Avascular osteochondral necrosis
This disease involves a fragment of bone near the joint surface separating together with the articular cartilage covering it
Avascular, separating osteochondral necrosis develops because of impaired blood supply resulting from injury, joint overload or developmental vascular abnormalities
In adults, it often requires arthroscopy of the joint
Using an appropriate cartilage-repair technique makes it possible to save the joint.
01
Symptoms
- pain in the ‘middle of the joint’
- swelling
- These symptoms gradually worsen, making everyday activities impossible
02
Diagnostics
- The basis of the diagnosis is a standard X-ray taken in 2 projections
- A standing computed tomography scan
- Magnetic resonance imaging (MRI) is particularly useful when planning the procedure
03
Treatment
- Most children and adolescents can be treated successfully without surgery. This treatment consists of periodic immobilization of the limb and modification of physical activity.
- Surgical treatment is the treatment of choice for adults and for children and adolescents when conservative treatment fails or the disease is advanced. The procedure uses an arthroscopic technique. It simulates the process of the separated fragment healing in and fixes it in place. Sometimes articular-cartilage defects require osteochondral grafts or biomaterials soaked in platelet-rich plasma.
04
Postoperative management
- In most cases, patients can leave the hospital as early as the second or third day after arthroscopic treatment of focal, separating osteochondral necrosis.
- For approximately 6 weeks, they usually walk on elbow crutches while protecting the operated ankle joint.
- The operated limb is fitted with an ankle orthosis for approximately 6 weeks.
- Thrombosis prevention is necessary during the period of immobilization in the orthosis.
- Patients discharged home learn the basic ways to manage postoperative swelling.
- After the procedure, patients undergo rehabilitation treatments.
