Cartilage injury - talar dome

[u1990]

I posted a reply to Zak, when really I should have asked the question here, I think. Sorry - I'm a new user.

I have had an arthroscopy on my right ankle (Nov 02). They removed two floating pieces of bone/cartilage/inflammation out of the front of my ankle joint, and said while they were in there, they also had to shave off a layer of the cartilage from the talar dome, where it meets the fibia (or the tibula - I can't remember now).

I have had pain ever since, trying to play footy hurts like hell, and if I dare run on roads, or play basketball, etc, I am in agony for a few days, and lose a lot of movement (dorsiflexion of the ankle mainly).

My question is whether there is anything else I can do to try to rehabilitate my ankle injury? I am booked to see an ankle specialist in Melbourne soon (Mr W EDWARDS of Prahran). Will he help do you think?

[Danny]

I think you need to go to the specialist with some really specific goals in mind of what you want out of your ankle in the future. If you can do that (not an easy thing) then he can give you the most specific and hopefully effective treatment.

[injuryupdate]

Unfortunately, some of the talar dome lesions can be big enough that they will never heal 100%, even with the best surgery.

The only way you can make a call on this is to see inside the joint, so the operation report from your first surgery, and photos and video of the surgery, will all help.

Another surgeon can possibly help you if you need further surgery (i.e. there are still loose pieces in the joint and you need them cleaned out). If your ankle has lost so much cartilage that it will never be good for running again (which is a possibility) then you might get better advice from someone who isn't a surgeon (as surgeons tend to be good at operating but not good at giving advice on how to handle long-term injuries).

Unfortunately no one on a Forum can work out how bad your ankle is inside. You really need advice from someone who was at the op or at least has reports, scans etc.

[aicabsolut]

I have a related problem. I just have cartilage damage--showed up on MRI; no talus fracture or need for surgery at this point. I've been doing strengthening exercises for the ankle that are non-weight-bearing, which are supposed to, if nothing else, help the ligaments stabilize the joint more. I am only on week 3 of my 2 month estimated minimal recovery period.

I saw my physical therapist yesterday, because the exercises seem to aggravate the ankle. I only experience pain at the site of the injury when my doctor presess there. My frequent pain and aches are focused around the deltoid ligament area. As far as I know, that ligament wasn't injured nor should the Theraband exercises be straining it. The therapist told me to take a week or so off from those exercises. There's never any swelling and only rarely mild heat.

I'm from the U.S. and I know that Adequan IM (or Arteparon) has really helped my horses with articular cartilage degeneration from DJD or OCD in the hock (the joint related to their talus). Is this drug used in Australia (or elsewhere) in humans? Is it effective for this type of cartilage damage?

How exactly is the cartilage supposed to be healing on its own?

[injuryupdate]

I have read that Arteparon (Glycosaminoglycanpolysulfate) injections may be helpful in osteoarthritis and can reverse some of the degenerative effects. Most of the literature has been from Eastern European countries or in animal experiments. Also have read product recalls suggesting some (human) patient deaths from the drug, due to incompatibility reactions.

As far as I'm aware this drug is not available in Australia. My feeling would be that it is probably helpful in O/A but may be not quite safe enough to get past TGA authorisation for use in humans in Australia. Would be interesting to know whether anyone has any further info on it.