Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):570-80. doi: 10.1007/s00167-010-1064-x. Epub 2010 Feb 12.
Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. The ankle joint has a high congruency. During loading, compressed cartilage forces its water into the microfractured subchondral bone, leading to a localized high increased flow and pressure of fluid in the subchondral bone. This will result in local osteolysis and can explain the slow development of a subchondral cyst. The pain does not arise from the cartilage lesion, but is most probably caused by repetitive high fluid pressure during walking, which results in stimulation of the highly innervated subchondral bone underneath the cartilage defect. Understanding the natural history of osteochondral defects could lead to the development of strategies for preventing progressive joint damage.
踝关节的软骨下骨缺损要么自行愈合且无症状，要么进展为负重时踝关节深部疼痛和形成软骨下骨囊肿。有症状的 OD 的发展取决于多种因素，包括软骨下骨板的损伤和修复不足。踝关节具有高度的一致性。在负重时，受压的软骨将其水分压入微骨折的软骨下骨，导致软骨下骨中的局部高流量和高压流体增加。这将导致局部溶骨，并可以解释软骨下囊肿的缓慢发展。疼痛不是来自软骨病变，而是很可能是由于行走时反复的高流体压力，导致在软骨缺损下方的神经丰富的软骨下骨受到刺激。了解软骨下骨缺损的自然病程可能会导致制定预防关节进行性损伤的策略。
