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WHY ARE CARTILAGE LESIONS CONSIDERED AS A CHALLENGE?

They are the “material” of the joints with a high specialisation: The cartilages, soft and extremely smooth, cover the ends of the bones and ensure the smooth movement of the joints as they minimise friction and distribute the loads. However, their main disadvantage is that they do not contain blood vessels, and therefore have a very limited self-healing capacity. Cartilage lesions are a challenge for orthopaedists, not only because they lack blood supply. but mainly because, if they are not diagnosed timely, and if no prompt treatment of the injury or condition takes place, then the entire cartilage is gradually affected, leading, first, to chondropathy, and, consequently, osteoarthritis, when full deterioration has occurred and the articular surfaces remain uncovered.

LESIONS OF THE TALOCRURAL (ANKLE) JOINT – ORIGIN

In the ankle, the joint where the tibia “meets” the foot (consisting of the tibia, the fibula and the ankle, while the calcaneous, the scaphoid, the cuboid and the cuneiform bones), the osteochondral lesions usually result from acute or chronic injury resulting in the crushing or detachment of a segment of the articular cartilage, while there are also cases involving a segment of the subchondral bone. Studies relate them to 70% of the ankle fractures, but also to the injuries of the ligaments. In patients without a history of injury, osteochondral lesions are a result, inter alia, of the genetic predisposition, osteonecrosis, loose ligaments, or thromboembolic disease.

CONSERVATIVE OR SURGICAL TREATMENT?

Usually, patients who generally belong to the sports-praticing individuals, visit the doctor with stage 3 and 4 lesions, which affect the normal joint function and cause pain, effusion, and sounds during movement. The treatment to be followed (either conservative or surgical) mainly depends on the age and level of activity of the patient, the severity of the symptoms, as well on the size and location of the lesion.

SURGICAL PROCEDURE

If surgical treatment is the selected option, then minimally invasive arthroscopy techniques are used. At the same time, since the arthroscope offers an accurate view of the joint, any ligament instability can be repaired, and any disruption of the mechanical axis can be assessed. Regarding lesions that occupy a small surface of the cartilage, the microfracture and micro-drilling techniques are selected to open “communication” channels between the injured cartilage and the subchondral bone, which rich in mesenchymal cells, which are transformed into chondrocytes when placed on the affected surfaces. Of course, the new cartilage tissue that is formed is of inferior quality and of limited mechanical strength. Alternatively, osteochondral cylindrical fragments originating from areas of the affected joint and which do not participate in its function, or synthetic grafts, are implanted. The advantage of this technique is that ready-made cartilage is placed, so any concomitant lesion of the subchondral bone (osteonecrosis) is also treated. The success rate reaches 80-90%, but the limitation on how many cylinders can be obtained from the donor area is a disadvantage. The constantly evolving research in the field of cartilage lesions has also offered chondrocyte-based techniques. Healthy tissue, which cells are isolated from, is obtained from the patient’s joint; they are consequently placed into synthetic collagen or sodium hyaluronate membranes, in order for them to be placed in the lesion area, so new cartilage can develop.

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