Cartilage therapy / Osteochondral lesions

Cartilage therapy / Osteochondral lesions

Cartilage lesions on the ankle can occur on any joint surface. In ankle injuries from recreational or sports accidents, the cartilage is often crushed or sheared off. Not infrequently, the subchondral bone is also torn off (osteochondral flake fracture). If the diagnosis is made early enough, the sheared piece of cartilage can often be repositioned using arthroscopy or open surgery and firmly affixed with the help of special absorbable nails or sutures, allowing it to heal back in place. Various surgical options are available for instances when the sheared fragments are unsuitable for refixation or if chronic cartilage damage is observed, depending on the size and depth of the damage. Bone marrow stimulation techniques can be used in case of small, flat defects, often with good results. After removing the unstable cartilage at the base of the defect, the bone surface is milled and drilled with special instruments to release the bone marrow. The stem cells and growth factors in the bone marrow are then able to grow and become new replacement cartilage at the site of the defect. This effect can be supported by the injection of hyaluronic acid or collagen matrix to bind any leaked blood, stem cells, and growth factors at the site and give the cells sufficient space to develop (autologous matrix-induced chondrogenesis—AMIC). Bone defects can be seamlessly filled with a bone cylinder from the iliac crest and mechanically stablized during the operation. For surgical cartilage therapy to truly succeed, however, all accompanying pathologies must also be addressed. Above all, ligament instability and mechanical overload resulting from axial misalignment must be eliminated during the operation using appropriate procedures.