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Cartilage Injuries: A Big Ankle Problem

Introduction

Cartilage injuries of the ankle, often referred to as osteochondral defects of the ankle (OCD’s) are all a way of saying that something happened inside the joint of the ankle. They most often come from trauma. Sometimes we don’t know why they occur. It could be as simple as an ankle sprain with pain that resurfaces years later, or it could be a more substantial injury such as a fracture. In addition, it can happen shortly after the injury, or it can happen several months and even years after the injury with new pain.

Testing

It is often hard to know at first glance that truly a cartilage injury is present. However, if left unnoticed, then they can cause you a lot of pain into the ankle and any location circumferentially around the ankle. They can limit you from running or even performing daily activities making you feel like your ankle gives way. Evaluation is important if the ankle is painful or feels unstable. An evaluation consists of a good clinical exam to identify where the ankle pain is coming from. Dr. Miller would examine the ankle in the office. We also identify your history with ankle injuries that could possibly lead to cartilage injuries. We begin with an x-ray series looking at the bone structure inside. This includes the tibia, fibula, talus and surrounding bones. These bones on the x-ray won’t show cartilage. However, they can show changes in the bone that are subtle, suggesting there might be a cartilage injury present.

X-Ray showing subtle cartilage injury changing talus bone.

MRI of same ankle showing much more obvious talus OCD. There is disruption of cartilage and underlying bone causing pain.

Nonsurgical Approach

We want to begin by treating this nonsurgical to see if it gets better. We often get more advanced imaging as well. Depending on the patient’s feedback regarding the pain, we often suggest walking boot therapy. Immobilizing the ankle in a walking boot for a few weeks can improve pain for the patient. Boot only has about a 30 to 40% success rate and likely can lead to no improvement. There are also certain injections that can help. If you are older, a steroid injection may be helpful. However, for younger patients, blood injections have become a new treatment. Taking the person’s own blood, we concentrate that down to get the good growth factors and blood products that may help the patient heal more effectively. These are often referred to as platelet rich plasma (PRP) injections.

Surgical Approach

If nonsurgical treatment fails, then you are looking at a surgical option to improve pain. This is usually decided upon largely by an MRI. (we’ve done a blog on MRI, so you can, you can link to that) MRIs are advanced imaging studies that look at soft tissue and cartilage better than just an x-ray. Based upon that imaging, if you do have a cartilage injury and we feel that it correlates to your pain, then you may be offered surgery as an effective way to treat the pain. While non-surgical treatment often varies anywhere from 30 to 50% successful, the surgical outcomes are often much more improved anywhere from 75 to 80% or more. These become an option for the patient when things fail or the pain is too significant. In most cases we can treat cartilage injuries of the ankle, minimally invasively. In other words, through an arthroscopy. Arthroscopy is a surgery where we make small incisions around the ankle to put instruments into the ankle (such as a camera or small cleaning tools) to fix the cartilage injuries. We often add additional grafts of material, such as cartilage or bone graft in the defect of the ankle to help it heal. Generally when you have these surgeries, you’re off the ankle for a short period of time to allow for protection and skin healing. Later we start physical therapy to recreate motion and strength and agility, and the patient is allowed to return to normal activities thereafter.

If you believe you may be experiencing a cartilage injury or know someone he may, Dr. Miller is Beacon Orthopedics’ foot and ankle specialist and is available at several locations around the Cincinnati area. Contact us today for more information! Click here to learn more and schedule an appointment with Dr. Miller for foot and ankle injuries.

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