Articular Cartilage lesions

The ankle is a joint composed of three different bones, the tibia, the fibula, and the talus. The lower parts of the tibia and fibula articulate together to form the “ankle mortice”, a structure that contains the talus and allows joint stability and mobility. Articular cartilage lesion is a term that describes an injury reported to the cartilage that covers the joint surfaces of the ankle joint, including the surfaces of the tibia, fibula and talus. These injuries are typically classified based on their location (e.g.: talus, tibia, fibula), size, shape, depth, number of affected sites, and severity of the condition (four-level classification). Cartilage damages reported in weight-bearing joints (e.g.: knee, hip, and ankle), which are usually under constant stress, have unfortunately limited intrinsic healing capacity and the management of these conditions can be challenging if not diagnosed and treated from the early stages. Typically, these injuries are the consequence of a direct trauma, either a single high-energy impact, or due to progressive and repetitive hits to the joint surface. Symptoms can widely vary between individuals from being completely asymptomatic to high levels of pain, stiffness, decreased mobility, potential joint blockage (depending on the presence of structures that can interfere with the joint movements, such as the presence of loose bodies), and limited function. Pain and swelling are usually linked to the physical activity performed by the patient, where an excess or a complete lack of that, can lead to increased symptomatology. Depending on the specifics of the injury and the patient’s reported symptoms, cartilage injuries can be treated conservatively or surgically.

Non-surgical management

Conservative treatment should be implemented as a first-line treatment since, even if rehabilitation cannot alter the natural course of the disease and the damaged structures, it can modify the symptoms by addressing the driving factors of the pathology. Aim of the non-surgical management is to slow down the advancement of the condition and limit the symptoms with a multitude of interventions such as rehabilitation, use of medications, injections, etc. In our opinion, while medications can limit the symptoms in the short term, improving your mobility, strength and movement quality will allow you a higher likelihood of positive long-term outcomes. Therefore, our recommendation is to implement a holistic approach that includes a stage-based rehabilitation with the supervision of a doctor. In isokinetic, after being visited by one of our specialised doctors, based on your diagnosis (including specific grading of the injury, location, etc.), you will receive a treatment plan tailored to the specifics of your condition. You will start your training plan with our medical team to limit your symptoms by increasing your mobility in the pool and gym, improving your strength in our gym, optimising your movement quality in the movement analysis room, and returning to your sports after completing our on-field rehabilitation.

surgical management

Some individuals with an advanced condition or unsuccessful non-surgical management may be potential candidates for a surgical approach. In these cases, when the surgical procedure is deemed necessary, our excellent relationships with Orthopaedic Surgeons will allow us to promptly refer you to them for a surgical opinion. Different procedures (such as cartilage shaving, microfractures, osteochondral autologous grafts, etc.) could be implemented during surgery and are always discussed in detail with the patients and the medical-surgical team. Post-surgical rehabilitation will vary widely depending on the surgical technique used. After the surgery, a period of joint protection with the implementation of crutches and a boot to limit the load on the ankle is typically recommended. This post-surgery period is particularly delicate because of the biological healing process of the joint surface that makes the joint vulnerable to mechanical stimuli. In Isokinetic, thanks to the expertise of our medical team, you will be followed in minimal detail to guarantee a safe and effective progression and optimise your short- and long-term outcomes.