An ankle sprain is a pretty common lesion: every day, in Italy, about 10.000 ankle sprains occur. It is a movement, most of the times, of foot and ankle inversion.

An ankle sprain should never be underestimated: on the contrary, it must always be evaluated carefully.

Although the patient is particularly focused on ligaments and their potential lesion, these ones, most of the times, do not represent the real problem.

Unlike knees, indeed, ankle ligaments are extra-articular. This means that if on one hand we have a greater fracture risk, especially of the Anterior Talofibular Ligament, on the other hand we have an almost-certainty that it can heal again, without any consequences.

Cartilage lesion: osteochondral lesion

The actual problem, though less known and therefore underestimated, is the osteochondral lesion, which can come after an ankle sprain. The osteochondral or cartilage lesion is one of the most common pathologies that can be linked to a cartilage trauma.

Cartilage

usuelli-Cartilage

Cartilage is the delicate tissue that covers our bones, placed where the latter organise themselves between each other: so, at joint level.

Cartilage has histologic and biomechanical characteristics which vary from joint to joint. For instance, knee cartilage is different from the ankle cartilage and it cannot be replaced with the same effectiveness, and vice versa.

It is a non-vascular tissue, rich in water, whose density varies according to the presence of hyaluronic acid and some other glycosaminoglycans which are created, deposited and metabolised by chondrocytes (the producer cells).

Cartilage lesions can be limited only to the different layers which cartilage is made up of, or they can involve the underlying spongy bone, by determining what is called osteochondral lesion.

An osteochondral lesion is sometimes associated with bone edema which surrounds the lesion area and, in most of the cases, is responsible for pain.

Usually, these lesions have a post-traumatic origin (typically, an ankle sprain or a chronic instability), even though it is their chronicization which determines symptomatology and the following need to resort to a physiotherapeutic treatment and, sometimes, surgery.

Symptomatology and diagnosis

The osteochondral lesion can affect every joint (especially those exposed to loading). Who suffers from this pathology shows the typical pain in ankles or, more generally, in the interested joint.

Usually, repercussions are more acutely perceived while walking or standing, but it is not rare to see a patient reporting a symptom at rest, too. Swelling and movement reduction are other symptoms which are sometimes reported even if not directly linked to the lesion location.

The patient sometimes struggles with associating the outbreak of symptomatology with a damage caused by a previous impact or sprain, even if the history of osteochondral lesions is strictly connected to trauma and instabilities (ligamentous lesions).

These lesions are usually emphasized at a later stage, far from the trigger event. It is important, for a correct evaluation, to ask for a Magnetic Resonance and a CAT scan as diagnostic tests, in order to determine the extension and the consequent seriousness, and to set up the most suitable treatment.