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The complex structure of articular cartilage requires extensive expertise: Cartilage is a soft and extremely smooth tissue that covers the articular surfaces of bones and facilitates joint movements, reduces friction and distributes weight-bearing forces. However, due to absence of blood supply, cartilage has a decreased ability to self-repair.
Chondral lesions present a challenge for orthopedists for more reasons than just the absence of blood supply. If they are not promptly diagnosed, and if the lesion or defect is not immediately treated, it can escalate into gradual extension of the lesion. As a result, chondral lesions can cause chondromalacia and eventually, once there is extensive damage and exposure of the underlying subchondral bone, lead to osteoarthritis.

The ankle (or talocrural region) is formed where the foot and the tibia meet. It includes the tibia, fibula, talus, as well as the heel bone, scaphoid bone, cuboid bone and the cuneiform bones. Osteochondral lesions are mainly the result of acute or chronic injuries that cause partial or complete chondral defect, and in some cases, additional defect of a portion of the subchondral bone.
According to research, a total of 70% of medical cases involving ankle sprains and joint injuries is associated with osteochondral lesions. In patients with no prior injuries, osteochondral lesions can occur due to genetic predisposition, osteonecrosis, articular hypermobility, thromboembolic disease etc.

Young individuals who participate in sports mainly visit the doctor for a grade III or grade IV lesion, which disrupts normal joint function, causes pain, joint effusion and noise during knee motion. Treatment for osteochondral lesions is either conventional or surgical, depending on the patient’s age, level of physical activity, as well as the severity of the patient’s symptoms and the size and location of the lesion. 

If the patient opts for surgery, the procedure is done using the minimally invasive arthroscopic technique. Since the arthroscope provides a clear and accurate image of the joint, joint instability and mechanical axis malalignment can be concomitantly corrected as well.
Surgical treatment options for small osteochondral lesions include the microfracture or drilling surgical techniques. Small holes are drilled between the bone of the affected site and the subchondral bone. The subchondral bone is rich in mesenchymal stem cells which can differentiate into chondrocytes once injected into the affected site. However, the quality of the regenerated chondral tissue is inferior and has low mechanical strength.
Alternatively, cylindrical osteochondral grafts or synthetic grafts are transferred from a low weight-bearing area of the knee towards the affected site. Advantages of this surgical technique include the transfer of healthy articular cartilage, thus addressing other potential subchondral lesions (osteonecrosis).  The surgery has an 80%-90% success rate, however limitations on the number of harvested cylindrical grafts from the donor site is considered a disadvantage of this surgical technique.
Ongoing progress in the surgical treatment of chondral lesions has led to transplantation techniques based on chondrocytes. Healthy tissue is harvested from the patient’s joint and the chondrocytes are isolated. Synthetic collagen or hyaluronic acid membranes are used to transfer the chondrocytes to the affected site in order to induce cartilage regeneration.

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