Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2010

Open Access 01-05-2010 | Ankle

Osteochondral defects in the ankle: why painful?

Authors: C. Niek van Dijk, Mikel L. Reilingh, Maartje Zengerink, Christiaan J. A. van Bergen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2010

Login to get access

Abstract

Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. The ankle joint has a high congruency. During loading, compressed cartilage forces its water into the microfractured subchondral bone, leading to a localized high increased flow and pressure of fluid in the subchondral bone. This will result in local osteolysis and can explain the slow development of a subchondral cyst. The pain does not arise from the cartilage lesion, but is most probably caused by repetitive high fluid pressure during walking, which results in stimulation of the highly innervated subchondral bone underneath the cartilage defect. Understanding the natural history of osteochondral defects could lead to the development of strategies for preventing progressive joint damage.
Literature
1.
Anderson DV, Lyne ED (1984) Osteochondritis dissecans of the talus: case report on two family members. J Pediatr Orthop 4:356–357PubMed
2.
Aspenberg P, Van der Vis H (1998) Migration, particles, and fluid pressure. A discussion of causes of prosthetic loosening. Clin Orthop Relat Res 352:75–80CrossRefPubMed
3.
Astrand J, Skripitz R, Skoglund B, Aspenberg P (2003) A rat model for testing pharmacologic treatments of pressure-related bone loss. Clin Orthop Relat Res 409:296–305CrossRefPubMed
4.
Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41-A:988–1020PubMed
5.
Braune W, Fischer O (1891) Die Bewegungen des Kniegelenks nach einer neuen Methode am lebenden Menschen gemessen. S Hirzel, Leipzig, pp 75–150
6.
Bretlau T, Tuxoe J, Larsen L, Jorgensen U, Thomsen HS, Lausten GS (2002) Bone bruise in the acutely injured knee. Knee Surg Sports Traumatol Arthrosc 10:96–101CrossRefPubMed
7.
Bruns J, Rosenbach B (1990) Pressure distribution at the ankle joint. Clin Biomech 5:153–161CrossRef
8.
9.
Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 47:487–504PubMed
10.
Bunger C, Harving S, Hjermind J, Bunger EH (1983) Relationship between intraosseous pressures and intra-articular pressure in arthritis of the knee. An experimental study in immature dogs. Acta Orthop Scand 54:188–193PubMed
11.
Canale ST, Belding RH (1980) Osteochondral lesions of the talus. J Bone Joint Surg Am 62:97–102PubMed
12.
Chen DS, Wertheimer SJ (1992) Centrally located osteochondral fracture of the talus. J Foot Surg 31:134–140PubMed
13.
Davies NH, Niall D, King LJ, Lavelle J, Healy JC (2004) Magnetic resonance imaging of bone bruising in the acutely injured knee–short-term outcome. Clin Radiol 59:439–445CrossRefPubMed
14.
Durr HD, Martin H, Pellengahr C, Schlemmer M, Maier M, Jansson V (2004) The cause of subchondral bone cysts in osteoarthrosis: a finite element analysis. Acta Orthop Scand 75:554–558PubMed
15.
Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM (2007) Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 28:154–161CrossRefPubMed
16.
Erban WK, Kolberg K (1981) Simultaneous mirror image osteochondrosis dissecans in identical twins. Rofo 135:357PubMed
17.
Ferkel RD, Scranton PE Jr (1993) Arthroscopy of the ankle and foot. J Bone Joint Surg Am 75:1233–1242PubMed
18.
Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR et al (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36:1750–1762CrossRefPubMed
19.
Flick AB, Gould N (1985) Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle 5:165–185PubMed
20.
Frenkel SR, Di Cesare PE (1999) Degradation and repair of articular cartilage. Front Biosci 4:671–685CrossRef
21.
Goddard NJ, Gosling PT (1988) Intra-articular fluid pressure and pain in osteoarthritis of the hip. J Bone Joint Surg Br 70:52–55PubMed
22.
Herberhold C, Faber S, Stammberger T, Steinlechner M, Putz R, Englmeier KH et al (1999) In situ measurement of articular cartilage deformation in intact femoropatellar joints under static loading. J Biomech 32:1287–1295CrossRefPubMed
23.
Hermanson E, Ferkel RD (2009) Bilateral osteochondral lesions of the talus. Foot Ankle Int 30:723–727CrossRefPubMed
24.
Irie K, Hara-Irie F, Ozawa H, Yajima T (2002) Calcitonin gene-related peptide (CGRP)-containing nerve fibers in bone tissue and their involvement in bone remodeling. Microsc Res Tech 58:85–90CrossRefPubMed
25.
Johansson L, Edlund U, Fahlgren A, Aspenberg P (2009) Bone resorption induced by fluid flow. J Biomech Eng 131:094505CrossRefPubMed
26.
Joy G, Patzakis MJ, Harvey JP Jr (1974) Precise evaluation of the reduction of severe ankle fractures. J Bone Joint Surg Am 56:979–993PubMed
27.
Junqueira L, Carneiro J, Kelly R (2007) Kraakbeen. In: Functionele Histologie, 11th edn. Elsevier, Maarssen, pp 140–147
28.
Kiaer T, Pedersen NW, Kristensen KD, Starklint H (1990) Intra-osseous pressure and oxygen tension in avascular necrosis and osteoarthritis of the hip. J Bone Joint Surg Br 72:1023–1030PubMed
29.
Koch S, Kampen WU, Laprell H (1997) Cartilage and bone morphology in osteochondritis dissecans. Knee Surg Sports Traumatol Arthrosc 5:42–45CrossRefPubMed
30.
Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236CrossRefPubMed
31.
Lassus J, Salo J, Jiranek WA, Santavirta S, Nevalainen J, Matucci-Cerinic M et al (1998) Macrophage activation results in bone resorption. Clin Orthop Relat Res 352:7–15CrossRefPubMed
32.
Lloyd J, Elsayed S, Hariharan K, Tanaka H (2006) Revisiting the concept of talar shift in ankle fractures. Foot Ankle Int 27:793–796PubMed
33.
Mach DB, Rogers SD, Sabino MC, Luger NM, Schwei MJ, Pomonis JD et al (2002) Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience 113:155–166CrossRefPubMed
34.
Maroudas A, Schneiderman R (1987) “Free” and “exchangeable” or “trapped” and “non-exchangeable” water in cartilage. J Orthop Res 5:133–138CrossRefPubMed
35.
Messner K (1993) Hydroxylapatite supported Dacron plugs for repair of isolated full-thickness osteochondral defects of the rabbit femoral condyle: mechanical and histological evaluations from 6 to 48 weeks. J Biomed Mater Res 27:1527–1532CrossRefPubMed
36.
Millington S, Grabner M, Wozelka R, Hurwitz S, Crandall J (2007) A stereophotographic study of ankle joint contact area. J Orthop Res 25:1465–1473CrossRefPubMed
37.
Mow VC, Flatow EL, Ateshian GA (2000) Biomechanics. In: Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, 2nd edn. American Academy of Orthopaedic Surgeons, Rosemont, pp 133–180
38.
Nakamae A, Engebretsen L, Bahr R, Krosshaug T, Ochi M (2006) Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc 14:1252–1258CrossRefPubMed
39.
40.
Qiu YS, Shahgaldi BF, Revell WJ, Heatley FW (2003) Observations of subchondral plate advancement during osteochondral repair: a histomorphometric and mechanical study in the rabbit femoral condyle. Osteoarthritis Cartilage 11:810–820CrossRefPubMed
41.
Quinn TM, Allen RG, Schalet BJ, Perumbuli P, Hunziker EB (2001) Matrix and cell injury due to sub-impact loading of adult bovine articular cartilage explants: effects of strain rate and peak stress. J Orthop Res 19:242–249CrossRefPubMed
42.
43.
Radin EL, Rose RM (1986) Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res 213:34–40PubMed
44.
Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58:356–357PubMed
45.
Rangger C, Kathrein A, Freund MC, Klestil T, Kreczy A (1998) Bone bruise of the knee: histology and cryosections in 5 cases. Acta Orthop Scand 69:291–294PubMedCrossRef
46.
Ray R, Coughlin E (1947) Osteochondritis dissecans of the talus. J Bone Joint Surg 29:697–706PubMed
47.
Reilingh ML, van Bergen CJ, van Dijk CN (2009) Diagnosis and treatment of osteochondral defects of the ankle. South Afr Orthop J 8:44–50
48.
Roemer FW, Bohndorf K (2002) Long-term osseous sequelae after acute trauma of the knee joint evaluated by MRI. Skeletal Radiol 31:615–623CrossRefPubMed
49.
Saxler G, Loer F, Skumavc M, Pfortner J, Hanesch U (2007) Localization of SP- and CGRP-immunopositive nerve fibers in the hip joint of patients with painful osteoarthritis and of patients with painless failed total hip arthroplasties. Eur J Pain 11:67–74CrossRefPubMed
50.
Schachter AK, Chen AL, Reddy PD, Tejwani NC (2005) Osteochondral lesions of the talus. J Am Acad Orthop Surg 13:152–158PubMed
51.
Schmalzried TP, Akizuki KH, Fedenko AN, Mirra J (1997) The role of access of joint fluid to bone in periarticular osteolysis. A report of four cases. J Bone Joint Surg Am 79:447–452PubMed
52.
Schuman L, Struijs PA, van Dijk CN (2002) Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br 84:364–368CrossRefPubMed
53.
Scranton PE Jr, McDermott JE (2001) Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. Foot Ankle Int 22:380–384PubMed
54.
Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 75:532–553PubMed
55.
Shepherd DE, Seedhom BB (1999) Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis 58:27–34CrossRefPubMed
56.
Simon WH, Friedenberg S, Richardson S (1973) Joint congruence. A correlation of joint congruence and thickness of articular cartilage in dogs. J Bone Joint Surg Am 55:1614–1620PubMed
57.
Specchiulli F, Capocasale N, Laforgia R, Solarino GB (1987) The surgical treatment of idiopathic osteonecrosis of the femoral head. Ital J Orthop Traumatol 13:345–351PubMed
58.
Stone JW (1996) Osteochondral lesions of the talar dome. J Am Acad Orthop Surg 4:63–73PubMed
59.
Sugimoto K, Takakura Y, Tohno Y, Kumai T, Kawate K, Kadono K (2005) Cartilage thickness of the talar dome. Arthroscopy 21:401–404PubMedCrossRef
60.
Tarr RR, Resnick CT, Wagner KS, Sarmiento A (1985) Changes in tibiotalar joint contact areas following experimentally induced tibial angular deformities. Clin Orthop Relat Res 199:72–80PubMed
61.
Thordarson DB, Motamed S, Hedman T, Ebramzadeh E, Bakshian S (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79:1809–1815PubMed
62.
Torzilli PA, Grigiene R, Borrelli J Jr, Helfet DL (1999) Effect of impact load on articular cartilage: cell metabolism and viability, and matrix water content. J Biomech Eng 121:433–441CrossRefPubMed
63.
Uozumi H, Sugita T, Aizawa T, Takahashi A, Ohnuma M, Itoi E (2009) Histologic findings and possible causes of osteochondritis dissecans of the knee. Am J Sports Med 37:2003–2008CrossRefPubMed
64.
van der Vis HM, Aspenberg P, Marti RK, Tigchelaar W, Van Noorden CJ (1998) Fluid pressure causes bone resorption in a rabbit model of prosthetic loosening. Clin Orthop Relat Res 350:201–208PubMed
65.
Vellet AD, Marks PH, Fowler PJ, Munro TG (1991) Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology 178:271–276PubMed
66.
Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 8:233–242CrossRefPubMed
67.
Wan L, de Asla RJ, Rubash HE, Li G (2008) In vivo cartilage contact deformation of human ankle joints under full body weight. J Orthop Res 26:1081–1089CrossRefPubMed
68.
Woods K, Harris I (1995) Osteochondritis dissecans of the talus in identical twins. J Bone Joint Surg Br 77:331PubMed
69.
Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 82:858–866CrossRefPubMed
70.
Zengerink M, Struijs PA, Tol JL, van Dijk CN (2009) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-009-0942-6
Metadata
Title
Osteochondral defects in the ankle: why painful?
Authors
C. Niek van Dijk
Mikel L. Reilingh
Maartje Zengerink
Christiaan J. A. van Bergen
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2010
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1064-x

Other articles of this Issue 5/2010

Knee Surgery, Sports Traumatology, Arthroscopy 5/2010 Go to the issue

Ankle

The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications

Hip

An unusual case of enthesophyte formation following an adductor longus rupture in a high-level athlete

Ankle

Difference in balance measures between patients with chronic ankle instability and patients after an acute ankle inversion trauma

Ankle

Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up

Ankle

Endoscopic resection of a calcaneonavicular coalition

Ankle

The relation between geometry and function of the ankle joint complex: a biomechanical review