Abstract
Dear Colleagues,
Autologous chondrocyte implantation was popularized in 1994 by the publication of an article by Mats Brittberg, Lars Peterson, and Anders Lindahl, who developed this completely new technology to overcome the poor repair capacity of cartilage. This concept of implanting autologous cultured chondrocytes into a defect is aimed to facilitate cartilage repair and produce tissue, which as much as possibly resembles articular cartilage in composition and structure. This was the introduction of the first cell therapy in the locomotor system and changed the paradigm of repair of articular cartilage to the regeneration of cartilage. Soon after the first publication of the use of autologous chondrocyte implantation in the knee, surgeons were clear that it is also a method that can be employed in the ankle. Cartilage defects in the ankles, in fact, are mostly related to acute injuries or osteochondritis dissecans, which are caused by avascular necrosis often with posttraumatic background. Since ankle sprains are the most common injuries in sports, it is known that there is a high rate of cartilage disturbances in the talus, which fortunately most of the time remains asymptomatic. However, the incidence of symptomatic cartilage defects in ankles is high and a challenging problem since the accessibility of the defects is not as easy as it is in the knee. It has also been ruled out that not only biomechanics but also the biology of ankle cartilage is different from the knee cartilage and hip cartilage. It is obviously more resilient to biomechanical impact, and also more resilient to the development of osteoarthritis. However, posttraumatic osteoarthritis is still a big problem in articular cartilage defects and complex injuries of the ankle.
In Bologna, Professor Giannini pioneered the use of autologous chondrocyte implantation in the ankle. First, by following the technique developed in Sweden for the knee. Then, improving the technique itself, thanks to the introduction of scaffolds, to an entire arthroscopic procedure. The first chondrocyte implantation in Austria in 1997 was not done in a knee but in an ankle.
Over time, cartilage repair techniques evolved and the use of scaffolds, bone marrow–derived cells, and even other different techniques have become widely used and have gained more popularity in the ankle also.
This special issue of Cartilage describes imaging and diagnosis of cartilage defects in the ankle as well as sports modalities and treatment options in cartilage defect of the ankle. It also relates to the cutting-edge research of recent developments in the treatment of cartilage defects in the ankle to prevent osteoarthritis in the long run. We definitely also wanted to include new aspects of the treatment that are still in development and cannot be yet considered as evidence based. However, the articles should be inspiring for the cartilage community looking for new methods in the treatment of ankle defects.
The guest editors are very grateful to the authors who took the effort to submit articles within the given frame on new aspects of treatment options in the ankle.