Our step-daughter is only 14 but she plays sports pretty intensely and now has a big hole in the cartilage of her right ankle. Since she's a right-legged soccer player, this is a bad injury for her. The surgeon says she might be able to lay off from sports, rest awhile and recover nicely. Is there any way to know for sure that this is the best way to handle this type of injury?
It sounds like your daughter may have an osteochondral lesion (OCL) of the ankle. The term osteochondral tells us that the joint cartilage (chondral) and bone (oste) underneath have been damaged.
Mild lesions cause a fissure or crack in the cartilage. With some of the more severe osteochondral lesions (OCLs), there is a piece of cartilage with the bone still attached. That fragment can become loose in the joint causing further problems.
Ankle sprains are the most common cause of osteochondral lesions. Sports athletes are affected most often. But anyone who injures the ankle or develops bone chips or fragments for any reason can develop debilitating osteochondral lesions.
Most people who are diagnosed with osteochondral lesions report ankle pain, swelling, stiffness, and weakness. There is often a history of repeated jumping, prolonged running, or other high impact activities. Many of the athletes describe frequent episodes of the ankle giving out from underneath them. This is a sign of ankle instability.
Children with mild-to-moderate osteochondral lesions seem to be able to heal spontaneously when given time and a little protection to the joint. An ankle brace, splint, or sometimes cast is used to keep the area quiet and free of movement that can create continued microtrauma to the defect. Antiinflammatory medications may be used as well. Adults are more likely to need surgery to pin the fragment in place until healing can occur. Other, more extensive procedures may be needed when the fragment has become displaced and a gaping hole is left in the joint.
Children and teens are encouraged to follow their surgeon's advice very carefully in order to get the best results possible. Compliance with protected weight-bearing is especially important to give the area a chance to heal. This particular area of the anatomy (cartilage) doesn't have a very good blood supply, so healing with new tissue needs all the help it can get.
Padhraig F. O'Loughlin, MD, et al. Current Concepts in the Diagnosis and Treatment of Osteochondral Lesions of the Ankle. In The American Journal of Sports Medicine. February 2010. Vol. 38. No. 2. Pp. 392-404.
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