One of the biggest “puzzles” in orthopaedic surgery is damages to the articular cartilage, the soft and smooth tissue that covers the surfaces of the bones that unite and form the joints. The reason, which Hippocrates had already identified since the ancient times, is due to the absence of blood supply of the cartilage, and, therefore, to the inability to regenerate and self-heal. Given that this specific anatomical structure ensures the smooth movement of the joints by reducing friction and absorbing the loads, cartilage and osteochondral lesions that remain undiagnosed and untreated, gradually expand and are one of the main causes of a total joint damage.
Contrary to the articular cartilage of the knee and hip, the ankle cartilage covers smaller surfaces, it is thinner by 1-2 mm, it less elastic and more resilient to osteoarthritic lesions, which is why osteoarthritis in this joint is not too common. The most common injury mechanism consists in acute or chronic injuries that lead to crushing, or even partial or total detachment of the cartilage. A lesion is defined as osteochondral, when a portion of the subchondral bone is also detached. The cartilage can also be damaged by non-traumatic causes, such as osteochondritis dissecans.

The main symptom is the persistent pain that usually appears on the anterior aspect of the ankle. It is also likely for a swelling to be present, due to that a swelling is observed due to effusion, mechanical problems (for example, an ankle locking caused by the osteochondral fragment which is “stuck” between the bones), or even a crackling sound, due to friction between the damaged surfaces.

Diagnosis is performed through the obtaining of a detailed history and a clinical examination. X-rays and MRI will “show” the orthopaedist the best treatment. Usually, the first approach is conservative: anti-inflammatory drugs, rest and changing of the activities, non-burdening of the affected extremity, and immobilizing of the ankle with a special splint. In cases of instability, an exercise programme by a physiotherapist shall help the recovery of the full range of motion, as well as muscle strengthening.
In the context of non-surgical treatment, injectable treatment may also be applied with hyaluronic acid infusion to control the symptoms, or growth factors and stem cells for the healing of cartilage, as much as possible. However, if all of the above do not have any effective results, and the symptoms persist, a part of the cartilage should be surgically removed and create the conditions for the formation a new one. If, of course, the cause is a loose osteochondral body, then the option of its arthroscopic removal and the repair of the cartilage damage, is preferred.
In young and active patients, in whom the lesion is single, and a large part of the cartilage remains intact, the microfracture technique is mainly selected. This method, which is minimally invasive, as it is applied arthroscopically, namely, through very small incisions, does not exclude older patients with extensive damages. In any case, the goal is to open a “passageway” for the mesenchymal cells and growth factors to replace for the lost surface of the cartilage. In fact, advancement in orthopaedic surgery has taken this specific method one step further: Globally, the microfracture technique is combined with the application of a collagen substrate, which acts as a rack.
Transplantation of autologous chondrocytes, which are “called upon” to imitate the physical properties of the cartilage, is a significant development. This method is suitable for those who are up to 55 years of age, without osteoarthritis or rheumatoid arthritis, and with a single injury. Chondrocytes are obtained by the patient themselves, they are grown in the laboratory and then arthroscopically placed in the affected joint.

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