Cartilage damage in the ankle


Cartilage damage in the ankle is not uncommon, which is not surprising when you consider that the ankle has to bear the entire weight of our body day after day and is additionally stressed when standing and walking.

The cartilage tissue covers all bone parts within the ankle and thus serves practically as a shock absorber and a kind of sliding layer, since it is able to absorb and redirect pressure. As a result, damage to this cartilage leads to impaired functionality of the joint and also sometimes to pain, which, however, can also be absent because the cartilage tissue is poorly supplied with nerves.

Bald cartilage describes the condition when there is no more cartilage. For more information, read the article at: Bald cartilage - is it dangerous?

In order to better classify cartilage damage in the ankle, the classification is used Outerbridgein which the degrees 0 to 4 can be distinguished.

  • Grade 0: no existing cartilage damage;
  • Grade 1: the cartilage is completely preserved, but softens under pressure;
  • Grade 2: the cartilage is a little roughened on the surface;
  • Grade 3: the cartilage is torn down to the bone;
  • Grade 4: the cartilage is completely lost down to the bone

This damage itself is not referred to as osteoarthritis, but if left untreated, it can often lead to secondary osteoarthritis.

Cartilage damage using the knee as an example

Illustration of cartilage damage (construction diagram using the example of the knee joint - right knee from the front)
  1. Articular cartilage
    (hyaline cartilage) -
    Cartilago articularis
  2. Cartilage remodeling zone
    in bones -
    Zona ossificationis
  3. Joint body (articular gnar
    of the femur) -
    Femoral condyle
  4. Femur -
  5. Articular cartilage -
    Cartilago articularis
  6. Outer band -
    Ligamentum collaterale fibulare
  7. Outer meniscus -
    Lateral meniscus
  8. Inner meniscus -
    Meniscus medialis
  9. Fibula - Fibula
  10. Shin - Tibia

You can find an overview of all Dr-Gumpert images at: medical illustrations

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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Factors that cause cartilage damage in the Ankle joint favor are among others Obesity (since the joint is then permanently exposed to higher loads), Incorrect loads (for example with states like Articulated flat splayfoot) or long-term additional stress caused by certain sports such as Soccer or extreme sportswhich are also associated with an increased risk of injury.

In contrast to other joints, the cartilage damage in the ankle is mainly caused by Injuries. This is a typical trigger Twist of the ankle outwards (a so-called Supination trauma). This will make the cartilage extremely compressed on the inside of the ankle. Damage of various degrees can occur, from slight crushing to cracks in the cartilage, which in the worst case can be accompanied by detachment of cartilage tissue and / or bone fractures.

Also a Bone spur (Osteophyte) on the front of the tibia can damage this tissue by rubbing against the cartilage of the ankle. In addition, due to the increased pressure at this point, a so-called Impingement syndrome is triggered.


The problem with Cartilage damage is that the human body is only able to regenerate cartilage tissue to a very limited extent. This is because this type of tissue is not supplied by nerve cells and blood vessels, which are, however, of great importance for the healing process. One assumes that only about 4% of the cartilage cells can be renewed, which, however, sometimes dated Age depends. Most of the time, the damage will tend to increase rather than improve over time. For this reason, the aim of treatment is rather to prevent further damage from occurring.

Consequently, the treatment of cartilage damage in the ankle is not a simple matter and only possible to a very limited extent. First of all, it is important that everyone Risk factors be switched off or reduced as far as possible. Obesity should be reduced, stressful sports and other Overexertion should be avoided Underlying diseases or Misalignments of the foot should be eliminated. Also of great importance is the physical therapy, a conservative (non-operative) therapy. The principle of physiotherapy for cartilage damage in the ankle is to decongest the joint, to improve the diffusion conditions for the nutrients again and to minimize the functional restrictions by restoring normal pressure conditions.
Can accompany Painkiller and or Shoe insoles are used. If these measures are not sufficient to significantly improve the symptoms, there are various surgical options. There are options to irrigate the joint, to smooth the cartilage, to stiffen the joint, to remove damaged parts, to stimulate cartilage growth with the help of drilling or to transplant healthy cartilage tissue. In extreme cases, the implantation of a prosthesis to be necessary.

Op for cartilage damage in the ankle

In addition to a number of different conservative treatment methods, there are also surgical therapeutic measures that can be used for cartilage damage to the ankle. Whether an operation makes sense in individual cases depends on various factors. In addition to the respective cause, which is responsible for the cartilage damage in the ankle, factors such as age and the response to conservative treatment methods also determine the treatment recommendations of the treating doctor.

A surgical option to improve the healing of the articular cartilage and the symptoms of the affected person is to carry out a so-called debridement. In this case, structures that are foreign to the joint and are located in the joint space due to inflammation and damage to the cartilage are removed. The so-called Lavage in which the joint space is flushed with a fluid. Often both procedures are carried out at the same time.

In addition to these procedures that have been carried out for a long time, new procedures have recently come into use, which in many cases have been able to effectively prevent the cartilage damage from progressing. Because the body itself Not if the cartilage is able to rebuild, other ways must be found to form cartilage at the joint. By drilling or microfracturing the bone, it can be moved to build up the cartilage. Whether this measure has a chance of success must be decided on a case-by-case basis.

Another option is to carry out a cartilage cell transplant. Here, healthy cartilage cells are removed from the affected person and stimulated to multiply in the laboratory. As soon as enough material is available, the cartilage tissue can be transplanted into the damaged area at the ankle.

In the case of cartilage-bone transplantation (OATS) it is also the transplantation of cartilage tissue with the difference that the transplanted cartilage is removed together with a piece of bone and inserted into the damaged cartilage.
This greatly increases the success rate, since the transplantation of cartilage tissue itself is very difficult. The disadvantage of this operation is the need to remove healthy cartilage from another part of the body. Care is taken to ensure that cartilage material is removed from places where there is only little stress on the joints.

Ankle cartilage damage and exercise

Cartilage damage in the ankle can develop in a number of different ways.

Damage is often caused by an injury. Especially the "twisting / ligament stretching" inwards of the foot, also called suppination trauma, very often leads to cartilage damage of the ankle.
For this reason, doing certain sports is particularly predestined for the development of cartilage damage.This generally includes all sports with a high running quota such as football, basketball, handball or jogging. In sports such as basketball, there is also the fact that sudden stopping movements make it easier to twist the foot.

If there is cartilage damage, it should be treated if possible.
Continuing to run the sports at high speed can lead to osteoarthritis of the joint and thus widen the cartilage damage. Carrying out a cartilage transplant on the ankle should therefore be considered, especially in young and sporty patients.

Read also the topic: Cartilage flake