Osteochondral or cartilage lesion
The osteochondral or cartilage lesion is one of the most common diseases caused by a trauma of the cartilage.
About osteochondral lesion
The cartilage is the delicate tissue that connects the joints to our bones. It located where those are articulated. It has biomechanical and histological features that vary from joint to joint. For example, the cartilage of the knee is different from that of the ankle and cannot replace it with the same effectiveness, and vice versa.
It is a non-vascularised tissue, rich in water, whose density varies according to the presence of hyaluronic acid and other glycosaminoglycans that the chondrocytes (producing cells) generate, settle and metabolise.
The cartilage lesions may be limited to the tissue itself or involve the underlying cancellous bone, leading to what is called osteochondral lesion, often associated with bone oedema surrounding the lesion area, which, in most cases, is responsible for the pain.
These lesions are usually of post-traumatic origin, even if it is their chronic symptoms to determine the consequent use of physiotherapy or even surgery.
People with this condition have pain in the ankle or, more generally, in the affected joint. Usually pain is perceived more acutely in weight-bearing, i.e. walking or standing, but the symptoms can sometimes occur at rest.
Swelling and a decreased motion are other symptoms that are often present even though they are not directly correlated to the site of the lesion.
The patient sometimes struggles to associate the onset of symptoms to a damage caused by previous stroke or shock, while the story of osteochondral lesions is closely related to trauma and instability (ligament injuries).
A medical examination is definitely the first and most recommended therapeutic step to take.
When an osteochondral lesion is assumed, the path I suggest to follow includes: first, a careful study of the biology of the lesion by MRI (magnetic resonance imaging), to ascertain the extent of bone oedema.
Finally, a weight-bearing X-ray to study what is called biomechanics of the lesion.
I also recommend this exam, as an undiagnosed axis deviation of the hind foot or ankle can overload the damaged area, compromising the final result of the therapy.
How to cure it
Once a symptomatic osteochondral lesion is diagnosed, it is very important to reduce the cancellous bone oedema, which is the suffering area around the lesion itself. In the first instance, to take effective action on this issue, of physical therapies are recommended as this stimulates microcirculation and bone metabolism, activate the healing processes.
For this purpose, nowadays, the magnetic therapy and Tecar therapy are widely used. The latter represents a significant step forward in physiotherapy.
With this innovative technique you can get relatively and quickly reduce the perilesional oedema and a simultaneous stimulation of peritendinous microcirculation.
It is necessary to resort to surgery when symptoms persist, despite physical therapies, or if the lesion has characteristics of instability that would result in a risk of further increasing in size.
Even today it is considered “gold standard” the choice of micro-perforations or nano-perforations. It is a minimally invasive treatment, completely arthroscopic, effective in controlling symptoms for a medium long time period (hardly more than 5/6 years after surgery), but not able to regenerate the original cartilage.
Alternatively, recently new surgical procedures were born in an attempt to regenerate this valuable tissue. Over time we have developed techniques commonly indicated with the acronyms ACI and MACI, and the two most innovative techniques practiced today: AMIC and MAST. The latter consist in the insertion of a membrane between the joints with a weave that facilitates ordered cell proliferation. This type of operation is limited with the use of an open surgery.
Considering the limits of AMIC and MAST, I started to develop an innovative surgical practice that allows the total execution of the AMIC arthroscopically, reducing considerably the invasiveness and recovery times.
This year, at the World Congress of Foot and Ankle Surgery of Chicago, I introduced the encouraging preliminary results of my research, arousing great interest especially in the American colleagues who have not mastered yet the execution of this technique yet.
But the road is still long. This is also why I promoted the fellowship of Dr. Camilla Maccario, a graduate of my team, at the J. Hopkins University in Baltimore, to conduct studies of therapies, involving the use of a young donor cartilage instead of the artificial membrane.
Assessed the need to proceed to the cartilage regeneration with the AMIC technique, once the date of an operation has been set, there will be a pre-admission for the usual routine tests and for an interview with the anaesthesiologist.
Hospitalisation will follow. You enter the hospital on the day of surgery and will be discharged the morning after or a few days later, depending on the evaluation of the general conditions.
Back in the game
The most frequently asked question by a patient after cartilage surgery, and even more of a sportsman, is: When will I be able to get back to my normal activities?
After surgery you are usually discharged with a bandage and with the advice to avoid the movement of the ankle as much possible, to prevent the mobilization of what was inserted in the operated joint.
From day 15 physiotherapy and water gymnastics (Hydrokinesitherapy) will begin, to help restore the patient’s mobility with the load being in upright position. The recovery of the full load will gradually begin from the fourth week to end within 3/6 months.
The return to driving will be possible after 4 weeks; a cautious and gradual return to running on even ground will be generally possible 3 months after surgery; sports activities can stress the ankle after 6 months.
Nowadays, it is important to consider that you will not suffer symptoms related to the disease after only three weeks after surgery, and the priority is to avoid mechanical stresses that could compromise the quality of cartilage repair.
My involvement in the prevention and improvement of surgery for the treatment of cartilage diseases is the subject of daily study and research.
To investigate these issues and appreciate my commitment to the international development of innovations, please visit the “blog” section.