Gelenk-Klinik Dr. Baum - Arthrosebehandlung

There are different types of cartilage tissue differed. The articular cartilage of the ankle consists of so-called hyaline cartilage. It covers all the movable portions of the ankle bone, he serves as a sliding and as a major shock.
The cartilage tissue is made of cartilage cells (chondrocytes) and intermediate cell substance (matrix) structure. The cartilage is adapted to specific functions. He directs the pressure to the adjacent bones on. This feature allows the cartilage by collagen fibers and by so-called Proteoglykane in the intermediate cell substance meet.

What is a cartilage damage at the upper ankle?

The destruction of cartilage in the upper ankle joint cartilage damage, we call
The cartilage damage at the upper ankle joint is different than hip or knee often through an injury.
The cartilage damage itself is not designated as osteoarthritis, but due to a cartilage injury may be arthritis of the ankle emerge.
The damage to the cartilage requires a causal therapy. For example, by abnormal, multi-movement (instability) to a continuous deterioration of the cartilage condition come. Only if these causes are detected, a hilfreicht Therapiestategie developed.

How can a cartilage damage at the top of the ankle?

• Cartilage damage after accident with so-called fracture osteochondralen
• Bone spur on the anterior edge of tibia

Under a Umknickens of the ankle to the outside world, a so-called Supinationstraumas cartilage can lead to injury. This ankle injury occur massive shear (force perpendicular to the cartilage surface) at the outer anklebone on cartilage. The cartilage on the inside of the ankle is a maximum compressed (compression strength). This pressure on the cartilage it may be at this point to injuries of the bone beneath the cartilage come. This leads to the smallest bones beneath the cartilage (subchondral micro-fractures). These injuries can be, if in violation of a multi-movement in the upper or lower ankle joint (instability of the ankle) remains, to a so-called lesion osteochondralen lead. It heals the breach in the cartilage does not suffice, it forms a scar between the bone and the bone-cartilage moving piece.
The release of that damage is comparable to a fallen apple. By the fall, the tougher outer skin of the apple intact, the underlying supportive apple flesh collapses. Depending on the energy upon impact, the skin may also break. This damage corresponds to the accident-related damage to the cartilage in the ankle.
Another mechanism is the damage to the cartilage by bone anklebone Addition (Osteophyten) at the front edge of the tibia (anterior-lane syndrome, Impingement of the upper ankle) responsible.
This preference for football players and athletes extreme damage is occurring, because the bone spur with a high friction on the cartilage and grind this hurts.
Non-accidental cartilage damage is a rare cause.

How is cartilage damage to the ankle divided?

The classification of cartilage damage, commonly referred to Outerbridge from stage 0 to 4

• Grade 0 cartilage damage to the ankle: normal findings, cartilage is smooth shiny when assessing the Tasthacken he is stable.
• Grade 1 cartilage damage to the ankle: The cartilage is smooth preserved in print but softens.
• Grade 2 cartilage damage to the ankle: The cartilage is superficial aufgefasert
• Grade 3 cartilage damage to the ankle: The cartilage is torn down to the underlying bone lamella.
• Grade 4 cartilage damage to the ankle: The loss of cartilage down to the bone.

How is the cartilage of the ankle structured?

Despite the high load on the articular cartilage at the upper ankle joint is especially in this articular cartilage thickness is very low. The composition of the cartilage is different than in other joints. The reason we know not yet. But the scientific evidence certainly important for an adequate therapy.
To understand the disease and the treatment of cartilage damage in the ankle is that it is in no cartilage or nerve cells, blood vessels there. The supply of nutrients to the cartilage cell needs are handled exclusively by diffusion. Diffusion has a nutrient transport through concentration differences. The nutrients come from a healthy ankle sufficiently out of the joint lining (synovia).
The articular cartilage is also supported by the transition between loading and discharge of the ankle feeds. The articular cartilage is like a sponge, wring out after re-absorbing liquid.

Can cartilage recover? Regenerates Cartilage?

The human organism has a limited ability for their own recreation or regeneration of cartilage tissue. This is not only in the ankle so, but in all Gelenkknorpeln of the body.
Depending on the age can cartilage cells in the tissue only about 4% to be renewed. This is a very small portion of cartilage cells divide in the ankle. An important objective of any therapy, it is the breakdown of cartilage cells, and thus the more damage to occur. Which then leads to a slow regeneration of cartilage.
Cartilage damage in the ankle joint is therefore also a serious therapeutic problem

What possibilities of conservative or non-operative therapy, there is cartilage damage in the upper ankle?

There are various approaches to conservative treatment of cartilage damage at the upper ankle joint.
Physiotherapy is part of the standard repertoire of the conservative therapy of cartilage defects of the upper ankle. The use and selection of treatment means based on empirical considerations and experiences. A specific proof of efficacy has not been led. Here are the symptoms of pain, irritable condition and limitation of ankle function specifically addressed.

It made subsequent measures.

• Pain Management
• Optimization of pressure conditions and avoid peak
• Improving the diffusion
• Drain

What are the surgical approaches to improve the cartilage structure there?

There are operational methods with a structural approach on the upper ankle joint. This is the structure or the structure of the cartilage in the ankle improved.

• Debridement of the cartilage (formerly often used)
• Lavage of the ankle (formerly often used)
• Knochenmarkstimmulation by drilling, abrasion, Mikrofrakturierung on ankle
• Cellular transplantation as autologous (own body) the cartilage-bone cylinders (OATS) Ankle
• Cellular transplantation as Autologous chondrocyte transplantation (ACT) at the ankle