Welcome to the ICRS Patient & Public Education Site

If you suffer from joint pain, you’re not alone. Each year, more than 50 million people visit their doctors because of joint pain — half of them with a damage of the articular cartilage.

On this website, you can find useful, updated information on specific cartilage-related conditions and possible treatments options, written by world-renowned experts in this field, helpful patient information to read and download, and other useful resources

The choice of procedures depends on the size and location of cartilage defect. Larger defects are typically treated with autologous chondrocyte transplantation, osteochondral allograft transplantation, or newer synthetic or natural scaffolds which may require open incisions. Smaller defects in specific locations may be treated with enhanced bone marrow stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer which may be completed through the arthroscope. There is also a chapter for conservative treatments options and rehabilitation after cartilage repair.

Intended Audience for this Website

People of all ages can suffer from cartilage complications, whether due to ‘wear and tear’ or injury. While the former is much more common in middle-aged patients, and even more so in women, injuries to the joints, such as trauma or accidents during active sports, can affect any age group or gender. Careers requiring repetitive or intense motion can increase the risk of developing cartilage problems, but there are several other risk factors, including age, weight and genetic predisposition.

What is Cartilage Repair?

On this website, we focus only on articular cartilage repair treatments, which means the restoration of damaged hyaline cartilage in the joints. Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy. Typically, these procedures are recommended for cartilage damage or deterioration caused by:

Injury or trauma, including sports injuries or repetitive use of the joint Congenital abnormalities – abnormalities a person is born with (for instance misalignment) – that affect normal joint structure Hormonal or idiopathic disorders that affect bone and joint development, such as osteochondritis dissecans (OCD). There are several types of new and modern procedures for cartilage repair and regeneration techniques that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.

What is not covered in this Website?

There are several types of bone and joint pain, each with many potential sources or etiologies. This site is not intended for people who suffers from rheumatoid arthritis (RA), gout, avascular necrosis (AVN), and cancer within bones, osteoporosis and other inflammatory or autoimmune diseases.

Acknowledgements

To the Mäxi Foundation: 
This website project would not have been possible without the substantial support of the Swiss “Mäxi Foundation”. The ICRS would like to express a deep gratitude for this very generous contribution to the International Cartilage Repair Society and the respective patient community, making it possible to provide updated information about cartilage damage and cartilage repair technologies free of charge to all interested persons.

To the Authors & Contributors:
The following world-renowned experts in cartilage repair & cartilage research have contributed to the extensive content of this website: Stephen Abelow (USA), William Bugbee (USA), Susan Chubinskaya (USA), Brian Cole (USA), Stefano Della Villa (IT), Chris Erggelet (CH), Jack Farr (USA), Ralph Gambardella (USA), Michael Gerhardt (USA), Wayne Gersoff (USA), Alan Getgood (CA), Alberto Gobbi (IT), Laszlo Hangody (HU), Oliver Kessler (CH), Elizaveta Kon (IT), Jos Malda (NL), Bert Mandelbaum (USA), Tom Minas (USA), Kai Mithoefer (USA), Stefan Nehrer (AT), Lars Peterson (SE), Scott Gillogly (USA), Holly Silvers (USA), Jason Theodosakis (USA) and Kenneth Zaslav (USA)

To anyone else who contributed to this important project
ICRS Office Staff, Medical Writers, Committees, Illustrators and Web Developers, etc.

Terms of Use

These terms of use, together with our Privacy Policy collectively, these “Terms of Use”, governs access to and any use of the website cartilage.org and any sub-sites (the “Website“), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree to bound and abide by the Terms of Use on behalf of all users of the respective computer. Visitors who do not agree with these Terms of Use must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them. Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes. You are expected to check this page from time to time so that you are aware of any changes, as they are binding on you.

The information on the Website is not intended to treat, diagnose, cure or prevent any cartilage related issues. Always seek the advice of a physician or other qualified health care provider with any questions you have regarding your medical condition.

Privacy Policy

This privacy policy (“Privacy Policy”), together with the Terms of Use for the patient website section, applies to any use of the website cartilage.org and any sub-sites (the “Website”), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree on behalf of all users of the respective computer to be bound and abide by the Terms of Use and this Privacy Policy. Visitors who do not agree with the Terms of Use and this Privacy Policy must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) is committed to protecting your privacy and ensuring that your personal information is protected. This Privacy Policy explains the types of personal information we collect and how we use, disclose and protect that information.

Accept & Proceed
  • facebook
  • twitter
  • linked in
  • google+
 back top
Diagnosis & Treatment of Ankle Disorders

Doctor Finder

Find a specialist in your area

Medical Devices and Techniques

Cartilage Repair Techniques
Knee Video Banner

Diagnosis & Treatment of Ankle Disorders

The ankle is a complex joint consisting of the tibia, talus, and fibula bones. The most common bone in the ankle to have cartilage injury is the talus. The cartilage of the talus is like any other articular cartilage and is arranged similarly to that in other weight-bearing joints. It is thought that the ankle joint is less likely to develop degenerative osteoarthritis than the hip due to its ability to resist tension (tensile forces) over time.

Injury to the ankle and stretching (instability) of the ligaments can lead to cartilage injury to the ankle joint.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about cartilage disorders of the knee, as well as anyone interested in cartilage problems.

What are cartilage disorders of the ankle?

The most common ankle injuries are sprains, with a daily occurrence (incidence) of one in every 10,000 people. In the U.S., for example, there are 23,000 ankle injuries every day, with the highest injury rate for every hour of play in basketball, soccer, and volleyball. The articular cartilage is damaged by direct impact on the bone due to ankle sprains.

Fractures are becoming recognised as a major cause of cartilage damage and, in this context, are called bone and cartilage (‘osteochondral’) defects (lesions) of the talus. Both acute (new) injuries and chronic (long-term) insufficient ligament stability can lead to osteochondral lesions of the talus [Figure].

Cartilage injury becomes more likely as the energy and severity of an ankle injury increases.

Patients usually have persistent pain after an ankle sprain or injury. Pain is typically deep inside the ankle joint and may be accompanied by occasional swelling, stiffness and weakness. Mechanical symptoms such as locking and catching may also be present.

It may be a long while after the injury before they present to a doctor, with patients taking up to three years, in some cases. High-level athletes often tolerate the pain and may present after numerous injuries.

How are cartilage disorders of the ankle diagnosed?

Some surgeons find that injection of a local anaesthetic into the ankle joint can help determine if the pain is being caused by a cartilage defect (lesion) or other factors. Other causes of pain that should be considered include:

  • Mechanical ligament instability;
  • Deep bone bruises;
  • Loose cartilage bodies (floating bone chips);
  • Other ankle bone fractures;
  • Tendon injury;
  • Nerve pain from a stretch injury; and
  • Impingement of the ankle from chronic scar tissue inside the ankle.

X-rays of the ankle are appropriate in the initial assessment of a patient with persistent pain after an ankle sprain. However, as routine X-rays can fail to identify up to half of cartilage defects identified by other means, patients with severe pain lasting 8–12 weeks or longer should have magnetic resonance imaging (MRI). This has an increased sensitivity for diagnosis and for characterising defects in preparation for possible surgery.

The stability and location of the defect, and the presence of bone bruising all help with preoperative planning.

What are the treatment options?

Managing bone and cartilage (osteochondral) defects of the talus bone (see above) continues to be a challenge. There is an association between ankle instability and injury for both new and old talus injuries. Early attempts at stimulating healing, whether by curettage and/or drilling and microfracture achieve similar results.

Patients in whom first-choice treatments have failed are candidates for cartilage replacement surgeries such asosteochondral autograft transfer (OATS), autologous chondrocyte implantation (ACI) and matrix-based chondrocyte implantation (MACI). Larger, non-healing lesions are potential candidates for bulk osteochondral allografts.

Researchers are currently investigating more precise patient selection, optimal rehabilitation, techniques performed entirely via arthroscopy, and advanced biomaterials to accelerate healing.

Conservative treatment

Conservative or non-surgical treatment is guided by the potential for a defect (lesion) to heal, and by patient preferences.

Minor, stable injuries can be treated non-operatively by being immobilised and protected from weight bearing for six weeks.

This is followed by a rehabilitation programme involving gradual weight bearing for another six weeks, with a focus on range of motion and ankle strengthening exercises.

Range of motion exercises are important for cartilage healing, as they support the diffusion of nutrients through the fluid in the ankle joint, although they should only performed once the initial injury has stabilised.

Around half of all cartilage injuries will improve or stay the same after 1 year.

Surgical treatment

When different surgical approaches have similar outcomes, the decision over treatment choice is based on individual surgeon preferences, experience, and lesion location and amount of cartilage damage. The initial surgical treatment for most defects involves arthroscopy with debridement (removal of damaged tissue), andmicrofracture.

Regardless of the specific technique, improvement in pain is seen in 85% of people. If the initial microfracture or drilling procedure is not successful, repeat microfracture for continued pain can be effective.

Revision microfracture is used in patients with persistent pain who have imaging results that suggest healing was incomplete but who cannot have more invasive surgical procedures. Repeat microfracture or drilling is a reasonable, low complication procedure for such patients.

Although the goal of drilling and microfracture is to stimulate healing and restoration of hyaline cartilage, defects usually heal with fibrocartilage, which is less organised ‘scar’ cartilage. Patients who have continued pain and swelling after six months of healing and physical therapy should be assessed for other procedures.

Osteochondral autografts

Osteochondral autografts are recommended for patients with talus defects less than 1.5 cm² who are aged less than 50 years, and in whom either non-operative treatment or initial cartilage surgery has failed. Patients with defects in both the tibia and talus or those who have severe deformity cannot have osteochondral autografts.

Autologous chondrocyte implantation

Autologous chondrocyte implantation (ACI) may be used in patients with cartilage defects of the talus, which can be effective after failed previous arthroscopy. Disadvantages include the cost and the need for the ankle bone to be cut (osteotomy) to gain access to the ankle joint.

Matrix-based chondrocyte implantation

Matrix-based chondrocyte implantation (MACI) is similar to ACI. The advantages of MACI include that it is technically easier than ACI and no osteotomy is needed, and it has shown good outcomes in patients with ankle cartilage injuries.

Frequently Asked Questions (FAQs)

When can I return to work?

The time-off from work depends on the type of work. A manual worker will be off work until the cartilage is fully healed, which may take 8 months or longer. Someone with a desk job may be at work within a week while keeping to non-weight bearing period during this time.

How long is rehabilitation period following a cartilage injury?

After cartilage injury there must be a six-week period of non-weight bearing, but full recovery can take up to a year to fully heal and regain the full range of movement.

Further reading
  • Athanasiou, K. A.; Niederauer, G. G.; and Schenck, R. C., Jr.: Biomechanical topography of human ankle cartilage. Ann Biomed Eng, 23(5): 697-704, 1995.
  • Baker, C. L., Jr., and Morales, R. W.: Arthroscopic treatment of transchondral talar dome fractures: a long-term follow-up study. Arthroscopy, 15(2): 197-202, 1999.
  • Becher, C., and Thermann, H.: Results of microfracture in the treatment of articular cartilage defects of the talus. Foot & Ankle International, 26(8): 583-9, 2005.
  • Giza, E.; Ocel, D.; Lundeen, G.; Mitchell, M.; Veris, L.; Walton, J.; and Sullivan, M.: Matrix induced Autologous Chondrocyte Implantation of Talus Articular Defects: Two Year Prospective Foot & Ankle International, 31(9), 2010.
  • Hepple, S.; Winson, I. G.; and Glew, D.: Osteochondral lesions of the talus: a revised classification. Foot & Ankle International, 20(12): 789-93, 1999.
  • Hintermann, B.; Boss, A.; and Schafer, D.: Arthroscopic findings in patients with chronic ankle instability. American Journal of Sports Medicine, 30(3): 402-9, 2002.
  • Loomer, R.; Fisher, C.; Lloyd-Smith, R.; Sisler, J.; and Cooney, T.: Osteochondral lesions of the talus. American Journal of Sports Medicine, 21(1): 13-9, 1993.
  • Loren, G. J., and Ferkel, R. D.: Arthroscopic assessment of occult intra-articular injury in acute ankle fractures. Arthroscopy, 18(4): 412-21, 2002.
  • Mandelbaum, B. R.; Gerhardt, M. B.; Peterson, L.; Mandelbaum, B. R.; Gerhardt, M. B.; and Peterson, L.: Autologous chondrocyte implantation of the talus. Arthroscopy, 19 Suppl 1: 129-37, 2003.
  • Marlovits, S. et al.: Early postoperative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle. Knee Surgery, Sports Traumatology, Arthroscopy, 13(6): 451-7, 2005.
  • Robinson, D. E.; Winson, I. G.; Harries, W. J.; and Kelly, A. J.: Arthroscopic treatment of osteochondral lesions of the talus.[see comment]. Journal of Bone & Joint Surgery – British Volume, 85(7): 989-93, 2003.
  • Ronga, M.; Grassi, F. A.; Montoli, C.; Bulgheroni, P.; Genovese, E.; and Cherubino, P.: Treatment of deep cartilage defects of the ankle with matrix-induced autologous chondrocyte implantation (MACI). Foot and ankle Surgery, 11: 29-33, 2005.
  • Savva, N.; Jabur, M.; Davies, M.; Saxby, T.; Savva, N.; Jabur, M.; Davies, M.; and Saxby, T.: Osteochondral lesions of the talus: results of repeat arthroscopic debridement. Foot & Ankle International, 28(6): 669-73, 2007.
  • Schafer, D. B., and Schafer, D. B.: Cartilage repair of the talus. Foot & Ankle Clinics, 8(4): 739-49, 2003.
Keywords

Ankle cartilage, Osteoarthritis, Osteochondral defect, Talus

The ankle is a…
ICRShttps://cartilage.org/content/uploads/icrs.jpg
Thank You for Your vote

How useful did you find the information on this page?

Rating

3.7 (47 votes)