TREATMENT OF OSTEOCHONDRITIS OF THE ANKLE
DEFINITION OF ANKLE OSTEOCHONDRITIS
Ankle osteochondritis, also known as Osgood-Schlatter disease of the ankle or osteochondral injury of the ankle, is a joint condition in which the cartilage and underlying bone of the ankle joint the ankle suffers degeneration or injury. This condition can affect different parts of the ankle joint, including the talus (the bone in the foot that forms the joint with the tibia and fibula) or the articular cartilage itself.
Ankle osteochondritis is often associated with decreased vascularity (blood supply) to the subchondral bone, which can lead to deterioration of the cartilage and bone. The precise causes of this condition are not fully understood, but several factors can contribute to its development, including :
- Repetitive strain injuries : Physical activities or sports that involve repeated movements of the ankle, such as running, jumping, or pivoting sports, can place excessive strain on the ankle joint, resulting in repetitive strain injuries that can damage the cartilage and underlying bone.
- Acute trauma : Direct trauma to the ankle, such as a fall or strong blow, can cause sudden injury to the cartilage and bone of the ankle joint, which may contribute to the development of osteochondritis .
- Genetic Factors : Some people may be predisposed to developing osteochondritis of the ankle due to genetic factors that affect the structure or blood supply of bone and cartilage.
Symptoms of ankle osteochondritis may vary depending on the severity of the injury, but they may include :
- Ankle pain, usually localized to a specific location.
- Swelling and tenderness around the ankle.
- Joint stiffness and difficulty moving the ankle.
- Creaking or grinding noises during ankle movements.
- Weakness or instability of the ankle.
The diagnosis of ankle osteochondritis can be confirmed by imaging tests such as x-rays, MRI (magnetic resonance imaging), or CT scans. Treatment for ankle osteochondritis may vary depending on the severity of the injury, but it may include conservative measures such as rest, reduction of physical activity, physiotherapy, orthotics to support the ankle, as well as surgical procedures, such as arthroscopy or cartilage grafting, in more severe cases. It is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan for persistent ankle symptoms.
WHY OPERATE FOR OSTEOCHONDRITIS?
Surgery to treat osteochondritis of the ankle may be considered in cases where conservative measures, such as rest, physiotherapy or anti-inflammatory medications, have failed to relieve symptoms or stop progression. of the lesion, or when the lesion is too large to heal spontaneously. Here are some reasons why surgery may be necessary for ankle osteochondritis :
- Relief of Persistent Symptoms : If symptoms such as ankle pain, swelling, stiffness, or instability persist despite conservative treatment, surgery may be considered to relieve symptoms and improve ankle function.
- Cartilage preservation : The goal of surgery in the treatment of ankle osteochondritis is often to preserve or restore damaged cartilage in the ankle joint, which can help prevent further deterioration of the cartilage and to prevent subsequent osteoarthritis.
- Promoting Healing : Certain surgical procedures, such as microfracture, cartilage transplantation, or tissue grafting, can help stimulate the growth of new cartilage tissue in the injured area, thereby promoting healing of ankle osteochondritis .
- Ankle Stabilization : In cases where ankle osteochondritis is associated with joint instability or concomitant injuries, surgery may be necessary to stabilize the ankle and restore normal function to the joint.
- Prevention of long-term complications : Untreated or poorly managed ankle osteochondritis can lead to long-term complications, such as joint degeneration, osteoarthritis, or loss of mobility. Early surgical intervention can help prevent these complications and improve long-term outcomes.
It is important to note that the decision to opt for surgery to treat osteochondritis of the ankle will depend on several factors, including the severity of the injury, the age and general health of the patient, as well as their functional goals and activity level. It is recommended to discuss treatment options with a qualified healthcare professional to determine the best approach for each specific case.
DEFINITION OF OSTEOCHONDRITIS
Osteochondritis can be operated on by different procedures.
First of all, there is arthroscopic curettage by arthroscopy.
This is the most used method. The operation can also be carried out using a method called « mosaicplasty », which is an osteocartilaginous graft generally taken from the patient’s knee to be implanted in the ankle area.
However, surgeons tend to favor arthroscopy because it is a minimally invasive procedure, less uncomfortable for the patient and allows for faster healing.
Arthroscopy is a procedure during which the surgeon makes two small incisions in the ankle, one to pass surgical instruments and the other to pass optical instruments such as a mini camera, in order to visualize the joint from the inside. . During the procedure, the surgeon cleans the inside of the joint and planes the bony beaks present.
But he also carries out a complete inspection of the joint to check the condition of the cartilage and ligaments. The patient is hospitalized for 48 hours in most cases, and the operation is carried out under regional or general anesthesia. The anesthesia performed depends on the overall state of health of the patient.
POST-OPERATIVE REHABILITATION AND RESUMPTION TO ACTIVITIES
The ankle operation can be done on an outpatient basis or with hospitalization for two to three days depending on the patient’s state of health.
The patient can get up the day after the operation using canes or crutches.
After surgery for osteochondritis of the ankle, the patient can leave the hospital after two days but must keep the ankle in a splint in order to maintain it and not weaken it.
When the splint is removed, the patient can in certain cases lean on his ankle and begin his rehabilitation, but in general, weight bearing is not recommended for around twenty days. Rehabilitation begins between the 5th and 10th day after the operation.
Doctors estimate that it takes around ten rehabilitation sessions, fifteen in some cases, for the patient to be able to use their ankle again in good conditions and without pain.
Physical and professional activities can be resumed gradually and with the doctor’s agreement approximately three weeks after the operation. Control x-rays must subsequently be taken to ensure the good condition of the joint.
RISKS AND COMPLICATIONS OF ARTHROSCOPY
Most surgeries carry risks and complications.
These risks depend on different factors, but also on the state of health of the patient. Concerning arthroscopy, the formation of a hematoma can be one of these complications.
It resolves on its own or can be subject to a puncture to evacuate it.
Likewise, phlebitis can occur despite taking anticoagulants. Phlebitis is characterized by the presence of a blood clot that has formed in a vein in the legs and can lead to a pulmonary embolism.
This is a possible complication that is closely monitored. Infection of the ankle, and even sometimes distant parts of the joint such as infection of the teeth, can occur, and may require further intervention.
Among the long list of possible complications, we must also note the appearance of new stiffness, slow healing, algodystrophy or even the continued degradation of the cartilage despite the operation.
EXPECTED RESULTS OF THE OPERATION
The aim of the operation is to stimulate the regrowth of the cartilage and to reduce or even stop the pain felt by the patient on a daily basis. In 80% of operated cases, it allows a rapid return to sporting activity, even for high-level athletes, and in all cases, this operation improves the patient’s life.
