Osteochondral defects in the ankle: why painful? Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 2. DD Amsterdam, The Netherlands Corresponding author. Received 2. 00. 9 Dec 8; Accepted 2. Jan 1. 1. This article has been cited by other articles in PMC. Abstract. Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. Foot and Leg Discoloration. Foot and leg discoloration can be caused by a variety of ailments. These include skin infections, peripheral vascular disease, Schamberg's. Learn all about arthritis - the common condition that causes pain and inflammation in the joints, the tissues that surround the joint, and connective tissue. Epidermolysis bullosa dystrophica; Classification and external resources; Specialty: medical genetics: ICD-10: Q81.2: ICD-9-CM: 757.39: OMIM: 131750: DiseasesDB: 29580. Herbs for back pain. A lot of people suffer back injuries; I've heard estimates that 65 million people in America alone suffer from. So, the type of foot structure one has, whether it is a high arched or flat foot can cause vulnerability and problems when wearing flip flops or sandals. ![]() ![]() The ankle joint has a high congruency. During loading, compressed cartilage forces its water into the microfractured subchondral bone, leading to a localized high increased flow and pressure of fluid in the subchondral bone. This will result in local osteolysis and can explain the slow development of a subchondral cyst. The pain does not arise from the cartilage lesion, but is most probably caused by repetitive high fluid pressure during walking, which results in stimulation of the highly innervated subchondral bone underneath the cartilage defect. Understanding the natural history of osteochondral defects could lead to the development of strategies for preventing progressive joint damage. Keywords: Osteochondral defect, Cartilage, Ankle joint, Subchondral cyst, Natural history, Pain. Introduction. An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 4. The defect initially may consist only of cartilage damage caused by shearing stresses, with the subchondral bone intact, but a bone contusion following high- impact force also can cause a defect [4. Ankle trauma associated with an OD often leads to subchondral bone cysts. These cysts are associated with persistent deep ankle pain thereby limiting the patients mobility. Most ODs of the talus are localized on the anterolateral or posteromedial talar dome [7. Lateral lesions are usually shallow oval shaped and are caused by a shear mechanism. Medial lesions in contrast are usually deep, and cup- shaped, indicating a mechanism of torsional impaction and axial loading [4, 1. Even though elaborate knowledge exists concerning ODs of the talus, its etiology and pathogenesis are still not fully understood. Increasing attention is paid to invasive and sometimes expensive surgical treatments, while research for pathogenesis of the lesions has somewhat been neglected. In order to treat ODs in all its dimensions, more should be known about their natural history. The development of an OD may have a sudden onset, but the development of a subchondral cyst is most often a slow process. Why do some ODs remain asymptomatic and inert, while others develop pain on weight bearing, demonstrate persistent bone edema on magnetic resonance imaging and result in the progressive formation of a subchondral cyst? Understanding this process might make it possible to interfere and prevent progressive damage to the joint. In this manuscript, the most important factors related to the development of ODs are analyzed. Etiology. A traumatic insult is widely accepted as the most important etiologic factor of an OD of the talus. For lateral talar defects, trauma has been described in 9. As not all patients report a history of ankle injury [1. Ischemia, subsequent necrosis and possibly genetics are etiologic factors in nontraumatic ODs [5. ![]() THERE IS NO WAY TO DIAGNOSE YOU WITHOUT AN EXAMINATION BY A DOCTOR. What do you mean by a lump? Do you mean swollen ankles? When you press there with your finger does. Furthermore, ODs in identical twins and siblings have been described [1, 1. The defect is bilateral in 1. Traumatic cartilage injuries generally comprise three categories: microdamage or blunt trauma, chondral fractures and osteochondral fractures [2. Ankle sprains have a predominant role in traumatic ODs. ![]() When a talus twists inside its boxlike housing during an ankle sprain, the cartilage lining of the talus can be damaged. This may lead to a bruise and subsequent softening of the cartilage or even a crack in the cartilage with subsequent delamination. Separation in the upper layer of the cartilage occurs as a result of shearing forces. Alternatively, separation may occur in the subchondral bone, giving rise to a subchondral bone lesion. Fragments may break off, and float loose in the ankle joint, or they remain partially attached and stay in position. The lesions can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. In cadaver ankles, Berndt and Harty reproduced lateral defects by strongly inverting a dorsiflexed ankle. Rash & Joint Pain. When a rash or joint pain occur alone they often indicate common medical problems. But when they occur together, they may indicate a more serious. While knuckle cracking probably won't cause an inadvertent display of gang signs, don’t get too carried away with that snap, crackle, and pop. Though it's not tied. Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral. As the foot was inverted on the leg, the lateral border of the talar dome was compressed against the face of the fibula [4]. When the lateral ligament ruptured, avulsion of the chip began. With the use of excessive inverting force, the talus within the mortise was rotated laterally in the frontal plane, impacting and compressing the lateral talar margin against the articular surface of the fibula. A portion of the talar margin was sheared off from the main body of the talus, which caused the lateral OD. A medial lesion was reproduced by plantarflexing the ankle in combination with slight anterior displacement of the talus on the tibia, inversion and internal rotation of the talus on the tibia. Clinical presentation. In the acute situation, an OD of the talus often remains unrecognized since the swelling and pain from the lateral ligament lesion prevails. The weight- bearing anteroposterior (mortise) and lateral radiographs may not reveal any pathology, or only show an area of radiolucency. In case of a large OD the initial radiographs may be positive. When the symptoms of the ligament injury have resolved after some weeks, symptoms of persistent swelling, limited range of motion and pain on weight bearing may continue. If symptoms have not resolved within 4–6 weeks, an (osteo)chondral defect should be suspected. Locking and catching are symptoms of a displaced fragment. Chronic lesions typically present as persistent or intermittent deep ankle pain during or after activity [1. Most patients demonstrate a normal range of motion with absence of recognizable tenderness on palpation and absence of swelling. However, reactive swelling or stiffness may be present. The natural history of osteochondral lesions of the talus whether treated or not is benign. We reported the long- term results of ODs and found only one case of radiographic progression after 1. Reports of ankle arthrodesis following ODs of the talus are rare [1. Cartilage and bone anatomy. Cartilage consists of chondrocytes that lie groupwise in lacunae of the extracellular matrix they produce. The cartilaginous matrix consists of collagen, hyaluronic acid, proteoglycans and a small amount of glycoprotein’s (Fig. 1). Its elasticity is based on the electrostatic connections between collagen fibers and the glycosaminoglycan (GAG) side chains of the proteoglycans, the containment of water by the negatively loaded GAGs of the central protein of proteoglycans and the flexibility and the mutual sliding of the collagen fibers. Schematic diagrams showing normal anatomy of ankle cartilage, subchondral plate and subchondral bone area. The cartilage consist of chondrocytes that lie groupwise in lacunae of the extracellular matrix, which contains collagen fibers in an arcwise configuration.. Cartilage is avascular and is nourished by the intra- articular fluid. The tissue fluid of the cartilage matrix, which comprises about 7. In the healthy cartilage the GAG side chains of the proteoglycans play an important role for the elasticity and maintenance of the water content of 7. As a matter of fact, we all walk on water. Cartilage does not contain lymph vessels or nerves and has a slow metabolism [2. Mineralized bone consists of both compact and trabecular bone. Compact bone is found beneath the periosteum and acts as the main weight- bearing pillar for the skeleton. It is not a solid tissue but rather an aggregation of osteons, the major multicellular unit of compact bone. Each osteon is composed of groups of concentric calcified cylinders, each of which is made up of bone matrix proteins that form long cylinders- shaped structures, oriented parallel to the long axis of the bone [3. Histopathology. Koch et al. ODs of the knee [2. They intra- operatively harvested cylinders of the osteochondral areas as part of a cartilage- bone transplantation in 3. At the cartilage level there was a loss of acidic GAGs from the extra- cellular matrix and a decrease of the number of chondrocytes. Hyaline cartilage was often replaced by fibrocartilage. The subchondral bone plate was thinned compared to normal osteochondral samples and had fractured areas. Parallel with a general loss of proteoglycans from the superficial layers of the extracellular cartilage matrix, the amount of chondroitin sulfates and keratin sulfate was increased in deep cartilage layers and in the subchondral bone. Koch et al. [2. 9] stated that all morphological features tend to indicate that the main area of action is around the subchondral bone plate. In 2. 00. 9 Uozumi et al. ODs in 1. 2 knees. During the surgery, cylinder osteochondral plugs were taken from the center of the OD and examined with light microscopy. They classified three types in the subchondral bone area: (1) necrotic subchondral trabeculae, (2) viable subchondral trabeculae, and (3) cartilage without bone trabeculae. Uozumi et al. [6. An abnormal subchondral plate is likely to be one of the major factors in influencing the long- term outcome of articular cartilage repair. Qiu et al. [4. 0] studied ODs in femoral condyles of rabbits and found that the presence of an advanced and irregular subchondral plate was associated with degradation of repaired articular surface. Cause of pain in osteochondral ankle lesions. Several factors can play a role in the cause of pain in ODs.
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