Arthritis of ankle is not common, but local cartilage disorders are more common in the ankle. In other words, calcification refers to a common problem in joint cartilage, whereas in local cartilage disorders there is a problem of about 1 cm in area. It is usually caused by the loss of the vitality of the bone tissue under the cartilage, that is, by necrosis. In an arthroscopic procedure, it is enough to stay only one night in the hospital. Nowadays arthroscopy is preferred in the treatment of these types of local problems, since it is usually possible to return to normal life without the need of plaster.
A case of interest abroad: There is also a local lesion in the cartilage as seen here. The patient also had nerve compression, also called “Tarsal Tunnel”, and pain in the back region of the ankle. At another center, this patient was offered open surgery by cutting the bone. We arthroscopically performed the arthroscopy from the anterior region of the ankle, not the front of the ankle, and relaxed the nerve that was stuck. We also shaved the cartilage lesion at the same session and made the patient return quickly to his daily life. She was a 45-year-old woman and had no complaints for following two years. Sometimes we can see larger cysts as seen here and we can also arthroscopically scrape off and fill it with bone graft (patch). Sometimes, the cartilage lesion, especially between the ages of 40-60, can extend 1.5 cm. Such cases do not benefit from arthroscopy, especially if there is no extensive arthritis in the joints in lesions exceeding 1.5 cm. In such cases, we prefer open surgery.
What we do in an open surgery? We reach the lesion by performing normal open surgery. Here are examples of different cases. We dig the lesion thoroughly first, empty the dead bone, and then fill the inside with the living bone tissue. We usually prefer to provide this live bone from the hip. We apply this technique because the healthiest bone is in the hips and the healing period is much faster. Then we cover the lesion with a special material instead of cartilage. We prefer to combine this substance with bone marrow aspiration that is rich of root cell which is usually obtained from the hip bone. If the patient is very young and the age of 18 years or younger, the piece of cartilage sometimes tears down traumatically. Instead of removing it and putting it in place, we can choose to fix it with a straight bolt. To sum up: we treat arthroscopic lesions smaller than 1.5 cm in the ankle, but we prefer open surgery in larger lesions.
One of the most frequently injured areas of our body are menisci. Menisci are the thin pads that are present in the knee region as ‘C’ at the intersection of the two largest bones. The movement of the load in the knee plays an important role, such as the ability to rotate in many directions, and to balance the power between the femur (thigh bone) and tibia.
Meniscus can be ruptured after the rotation of the knee in the contact sports like football, the folding in the sudden movements, the load on one knee. In sports, injuries to the injured frontal ligament (ACL) may also be accompanied. In the advanced age group, menisci can be torn due to degeneration and cartilage damage in the knee without any trauma.
Symptoms and Complaints
Sounds coming from inside your knee may be the first findings you ruptured. Until edema develops in the knee, athletes can continue to play or daily activities can be done. However, complaints arise when the edema develops. Complaints develop within 24-48 hours.
- Tension and swelling of the knee
- Decreased joint range of motion
- Effusion in the knee
- When a ruptured meniscus piece falls into the cavity the joint can be locked
- This can only be rectified by a maneuver only a doctor can do.
Tell your doctor how the problems began. Your doctor will examine your knee with various maneuvers. In addition, x-rays for diagnosis and MR for displaying menisci can be requested. Arthroscopic examination may be advised when the knee is locked. There are several types of meniscal tears.
- Vertical or bucket-handle-like tears,
- In young athletes, “radial” or “beak” type tears are formed after repeated traumas
- There may be horizontal or interior tears in the elderly due to cartilage degeneration.
Treatment of the menisci
The initial treatment of meniscal tears is abbreviated as RICE:
If the complaints such as knee locking and chronic complaints do not develop following this treatment, the treatment lasts and ends throughout the resting period. Only 1/3 of the menici (near the joint capsule) has blood circulation. In the ruptures in these regions, the menisci provides repair of the tears due to its own nutrition. In the 2/3 inner area there would be no complete repair. Yet there is no rule that every menisci that is damaged will give symptoms.
Surgical treatment should be planned when meniscus is not healed and complaints continue. Meniscal tears that cause complaints may lead to cartilage erosions and calcification in later stages. It is suggested that meniscal tears should be operated on young, active patients. Depending on the age of the patient, your doctor will plan the appropriate treatment, whether or not there is another type of accompanying pathology. Post-surgery rehabilitation is an important part of treatment.