The osteochondral or cartilagineous lesion is one of the pathologies which are more commonly attributable to a cartilage trauma.

The person affected by this pathology shows pain in the ankle area or, more generally, in the involved joint. Usually, the irritation is more acutely felt while walking or standing up, but symptoms can also appear at rest. Swelling and decrease in movement are also other symptoms which are often reported, even if they are not directly linked to the lesion location.

The patient sometimes struggles with associating the outbreak symptoms to a damage previously caused by a blow or an impact. Instead, the osteochondral lesion matter is strictly linked to traumas and instability (ligamentous lesions).

Diagnosis of cartilagineous lesions

usuelli-cartilagineous-lesion-diagnosis

A specialized medical examination is surely the first, and more recommended, therapeutic measure to take.

Where a osteochondral lesion is presumed, the path I recommend expects: first of all, an accurate study of the lesion biology through magnetic resonance, in order to verify the entity of the bone edema. Secondly, a CAT scan to understand the actual dimensions of the possible lesion which are often overestimated with the magnetic resonance. Lastly, an x-ray, with the loaded foot, in order to study possible not-diagnosed axial deviations of the hindfoot or the ankle, which can cause an overload right on the lesioned area, and therefore compromise the final result of the therapy.

How can a cartilagineous lesion be treated

usuelli-cartilagineous-lesion-cure

Once a symptomatic osteochondral lesion is diagnosed, the main aim is to reduce the spongiosa edema, that is the area of pain around the actual lesion. In the first place, resorting to physical therapies can be helpful: these can activate the healing process by stimulating the microcirculation and the bone metabolism.

It becomes necessary resorting to surgery when the symptoms persists, despite the physical therapies, or whether the lesion presents such characteristics of instability that can entail a risk of a further increase in its own dimensions.

Still today, the choice of micro or nano-perforations is called “gold standard”.

AMIC and MAST techniques

Over time, people have developed various techniques, most commonly identified with the acronyms ACI and MACI, up to the two most innovative ones to date: AMIC and MAST. These latter two consist in inserting a piece of paper between the joints, with such a pattern that it eases an orderly cellular proliferation. Nevertheless, this kind of intervention has shown a limit which is linked to the usage of an open surgery approach.

Considering the limits of AMIC and MAST, I started to develop an innovative surgical practice which allows the total execution of AMIC via arthroscopy, while considerably reducing invasivity and the period of recovery. But there’s still a long way to go. For this reason too, I supported Camilla Maccario’s fellowship – a specializing doctor in my team, at Baltimora J. Hopkins University – in order to conduct a study on certain therapies which allow the employment of a young cartilage donor instead of the artificial piece of paper.

Return to “the field”

usuelli-cartilagineous-lesion-runners

The patient’s, mostly an athlete’s, most common question is: “when will I be able to return to the field?”

After the surgery, one is usually dismissed with a bandage and the recommendation that he/she should abstain from moving the ankle as much as possible, in order to avoid the mobilisation of what it has been positioned in the operated joint.

Starting from the 15th day, physiotherapy and water gymnastics (Hydrokinesitherapy) will commence, in order to regain the confidence with the load of an erect posture.

The recovery of a full load graudually starts from the fourth week, to finish it over the course of 3/6 months.

The return to driving will be granted after 4 weeks; a cautious and gradual restart of the running activity will be generally permitted after 3 months since the intervention; sport activities and high solicitation to the ankle after 6 months.

The research

My dedication to the prevention and the enhancement of the surgery for the treatment of cartilagineous pathologies is the aim of a daily study and research. To deepen these themes and value my commitment in the worldwide developement of innovations, I invite you to visit the “blog” section.