How Do Ankle Surgeons Evaluate Cartilage Damage?

Dr Yung Shing Wai
Consultant Orthopaedic Surgeon
Orthopaedic, Foot and Shoulder Surgery

MBBS, National University of Singapore (1985)
FRCSEd (General Surgery), Royal College of Surgeons of Edinburgh, United Kingdom (1990)
FAMS (Orthopaedic Surgery), Academy of Medicine, Singapore (1997)

Persistent ankle pain after a sprain or other injury does not always come from the ligaments or surrounding soft tissues. As with other orthopaedic conditions, identifying the source of ongoing symptoms may require consideration of the structures within and around the joint.

Cartilage is the smooth tissue covering the surfaces of bones where they meet within a joint. In the ankle, it helps the joint move smoothly and distribute forces during activities such as walking, running and jumping. An injury can damage this cartilage and sometimes affect the underlying bone, resulting in what may be described as an osteochondral lesion.

Evaluating cartilage damage is not simply a matter of identifying an abnormality on a scan. An ankle surgeon typically considers the pattern of symptoms, previous injuries, physical examination findings and imaging together. This helps determine whether cartilage damage is present, whether it is likely to be contributing to the patient's symptoms and whether other ankle problems may also be involved.

Key Takeaways

• Ankle cartilage damage is evaluated by considering symptoms and previous injuries alongside physical examination and imaging findings, rather than relying on a single test.
• During a physical examination, the ankle surgeon may assess joint movement, stability and areas of tenderness to identify possible sources of symptoms.
• X-rays and MRI scans provide different information about the ankle, and their findings are interpreted in the context of the patient's symptoms and examination.
• After the evaluation, factors such as the location and extent of cartilage damage, associated ankle problems, previous treatment and individual needs can help guide the next steps in management.

What Symptoms and Past Injuries Are Relevant to Ankle Cartilage Damage?

Persistent or recurring ankle pain, swelling, stiffness and discomfort during weight-bearing activities may be relevant when cartilage damage is suspected. Some patients may also experience clicking, catching or a sensation that something is interfering with normal joint movement.

The surgeon will also consider whether these symptoms developed after an injury. Previous ankle sprains, fractures and other ankle injuries can be relevant because cartilage damage may occur at the same time as injuries to other structures within or around the joint. Repeated injuries may also provide useful context when assessing ongoing ankle symptoms.

During the consultation, the surgeon may ask when the symptoms began, how they have changed over time and which activities make them better or worse. Previous treatment and whether it provided relief may also help build a clearer picture of the problem.

However, these symptoms do not necessarily indicate cartilage damage. Similar symptoms can occur with ligament injuries, tendon conditions, ankle instability and other joint disorders. The medical history and symptom pattern are therefore considered alongside the physical examination and imaging findings.

What Is Checked During an Ankle Examination?

During an ankle examination, the surgeon may check joint movement, ankle stability and areas of tenderness. These checks can help identify where symptoms may be arising from and whether other problems could be contributing to ankle discomfort.

• Joint Movement
  The surgeon may assess the ankle's range of movement and whether particular movements reproduce pain, stiffness or other symptoms. Comparing the affected ankle with the unaffected side may help identify differences in movement. Certain movements can also help the surgeon assess whether symptoms appear to originate from within the ankle joint or from surrounding structures.
• Stability
  A history of repeated sprains or a feeling that the ankle gives way may prompt the surgeon to assess ankle stability. Specific examination techniques can be used to evaluate the ligaments that help stabilise the joint. Identifying instability can be important because the surgeon needs to consider not only whether cartilage is damaged but also whether another structural problem could be placing ongoing stress on the ankle.
• Areas of Tenderness
  The location of tenderness can provide information about which structures may be involved. The surgeon may examine different areas around the ankle to determine whether tenderness appears to come from the joint itself, the surrounding ligaments or tendons, or another structure. This is particularly relevant because cartilage damage can occur alongside other ankle injuries rather than in isolation.

What Imaging Tests May Be Used?

X-rays and MRI scans may be used to assess suspected ankle cartilage damage, with each providing different information about the joint. The imaging recommended will depend on your symptoms, examination findings and what the ankle surgeon needs to assess.

X-rays

X-rays can show the bones and alignment of the ankle joint. They may also provide information about changes in the joint space or bone that could accompany cartilage problems.

However, cartilage itself does not show up clearly on standard X-rays. This means an X-ray may not reveal the full extent of cartilage damage.

MRI Scans

An MRI can provide more detailed images of the ankle's soft tissues and may help a specialist assess cartilage, bone, ligaments and other structures within the joint.

MRI findings are generally considered alongside your symptoms and clinical examination rather than interpreted in isolation. This can help the specialist determine whether an abnormality seen on the scan is likely to be relevant to your symptoms.

Other Imaging or Investigations

In some cases, further imaging or investigations may be considered depending on the suspected condition. The decision can vary according to the location of the problem, previous injuries and findings from the initial assessment.

What Happens After Ankle Cartilage Damage Is Evaluated?

After the evaluation, the ankle surgeon considers the medical history, physical examination and imaging findings together. This helps determine whether the cartilage damage is likely to be contributing to the symptoms, whether other ankle structures are involved and what the next steps may be.

The discussion may take several factors into account, including:

• Location and Extent of the Damage: The surgeon may consider where the cartilage is affected, how much of the joint surface is involved and whether there are changes in the bone beneath the cartilage.
• Severity and Pattern of Symptoms: How often pain or swelling occurs, whether there is catching or stiffness and how symptoms affect walking, exercise or other activities may help guide management.
• Other Ankle Problems: Cartilage damage can occur alongside ligament injuries, ankle instability or other joint problems. These findings may need to be considered as part of the overall treatment plan.
• Previous Treatment: The surgeon may review treatments already tried and whether they have helped improve the symptoms.
• Individual Needs: Factors such as activity level and the demands placed on the ankle may also be relevant when discussing the available options.

Take a Step Towards Better Ankle Health With Dr Yung Shing Wai

Persistent ankle pain, swelling or stiffness after an injury may warrant specialist assessment, particularly when symptoms do not improve with initial treatment, interfere with daily activities or exercise, or are accompanied by catching or instability.

An assessment can help determine whether cartilage damage, an associated injury or another ankle condition may be contributing to the symptoms. The findings can then guide a discussion about whether further investigation or treatment may be appropriate.

At SW Yung Orthopaedic Clinic, patients with persistent ankle symptoms can undergo a specialist assessment to better understand the possible causes of their pain and discuss appropriate management options. With over 30 years of orthopaedic experience, Dr Yung Shing Wai specialises in foot, ankle and shoulder surgery. If your ankle symptoms persist or affect your daily activities, you may book an appointment with the clinic for further assessment.

FAQs About Ankle Cartilage Damage

Meet Our Doctor

Dr Yung Shing Wai
Consultant Orthopaedic Surgeon
Orthopaedic, Foot and Shoulder Surgery

MBBS, National University of Singapore (1985)
FRCSEd (General Surgery), Royal College of Surgeons of Edinburgh, United Kingdom (1990)
FAMS (Orthopaedic Surgery), Academy of Medicine, Singapore (1997)

Dr Yung Shing Wai is an orthopaedic specialist in Singapore with over 30 years of clinical experience and a particular focus on foot, ankle and shoulder conditions. He is recognised as Singapore's first fellowship-trained foot and ankle surgeon and was also among the first fellowship-trained orthopaedic surgeons in the country specialising in shoulder surgery.

After graduating from the National University of Singapore in 1985, Dr Yung obtained his Fellowship with the Royal College of Surgeons of Edinburgh before pursuing sub-specialty fellowship training in Foot and Ankle Surgery and Shoulder Surgery at the University of Washington in Seattle. His extensive training has supported decades of experience in managing a wide range of musculoskeletal conditions and complex orthopaedic concerns.