Ankle cartilage injury

　　1, Etiology

　　Caused by intense exercise, excessive plantar flexion, dorsiflexion, and inversion of the ankle joint, causing soft tissue injury to the joint.

　　2, Pathogenesis

　　The ankle joint lacks muscle and fat protection, and the skin underneath is tendons and bones. When kicking the ball with the arch of the foot or supporting, the ankle joint overextends or hyperextends, causing the distal anterior and posterior margins of the tibia to repeatedly collide and compress with the talus neck or posterior joint tubercle. The tibio-talar joint surface is worn, and bone hyperplasia occurs at the anterior and posterior lips of the tibia, the talus neck, and the posterior process of the talus. When kicking the ball with the inside or outside of the foot, the ankle inversion and eversion can also cause local bone hyperplasia. Repeated sprains of the ankle joint can cause instability of the ankle joint, and the malalignment movement of the distal tibiofibular joint can also cause tibio-talar cartilage injury and local bone spur formation.

　　It can be complicated by ankle loose bodies. In the knee or elbow joints, the convex surface of certain pressure ossicles can undergo ischemic necrosis, peeling off, and floating in the joint, known as osteochondritis dissecans (joint loose bodies). In addition, metaplasia of the synovium on the loose bodies can form cartilage cells or bone cells that continue to grow. The movement of loose bodies within the joint is also called joint mice. If the loose bodies are locked between the joints, sudden severe pain may occur, and the joint cannot be moved. The operation should be performed to remove the loose bodies.

　　Pain and limited movement during ankle joint movement are the main symptoms of this disease. In the early stage, pain occurs during activity, and later, pain also occurs even when resting. The pain is mostly located in the front of the ankle. When kicking the ball with the arch of the foot, pain is produced by the impact and compression of the bony spur on the back of the ankle with soft tissue. During sprinting and jumping, pain is produced by the impact of the anterior tibial lip and the talus neck. With the growth of the bony spur, the thickening of the synovial sac and the formation of loose bodies, the limitation of joint movement becomes increasingly obvious, until the range of motion of the joint is significantly reduced.

　　Sometimes you can also feel the friction sound of the joint surface, mainly caused by rough joint surfaces and thick synovium or loose bodies.

　　The signs mainly include mild joint swelling, tenderness, friction, and friction sounds, narrowing of the joint space, and occasionally palpable loose bodies.

　　Strengthening the training of the muscles around the ankle joint, using elastic bandages or adhesives to wrap the injured area or during competitions to prevent excessive flexion and extension and inversion and eversion of the ankle joint, and to avoid repeated sprains, are effective preventive measures for football ankle. Pay attention to the protection of the affected area, avoid further injury. Do not lift heavy objects, do not stand for a long time, do not engage in剧烈 activities. Eat more nourishing foods, and regularly carry out radiographs of the affected area.

　　X-ray is the main means of diagnosing football ankle, showing the formation of bone spurs and osteophytes at the neck of the tibia and talus, posterior process of the talus, and elongation, the two ankles become pointed, sometimes showing the shadow of loose bodies, and the joint space becomes narrow.

　　Due to the long course of the disease, large ulceration surface, and long-term restriction of fish and meat foods, the body becomes malnourished and resistance decreases. Therefore, high-protein, high-vitamin, and easily digestible foods should be provided, including eggs, milk, fresh vegetables, fruits, and foods rich in collagen such as thick chicken soup. Spicy and刺激性 foods should be avoided, and smoking and drinking should be quit.

　　I. Treatment

　　I. Conservative treatment:Including external application of ankle supports, various ointments, ultrashort wave therapy, fumigation treatment, vinegar therapy or iontophoresis, intra-articular or local analgesic injection.

　　II. Surgical treatment:Surgical treatment can be considered for those with excessive osteophytes, loose bodies within the joint, or reduced joint space, and recurrent locking of the ankle joint. According to the location of the lesion, an anterior and medial, anterior and lateral, or posterior incision of the ankle joint is chosen, and the osteophytes are removed, and the residual bed is electrocoagulated to prevent the regeneration of osteophytes. Generally, there are varying numbers of loose bodies within the joint, which should be carefully removed and the joint cavity washed repeatedly with saline. The general postoperative effect is good, and training can be resumed about 3 months later.

　　II. Prognosis

　　Generally, the prognosis is good.