes a more
gradual transition from the rapid
early displacement to the
equilibrium.

CLINICAL RELEVANCE
The lower modulus and increased
permeability of osteoarthritic
cartilage result in greater and more
rapid tissue deformation than
normal.

RELATIONSHIP BETWEEN MECHANICAL

PROPERTIES AND COMPOSITION
Correlations between mechanical properties of
the cartilage and glycosaminoglycan content,
collagen content and water content has been
established.
The compressive stiffness of the cartilage
increases as a function of the total
glycosaminoglycan content. As the total
glycosaminoglycan decreases compressive
stiffness also decreases.
In contrast, there is no relation of compressive
stiffness with collagen content.

 Permeability and compressive

stiffness , as measured by the
aggregate modulus are both highly
correlated with water content.
As the water content increases
cartilage becomes less stiff and more
permeable.

CLINICAL RELEVANCE
Decrease in proteoglycan content
allows more space in the tissue for
fluid.
An increase in water content with an
increase in permeability, increasing
permeability allows fluid to flow out
of the tissue more easily, resulting in
more rapid rate of deformation.

JOINT LUBRICATION
Normal synovial joints operate with
relatively low coefficient of friction ,
about 0.001.
There are 2 mechanism that are
responsible for the low friction in
synovial joints.
Fluid film Lubrication.
Boundary Lubrication.

 FLUID FILM LUBRICATIONFor fluid film to lubricate moving surfaces

effectively, it must be thicker than the
roughness of the opposing surfaces.
The thickness of the film depends on the .
Viscosity of the fluids.
Shape of the gap between the parts.
Relative velocity
As well as the stiffness of the surfaces.

 If cartilage, is molded as a rigid material,

it is not possible to generate a fluid film of
sufficient thickness to separate the
cartilage surface roughness.
However, models that include deformation
of the cartilage and its surface roughness
have shown that a sufficient thick film can
be developed. This is known as
MICROELASTOHYDRODYNAMIC
LUBRICATION.

 BOUNDARY LUBRICATION A low coefficient of friction can also be

achieved without a fluid film through a
mechanism known as BOUNDARY
LUBRICATION.
Boundary lubrication of the articular
surface appears to be linked to a
glycoprotein fraction in synovial fluid
known as LUBRICIN.

 Lubricin may be a carrier for

lubricating molecules known as
surface active phospholipids that
provide boundary lubricating
properties for synovial joints.
Surface active phospholipids are
believed to be boundary lubricants
not just in synovial fluids, but in
other parts of the body such as
pleural space.

MECHANICAL FAILURE OF
CARTILAGE
cartilage is an anisotropic material, we
expect that it has greater resistance to
some components of stress than to others.
For example,it could be relatively strong in
tension parallel to collagen Fibers, but
weaker in shear along planes between
leaves of collagen.
Tensile failure of cartilage has been of
particular interest,since it was generally
believed that vertical cracks in cartilage
were initiated by relatively high tensile
stresses on the articular srface.

More-recent computational models of

joint contact show that the tensile stress
on the surface is lower than originally
thought, although tensile stress still
exists within the cartilage [1315].
Studies of the tensile failure of cartilage
are primarily concerned with variations
in properties among joints, the effects of
repeated load, and age.

Repeated tensile loading (fatigue) lowers the

tensile strength of cartilage as it does in many
other materials.
Repeated compressive loads applied to the
cartilage surface in situ also cause a decrease
in tensile strength.
Properties of most biological materials change
with the applied strain; the collagen network
becomes aligned with the direction of the
tensile strain, and the material becomes
strongly anisotropic.

Dropping three different-sized

spherical indenters (2, 4, and 8 mm)
onto the articular surface produces
three different states of stress and,in
some instances, a crack through the
surface.
Shear stresses do exist in cartilage,
although the orientation of these
stresses is not always obvious.

under rapid loading, cartilage

behaves as an incompressible elastic
material.
Cracks are common in articlar
cartilage

EXERCISE AND CARTILAGE

HEALTH
Participation in certain sports also appears
to increase risk of developing Osteoarthritis.
Saxon et al concluded that activity that
involve
Torsional loading.
Fast acceleration and decceleration.
Repetitive high impact
High levels of participation.
Increase risk of developing osteoarthritis.

Track and filed events.

Racket sports.
Soccer
Among the sports that are involved in
higher risk of developing osteoarthritis.
Swimming and cycling are not linked with
an increase risk of developing
osteoarthritis at the hip, although cycling
may be related to osteoarthritis of patella.

 Injuries to Anterior cruciate ligament,

collateral ligament or meniscus are
implicated in the development of
Osteoarthritis in knee.
Loss of ACL may impair sensory
function and protective mechanism
at the knee.
Distruption of internal joint structures
may alter joint alignment and the
ares of cartilage that are loaded.

 If ligament damage results in loss of

joint stability, then joint loads may
be increased by active muscle
contraction trying to stabilize the
joint.
Partial or total meisectomy can also
be expected to increase the stress on
the joint since joint force is
concentrated over a small area.

 Despite an increased risk of developing

osteoarthritis from excessive or abnormal joint
loading, some level of loading or exercise
appears to be beneficial for joint health.
In an in vivo study with 37 healthy human
volunteers, Tiderius et al shows that
glycosaminoglycan content in medial and
lateral femoral condyle cartilage is lower in
sedentary subjects than those who exercise
regularly.

 After an exercise regime there is also an increase in

glycosaminoglycan content in the knee of patient at
risk of developing osteoarthritis.
These latter two studies using an MRI imaging
technology known as d GEMRIC to quantitatively
measure glycosaminglycan content.
They show a biochemical adaptation to exercise ,
although there appears to be no adaptation of cartilage
morphology to exercise as determined by tissue mass.
Since exercise can enhance production of matrix
molecules,it mat seem reasonable to expect that it can
have positive effect on joint health.

CLINICAL RELEVANCE
Exercise in people with osteoarthritis is shown to
have positive effects on several outcome measures
such asPain.
Strength.
Self-reported disability.
Observed disability in walking.
Self- selected walking.
Stepping speed.
Although mild to moderate exercise is often
recommended