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When and How to Safely Start Stretching After Achilles Tendon RepairUnderstanding Loss of Range of Motion After Achilles Repair Achilles tendon repair is a significant orthopaedic procedure, often required after a complete or partial tear of this strong tendon at the back of the ankle. While surgery is effective in restoring tendon continuity, one of the main post-operative challenges patients…Understanding Loss of Range of Motion After Achilles Repair Achilles tendon repair is a significant orthopaedic procedure, often required after a complete or partial tear of this strong tendon at the back of the ankle. While surgery is effective in restoring tendon continuity, one of the main post-operative challenges patients face is regaining range of motion in the ankle and foot. Loss of motion can occur due to surgical immobilisation, swelling, and scar tissue formation. Many patients notice stiffness, particularly when attempting to move the ankle up (dorsiflexion) or down (plantarflexion). Understanding this potential side effect is crucial for setting recovery expectations, as well as beginning early strategies to prevent long-term stiffness. Recognising early signs of restricted movement and discussing them with your healthcare team can make a significant difference in functional recovery and overall satisfaction with the surgical outcome. Why Range of Motion Matters for Everyd...
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ACI vs MACI for knee cartilage repairBoth ACI and MACI for knee cartilage repair follow a two-stage structure: cartilage biopsy with laboratory expansion, then implantation. The difference lies in the second stage's delivery mechanism—ACI injects expanded cells beneath a periosteal patch, while MACI pre-seeds them onto a collagen membrane secured with fibrin glue.Both ACI and MACI for knee cartilage repair follow a two-stage structure: cartilage biopsy with laboratory expansion, then implantation. The difference lies in the second stage's delivery mechanism—ACI injects expanded cells beneath a periosteal patch, while MACI pre-seeds them onto a collagen membrane secured with fibrin glue.
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OATS and Mosaicplasty for Knee Cartilage RepairOATS delivers genuine hyaline cartilage — the knee's native resilient material — to repair focal defects in one operation; marrow-stimulation techniques like microfracture instead produce fibrocartilage, scar-like tissue that begins to break down within two to three years under athletic demand.OATS delivers genuine hyaline cartilage — the knee's native resilient material — to repair focal defects in one operation; marrow-stimulation techniques like microfracture instead produce fibrocartilage, scar-like tissue that begins to break down within two to three years under athletic demand.
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When Knee Alignment Must Come Before Cartilage RepairCartilage repair fails in a varus knee because the weight-bearing line runs through the damaged medial compartment instead of the joint's centre. High tibial osteotomy redirects that line toward the centre; expert guidance mandates combined surgery above 3° varus and forbids isolated repair beyond 5°.Cartilage repair fails in a varus knee because the weight-bearing line runs through the damaged medial compartment instead of the joint's centre. High tibial osteotomy redirects that line toward the centre; expert guidance mandates combined surgery above 3° varus and forbids isolated repair beyond 5°.
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Distal femoral osteotomy for lateral knee cartilage damageKnock-kneed alignment directs excessive load through the outer knee compartment, accelerating cartilage wear over time. Distal femoral osteotomy corrects this by adjusting the lower thighbone angle to redistribute load and allow the damaged cartilage to survive or heal.Knock-kneed alignment directs excessive load through the outer knee compartment, accelerating cartilage wear over time. Distal femoral osteotomy corrects this by adjusting the lower thighbone angle to redistribute load and allow the damaged cartilage to survive or heal.
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Autograft or allograft for large knee cartilage defectsKnee cartilage defects smaller than roughly 2 cm² are typically repaired with the patient's own tissue; larger defects require fresh donor grafts because the knee lacks sufficient low-load surface to harvest from safely.Knee cartilage defects smaller than roughly 2 cm² are typically repaired with the patient's own tissue; larger defects require fresh donor grafts because the knee lacks sufficient low-load surface to harvest from safely.
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Symptoms That Warrant a Cartilage SpecialistArticular cartilage cannot repair itself because it contains no blood vessels or nerves; defects exceeding approximately 1 cm in size tend to deteriorate rather than stabilise, and the window for joint-preserving intervention is finite.Articular cartilage cannot repair itself because it contains no blood vessels or nerves; defects exceeding approximately 1 cm in size tend to deteriorate rather than stabilise, and the window for joint-preserving intervention is finite.
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ACI for talar cartilage repairOsteochondral lesions of the talus occur in up to 70% of ankle fractures; defects measuring 2cm² or larger typically undergo autologous chondrocyte implantation, which uses cultured cells rather than bone plugs to restore cartilage but requires medial malleolar osteotomy to access the joint.Osteochondral lesions of the talus occur in up to 70% of ankle fractures; defects measuring 2cm² or larger typically undergo autologous chondrocyte implantation, which uses cultured cells rather than bone plugs to restore cartilage but requires medial malleolar osteotomy to access the joint.
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When cartilage repair is the right choiceCartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.Cartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.
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When OATS mosaicplasty beats other ankle cartilage repairsLesions exceeding 150 mm² require OATS mosaicplasty: marrow stimulation produces fibrocartilage that breaks down within two to three years, whilst transplanted hyaline cartilage lasts decades.Lesions exceeding 150 mm² require OATS mosaicplasty: marrow stimulation produces fibrocartilage that breaks down within two to three years, whilst transplanted hyaline cartilage lasts decades.
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OATS or microfracture for active knee patientsMicrofracture improves early but deteriorates progressively beyond two years because it deposits fibrocartilage, whilst OATS transplants intact cartilage that remains stable long-term.Microfracture improves early but deteriorates progressively beyond two years because it deposits fibrocartilage, whilst OATS transplants intact cartilage that remains stable long-term.
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Osteochondral Allograft for Ankle Cartilage DefectsLesions on the talus larger than 15mm fail with microfracture repair; osteochondral allograft instead restores the cartilage and bone using donor tissue, achieving 85% survivorship at ten years.Lesions on the talus larger than 15mm fail with microfracture repair; osteochondral allograft instead restores the cartilage and bone using donor tissue, achieving 85% survivorship at ten years.
