Articular cartilage repair strategies in the ankle joint

Abstract

Osteochondral lesions of the talus represent a significant source of disability to those affected. An understanding of the common mechanisms of injury and a high index of suspicion leads to early diagnosis and treatment. Most osteochondral lesions are a sequel of trauma; the exact etiology of others is unclear and may be multifactorial and related to microtrauma, genetic predisposition, or metabolic factors. Definitive imaging of osteochondral lesions consists of imaging with magnetic resonance, which is useful for qualitative analysis of the bony changes and the condition of the overlying cartilage. Just over half of patients with symptomatic osteochondral lesions of the talus will improve with nonoperative treatment. Failure of conservative therapy mandates operative treatment; surgical options include arthroscopy with debridement, drilling or microfracture of the lesion, mosaicplasty or osteochondral autografting, or autologous chondrocyte transplantation. The future for treating cartilage defects in the ankle is likely to involve implants that allow cartilage regrowth and are positioned by minimally invasive surgical techniques. © 2007 Humana Press Inc.