Mari- Not to sound pessimistic, but some of this information is not totally applicable to cartilage tears. I've had way too many surgeries to correct soft tissue tears, and have had to do lots of research to address pain issues. I've also taken the above enzymes, and looked into vitamin D and healing.

The first place to start with cartilage tears is sort of as Dr. B says above. Find out if the cartilage in question has vascularity around it. Some tears can heal and some can't. In addition to vascularity, there's some things that influence healing and pain: for example, if the tear is longitudinal, near the insertion point, fraying, etc etc. An MRI with or without contrast would be best way to find out, although the sensitivity or specificity is quite different depending on the body part in question.

If the tear can heal, and you have around $400 to spend, try a course of prolotherapy (dextrose injections) to reintroduce the inflammatory response. If you have $900 to spend, try platelet rich plasma. There are a few possible steps in between these, but unfortunately many of them are not just nutritional changes :(

Eating a paleo diet is the perfect place to begin as this lifestyle (contributes to an anti-inflammatory state. (pain=inflammation) You want to increase your omega 3:6 ratio which is exactly what paleo eating does. Fish Oil is highly antiinflammatory so you should start there.

Second, you want specific enzymes that are shown to reduce inflammation and increase tissue healing. These include, but is not limited to, bromelain (pineapple), papain (papaya), pancreatin ( from the pancreas), trypsin and various others. Look into protelytic enzymes for futher info.

Supplementation wouldnt be a bad thing. A product called Wobenzyme from Garden of Life is fantastic. Many of my patients get good relief of symptoms by taking this-typically post surgical in the shoulders and knees.

What is your current issue that you are concerned about?

High dose vitamin C would probably be a good bet. The people over at the Perfect health diet have a lot to say about the benefits of vitamin C:

http://perfecthealthdiet.com/?cat=54

Of course, the fastest way, I think, to heal is to correct any personal nutritional deficiency you might have coupled with an anti-inflammatory and antioxidant rich paleo diet. For example, if you're deficient in magnesium or iodine, high dose vitamin C probably won't help so much.

Eat paleo, get your vit D, get some magnesium, iodine (seaweed) and perhaps a vit. C supp. and you should be on your way to super healing.

Here are excerpts of two different studies on Wobenzym. They are not necessarily conducive to your exact condition but nonetheless it gets the point across. In these it was used for osteoarthritis and post-surgery. In my professional opinion, I think the enzymes could be highly beneficial for cartilage tears. However cartilage is avascular and and, as such, does not get its nutrients from the blood supply. I am not sure on the exact mechanism of how the cartilage heals or does not heal. There are theories but nothing has solid evidence to back it up. Often times some cartilage does not heal properly but that is usually d/t an arthritic condition. Have you seen anyone for this current condition you have?

Abstract Clinical efficacy of the antiphlogistic potency of enzymes (Wobenzym, 4 x 7 capsules/day) vs. Diclofenac-Na (2 x 50 mg capsules/day) on patients (n = 80) suffering from osteoarthritis of the knee in an acute phase was evaluated. The study design was double blind according to the GCP-guidelines. The treatment period lasted 28 days and was followed by a treatment-free controll-period of another 28 days. There was equal status of age, sex, duration and impact of osteoarthritis in both groups. The clinical parameters as pain at rest, on motion, on walking, at night and pain tenderness showed a significant improvement (p < 0.05) after the treatment period, with tendency to relapse in the following observation period. No significant difference between both treatment-groups could be seen. No changes in laboratory findings were observed. The global-assessment (physician's and patient's score) of efficacy and tolerability in both groups were mostly stated as "very good" and "good". Adverse events were reported as: Wobenzym: total 14 patients: gastrointestinal complaints (obstipation, vomiting, meteorism), allergic rash once and dizziness twice, 6 of these patients discontinued by that reasons. Diclofenac: total 11 patients: gastrointestinal complaints (epigastrical pain, upset stomach, meteorism), dizziness, 3 of these discontinued. All of these vanished after intake was stopped. Summarizing up it could be demonstrated that both evaluated drugs showed equal clinical potency. So it might be assumed that Wobenzym can be used as an alternative substance in treatment of acute painful osteoarthritis.

METHODS: Following ethics committee approval and with written informed consent, 80 patients (61 female, 19 male) were randomly allocated in this double-blind, placebo-controlled, parallel group study to two groups of 40 patients each. The treatment group received a compound of proteolytic, glycolytic, and lipolytic enzymes and rutoside (Wobenzym), while the control-group received placebo. Efficacy and tolerance of the study medication was examined before and after day case surgery for the carpal tunnel syndrome. Medication was given 10 tabs t.i.d. for 15 days, starting 7 days before surgery. Pain intensity (visual analogue scale), intake of analgesics, and tolerance of the study medication were recorded daily and treatment differences between the two groups were statistically evaluated.

RESULTS: Comparison of demographic data of all enrolled patients showed no significant difference between the two groups. In the enzyme group, pain scores were lower on the day of operation and for the following 5 days but did not differ significantly from the control group; however, patients of the enzyme group took significantly less analgesics and experienced significantly earlier pain relief than those of the control group, thus demonstrating a pain-reducing effect of the enzyme compound. Only few side effects were reported in both groups, none of them serious.

CONCLUSION: Enzyme therapy is an effective and safe adjuvant treatment for the control of postoperative pain

I have read that Dr William Davis at the heartscan blog checks all of his patients for Vit D3 levels prior to surgery. Of course, most are low, so he prescribes high doses of D3....50,000IU/day Results post op recovery are much better than those that have surgery with low Vit D3 levels.

Vitamin D has also been cited in the March 2007 issue of the Journal of Clinical Investigation for fighting infection which leads to faster wound healing.

http://www.earthtimes.org/articles/news/29153.html

The team has discovered that injury stimulates skin cells called keratinocytes, which surround the wound, to increase the production of vitamin D3 and that this in turn increases the expression of genes -- CD14 and TLR2 -- that detect microbes. These genes, together with active vitamin D3, called 1,25D3, then lead to more cathelicidin. In both mice and humans, a deficiency in cathelicidin allows infections to develop more readily.

Our study shows that skin wounds need vitamin D3 to protect against infection and begin the normal repair process, said Gallo. The study is published online in advance of publication in the March issue of the Journal of Clinical Investigation.

Also Vitamin C, and amino acids Proline and Lysine might also be good for healing cartilage. Cartilage is made of collagen and collagen is built by the body with the use of those three things. Proline is in gelatin, beef, cheese, probably in bone broth. Lysine is in high amounts in pork, Beef, fish.