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Cartilage damage – when smooth movement is no longer possible

Cartilage damage (chondral lesions) is increasingly occurring in younger people. One reason for this is ankle joint injuries caused by sprains (distortion), the most common injuries of the lower extremities, and which may lead to ligament injuries and cartilage lesions. Around 50% of patients suffering from fractures of the ankle joint or ligament injuries show damage to cartilage and/or adjacent bone as a consequence.

Repeated injury, chronic tendon instability, and accompanying effects: their causes are as diverse as the problems generated by cartilage damage. In many cases, cartilage or cartilage-bone injuries don't spontaneously recover and, if not diagnosed and treated in time, can lead to ankle joint arthritis.

Cartilage-bone damage (osteochondral lesion) is also known as osteochondritis dissecans (OD). What causes OD is sometimes difficult to identify, though circulatory disorders in adjacent sections of bone are possible causal factors, as well as repeated small injuries and malposition.

Modern, precise diagnostic techniques with MRT and/or CT allow for early diagnosis and respective treatment.

What is cartilage?

Where they meet in a joint, human bones are covered in a layer of cartilage, which consists of smooth, firm and elastic tissue, ensuring (in combination with synovial fluid) optimal movement. Additionally, cartilage serves as a buffer, protecting joints and bones during strong movements.

Causes of cartilage damage

Damage to cartilage and the underlying supporting bone (subchondral zone) can occur for different reasons:

  • Ankle distortion: A twisted ankle causes a tilt in the ankle joint, bruising in the cartilage or a sprain of the joint edge, which can lead to permanent injuries such as a loose joint body and scar tissue.
  • Instabilities: Lax ligaments or poorly healed ligament rupture cause repeated tilting movements and overstressing of cartilage sections close to the edge. In the long run, this results in permanent cartilage damage.
  • Bone fractures: A fractured bone in the upper ankle joint not only causes osseous injury but also significantly damages the cartilage adjacent to the fracture line. In addition to the direct cartilage damage caused by accidents, poorly healed fractures with damage to the bone cause rapidly extended abrasion of cartilage tissue.
  • Malposition: An axis malposition of the leg or foot (deformity) can cause steady overload, leading to permanent damage of cartilage tissues in the upper ankle joint.
  • Disorders: Some pre-existing conditions, such as localized circulatory disorders of the joint, adjacent bone sections or metabolic disorders, can have a negative impact on the nourishment of the cartilage, thereby affecting joint function. Rheumatic diseases can also cause damage to the joint by degrading cartilage tissue.

Stages and treatment of cartilage damage

Treatment options for cartilage damage depend on the extent and causes of the injury, which is why proper diagnosis is an essential part of the treatment plan.

Cartilage damage (chondral lesions)

  • Stage 1: The cartilage tissue shows a rough surface.
  • Stage 2: The cartilage tissue shows crevices in the surface (up to 50% of cartilage diameter).
  • Stage 3: The cartilage shows deep crevices (over 50% cartilage diameter).
  • Stage 4: The cartilage shows a defect as crevices in the cartilage have broken through the bone section (subchondral bone). The bone has lost its protective cartilage layer.

Bone-cartilage damage (osteochondral lesions)

  • Stage 1: The cartilage-bone tissue area is softened but intact on the surface.
  • Stage 2: The cartilage-bone tissue area shows deep tears but is in part still attached to healthy tissue.
  • Stage 3: The cartilage-bone tissue area has come loose but is still in place.

  • Stage 4: The cartilage-bone tissue area is completely detached (free joint body / joint mouse), a cartilage-bone defect is apparent ("The mouse-bed is empty").
  • Stage 5: Wider softening of bones (cysts/defects), even of deep bone-layers, is apparent.

Experts for cartilage repair

For treating cartilage-bone-damage, you can place your trust in the thorough expertise of the capable team at Foot & Ankle Center Berlin. We provide you with an individualized plan of therapy, not only to directly treat the cartilage damage but also to permanently correct the causes of the impairment.

Get in contact with us today to book your examination and consultation appointment.