By Gian Luigi Canata, C. Niek van Dijk
This ebook, released in cooperation with ISAKOS, is a concise, updated consultant and reference at the remedy of cartilage lesions of the ankle that might be of sensible scientific price for experts in activities drugs and activities traumatology. diverse thoughts and the administration of varied lesions are defined step-by-step, guiding the practitioner in the course of the whole spectrum of care from overview of the harm to winning restoration. Chondral and osteochondral lesions of the talus can current due to repetitive ankle accidents, inflicting persistent soreness, recurrent swelling, and weak point and stiffness of the ankle joint. a correct early prognosis is needed, utilizing scientific assessment, imaging concepts and arthroscopy of the ankle. In acute and non-displaced chondral and osteochondral lesions, conservative therapy is the mainstay. surgical procedure is suggested for volatile and protracted lesions and is composed in different concepts involved in regeneration of the cartilage. Returning to play is feasible after trying out stability and proprioception, power, variety of movement, and agility.
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Gobbi et al. performed a randomised study of 30 patients comparing chondroplasty with microfracture and autologous osteochondral transplantation . At a mean of 53 months, there was no difference in AOFAS scores and single assessment numeric rating. 5 mm2 in patients younger than 50 years. Other authors have found age not to affect the clinical outcome . Short- to medium-term results of marrow stimulation have generally been good . 58 G. McCollum Fig. 5 Marrow stimulation with microfracture Of concern, fibrocartilage has inferior mechanical properties compared to hyaline cartilage, and there is a limit to the size of lesion that will fill with repair tissue.
Pap et al. 5 Diagnosis After thorough history taking and physical examination, routine radiographs of the ankle are made consisting of weight-bearing anteroposterior, mortise and lateral views of both ankles. The radiographs may show an area of detached bone, surrounded by radiolucency (Fig. 3). Initially, the damage might be too small to be visualised on routine X-ray. By repeating the images in a later stage, the abnormality sometimes becomes apparent. A heel-rise view with the ankle in a plantarflexed position may reveal a posteromedial or a posterolateral defect .
The majority of lesions are trauma related. Ankle sprains are very common, affecting 28,000 individuals in the United States every day, and in many sports it is the most commonly injured joint . About 50 % of these will have some form of chondral injury and in up to 70 % of ankle fractures . A smaller percentage of lesions do not have a history of trauma and have metabolic, genetic or local ischaemic aetiologies . Reliable repair techniques are important to reduce pain and return patients to function.