Any injury or damage to the cartilage lining at the end of the tibia bone is known as tibial osteochondral fracture. It is the area which joins with the talus to form the ankle joint.
Osteochondral fractures of the ankle are commonly seen in the upper region of the talus bone. Articular cartilage injury is difficult to diagnose and is usually confused with ankle sprain due to similar symptoms. Osteochondral injuries are usually not obvious on x-rays. Due to this, osteochondral fractures are not diagnosed easily and are suspected if the ankle pain continues after starting training for sports or any other activity.
Symptoms of Tibial Osteochondral Fracture
- Abrupt pain upon twisting the ankle.
- Loss of function and movement of the ankle.
- Pain upon weight bearing.
- Ankle joint instability.
- Bruising may be present.
- Tenderness is present.
- Pain upon movement of the ankle.
- Instant swelling.
- Deformity of the ankle may be present.
- Clicking or creaking can be felt in the ankle.
Causes of Tibial Osteochondral Fracture
- Twisting force to the knee.
- Direct trauma.
- Recurring or repetitive injury to the ankle e.g. sprain.
Treatment of Tibial Osteochondral Fracture
- Rest is important.
- Ice therapy helps in pain and swelling.
- Compression and elevation also helps in reducing swelling.
- Patient should seek immediate medical attention.
- X-ray or MRI scan can be done to assess the severity of the injury.
- For minor injuries, conservative treatment usually suffices.
- The ankle can be casted for immobilization.
- NSAIDs such as ibuprofen and naproxen help in easing the pain.
- After complete healing, patient should start rehab program comprising of stretching and strengthening exercises to regain mobility, flexibility, and range of motion of the ankle.
- For severe injuries, surgery may be required in order to remove the fractured pieces of the cartilage.
What is the Recovery Time for Tibial Osteochondral Fracture?
The rehabilitation and recovery time for Tibial osteochrondral fracture depends on the severity of the injury. The rehabilitation process normally goes upwards of four to five months. The rehabilitation is done in a phased manner as explained below.
Phase I: This phase begins after about eight weeks after repair of the injury with the goals of the phase being protecting the repair site, restoring normal quadriceps function as well as patellar mobility, and reducing swelling of the joint. Since the femoral condyles are used during weightbearing hence there will be restrictions placed on the amount of weight that the affected individual can bear on the affected leg. In majority of the cases, the patient is allowed touchdown weightbearing in the first eight weeks with the help of crutches but this depends on the nature of the repair. If the injury and the repair is quite mild then weightbearing may be started relatively early.
Phase II: This phase is started between 8 to 12 weeks after repair. In this phase emphasis is given on gait training to begin with. The patient is weaned off the crutches and the patient is asked to weight bear as comfort allows. The patient is instructed on proper gait mechanics so as to advance to normal gait in the fastest possible time. Once gait has been normalized and the patient is allowed full weightbearing, then the patient is allowed to perform exercises like treadmill, pool exercises and the like. In this phase, the exercises are directed at strengthening and increasing endurance of the muscles of the quadriceps, hamstrings, gastrocsoleus complex, and gluteal muscles along with focusing on core stability. Patients are instructed to do these exercises repetitively so as to protect the injured site.
Phase III: This phase is done between 12 to 16 weeks post repair of the injury. In this phase of rehab, there is aggressive rehabilitation of the cardiovascular portion with use of elliptical machines along with low impact joint loading. Agility exercises are also initiated on soft surfaces. The focus of this part of rehabilitation is to teach the patient to protect the joint surface. It is also stressed to strengthen the hip flexors as weakness of this muscle can lead to overuse of the quadriceps muscles and affect the knee joint which may predispose the patient to injuries.
Phase IV: By this time, the patient has almost healed from this injury and can advance to agility exercises. Exercises in this phase are aimed to slowly return the patient back to sporting activities. This is done by recreating an environment which is similar to the sport that the patient is involved with including the same demands that the sport requires of the patient to evaluate whether the patient is mentally and physically ready to return back to the sporting activity. The patient is also allowed to perform the activities like golfing and biking to check on the strength and endurance of the affected extremity. Return to full unrestricted activity is allowed after about nine months following the injury and repair.