Management of Cartilage Injuries of the Foot and Ankle in Handball

  • Mike Carmont
  • Martin Hägglund
  • Helder Pereira
  • Pieter D’Hooghe
  • Manuel J. Pellegrini
  • Jon Karlsson


In prospective season-long observation studies of handball, the lower extremity is marginally more frequently affected compared with the upper limb [1]. As with many other sports where physical contact occurs, the incidence of injury during match play of 13.5 injuries per 1000 h far exceeds training 0.8 injuries per 1000 h [2].


  1. 1.
    Seil R, Rupp S, Tempelhof S, Kohn D. Sports Injuries in team handball. A one-year prospective study of sixteen men’s senior teams of a superior non-professional level. Am J Sports Med. 1998;26(5):681–7.CrossRefGoogle Scholar
  2. 2.
    Seil R, Rupp S, Tempelhof S, Kohn D. Injuries during handball. A comparative retrospective study between regional and upper league teams. Sportverletz Sportschaden. 1997;11(2):58–62.CrossRefGoogle Scholar
  3. 3.
    Giroto N, Hespanhol Junior LC, Gomes MR, Lopes AD. Incidence and risk factors of injuries in Brazilian elite handball players: a prospective cohort study. Scand J Med Sci Sports. 2017;27:195–202.CrossRefGoogle Scholar
  4. 4.
    Moller M, Attermann J, Myklebust G, Wedderkopp N. Injury risk in Danish youth and senior elite handball using a new SMS text messages approach. Br J Sports Med. 2012;46(7):531–7.CrossRefGoogle Scholar
  5. 5.
    Bere T, Alonso JM, Wangensteen A, Bakken A, Eirale C, Dijkstra HP, Ahmed H, Bahr R, Popovic N. Injury and illness surveillance during the 24th Men’s Handball World Championship 2015 in Qatar. Br J Sports Med. 2015;49(17):1151–6.CrossRefGoogle Scholar
  6. 6.
    Langevoort G, Myklebust G, Dvorak J, Junge A. Handball injuries during major international tournaments. Scand J Med Sci Sports. 2007;17(4):400–7.Google Scholar
  7. 7.
    Petersen W, Braun C, Bock W, Schmidt K, Weimann A, Drescher W, Eiling E, Stange R, Fuchs T, Hedderich J, Zantop T. A controlled prospective case control series of a prevention training program in female team handball players: the German experience. Arch Orthop Trauma Surg. 2005;125(9):614–21.CrossRefGoogle Scholar
  8. 8.
    Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury patterns in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports. 2007;16(6):426–32.CrossRefGoogle Scholar
  9. 9.
    Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Injuries in young female players in European team handball. Scand J Med Sci Sports. 1997;7(6):342–7.CrossRefGoogle Scholar
  10. 10.
    Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 1959;41-A:988–1020.CrossRefGoogle Scholar
  11. 11.
    Choi GW, Choi WJ, Youn HK, Park YJ, Lee JW. Osteochondral lesions of the talus: are there any differences between osteochondral and chondral types? Am J Sports Med. 2013;41(3):504–10.CrossRefGoogle Scholar
  12. 12.
    Orr JD, Dutton JR, Fowler JT. Anatomic location and morphology of symptomatic operatively treated osteochondral lesions of the talus. Foot Ankle Int. 2012;33(12):1051–7.CrossRefGoogle Scholar
  13. 13.
    Murawski CD, Kennedy JG. Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2013;95(11):1045–54.CrossRefGoogle Scholar
  14. 14.
    Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? Br J Sports Med. 2012;46(4):220–1.CrossRefGoogle Scholar
  15. 15.
    Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG. Osteochondral lesions of the talus: aspects of current management. Bone Joint J. 2014;96-B(2):164–71.CrossRefGoogle Scholar
  16. 16.
    Aktas S, Kocaoglu B, Gereli A, Nalbantodhu U, Guven O. Incidence of chondral lesions of talar dome in ankle fracture types. Foot Ankle Int. 2008;29(3):287–92.CrossRefGoogle Scholar
  17. 17.
    Takao M, Ochi M, Naito K, Uchio Y, Kono T, Oae K. Arthroscopic drilling for chondral, subchondral and combined chondral-subchondral lesions of the talar dome. Arthroscopy. 2003;19(5):524–30.CrossRefGoogle Scholar
  18. 18.
    Stiell IG, Greenberg GH, McKnight RD, Wells GA. The “real” Ottawa ankle rules. Ann Emerg Med. 1996;27(1):103–4.CrossRefGoogle Scholar
  19. 19.
    Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999;20(12):789–93.CrossRefGoogle Scholar
  20. 20.
    Mintz DN, Tashjian GS, Connell DA, Deland JT, O’Malley M, Potter HG. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy. 2003;19(4):353–9.CrossRefGoogle Scholar
  21. 21.
    Van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ. The natural history of osteochondral lesions of the ankle. Instr Course Lect. 2010;59:375–86.PubMedGoogle Scholar
  22. 22.
    Klammer G, Maquieria GJ, Spahn S, Vigfusson V, Zanetti M, Espinosa N. Natural history of non-operatively treated osteochondral lesions of the talus. Foot Ankle Int. 2015;36(1):24–31.CrossRefGoogle Scholar
  23. 23.
    Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, Verhagen EA, Vicenzino BT, Wikstrom EA, Delahunt E. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496–505.CrossRefGoogle Scholar
  24. 24.
    Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M. Platelet rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med. 2012;40(3):534–41.CrossRefGoogle Scholar
  25. 25.
    Fraser EJ, Savage-Elliott I, Yasui Y, Ackermann J, Watson G, Ross KA, Deyer T, Kennedy JG. Clinical and MRI donor site outcomes following autologous osteochondral transplantation for talar osteochondral lesions. Foot Ankle Int. 2016;37(9):968–76.CrossRefGoogle Scholar
  26. 26.
    Dahmen J, Lambers KTA, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2017.
  27. 27.
    Lambers KTA, Dahmen J, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. No superior surgical treatment for secondary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2017.
  28. 28.
    Kok AC, Dunnen SD, Tuijthof GJ, Dijk v, Kerkhoffs GM. Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg. 2012;51(6):777–82.CrossRefGoogle Scholar
  29. 29.
    Kok AC, Tuijthof GJ, den Dunnen S, van Tiel J, Siebelt M, Everts V, van Dijk CN, Kerkhoffs GM. No effect on hole geometry in microfracture for talar osteochondral defects. Clin Orthop Relat Res. 2013;471(11):3653–62.CrossRefGoogle Scholar
  30. 30.
    Choi JI, Lee KB. Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2140–7.CrossRefGoogle Scholar
  31. 31.
    Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, Calder JDF, Takao M, Vannini F, Choi WJ, Lee JW, Stone J, Kennedy JG. Lesion size is predictive of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med. 2017;45(7):1698–705.CrossRefGoogle Scholar
  32. 32.
    Park HW, Lee KB. Comparison of chondral vs. osteochondral lesions of the talus after arthroscopic microscopic microfracture. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):860–7.CrossRefGoogle Scholar
  33. 33.
    Clanton TO, Johnson NS, Matheny LM. Outcomes following microfracture in grade 3 and 4 articular lesions of the ankle. Foot Ankle Int. 2014;35(8):764–70.CrossRefGoogle Scholar
  34. 34.
    Kim JY, Reyes FJ, Yi Y, Lee WC. Is antegrade transmalleolar drilling method for osteochondral lesion of talus necessary? Iatrogenic cyst formation at the tibia: a report of five cases. Clin Orthop Surg. 2016;8(1):119–22.CrossRefGoogle Scholar
  35. 35.
    Steadman JR, Rodkey WG, Briggs KK. Microfracture: Its history and experience of the developing surgeon. Cartilage. 2010;1(2):78–86.CrossRefGoogle Scholar
  36. 36.
    Zengerink M, Szerb I, Hangody L, Dopirak RM, Ferkel RD, van Dijk CN. Current concepts: treatment of osteochondral ankle defects. Foot Ankle Clin. 2006;11(2):331–59.CrossRefGoogle Scholar
  37. 37.
    Lee KB, Park HW, Cho HJ, Seon JK. Comparison of arthroscopic microfracture for osteochondral lesions of the talus with and without subchondral cyst. Am J Sports Med. 2015;43(8):1951–6.CrossRefGoogle Scholar
  38. 38.
    Polat G, Ersen A, Erdil ME, Kizilkurt T, Kilicoglu O, Asik M. Long-term results of microfracture in the treatment of talus osteochondral lesions. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1299–303.CrossRefGoogle Scholar
  39. 39.
    Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow up. Knee Surg Sports Traumatol Arthrosc. 2014;18(5):656–66.CrossRefGoogle Scholar
  40. 40.
    Reilingh ML, Lambers KTA, Dahmen J, Opdam KTM, Kerkhoffs GMMJ. The subchondral bone healing after fixation of an osteochondral talar defect is superior in comparison with microfracture. Knee Surg Sports Traumatol Arthrosc. 2017. Doi:1007/s 00167–4654-z.Google Scholar
  41. 41.
    Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, Atay OA, Uzumcugil A, Atesok K, Kaya D. Treatment of osteochondral lesions of the talus with microfracture and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc. 2012;20(7):1398–403.CrossRefGoogle Scholar
  42. 42.
    Loveday D, Clifton R, Robinson A. Interventions for treating osteochondral defects of the talus in adults. Cochrane Database Syst Rev. 2010;8:CD008104.Google Scholar
  43. 43.
    Vannini F, Costa GG, Caravelli S, Pagliazzi G, Mosca M. Treatment of osteochondral lesions of the talus in athletes: what is the evidence? Joints. 2016;4(2):111–20.CrossRefGoogle Scholar
  44. 44.
    Lundeen GA, Dunaway LJ. Immediate unrestricted weight-bearing and mobilization after bone marrow stimulation of large osteochondral lesions of the talus. Cartilage. 2017;8(1):73–9.CrossRefGoogle Scholar
  45. 45.
    Van Eckeren IC, Reilingh ML, van Dijk CN. Rehabilitation and return-to-sports after debridement and bone marrow stimulation of osteochondral talar defects. Sports Med. 2012;42(10):857–70.Google Scholar
  46. 46.
    Savva N, Jabur M, Davies M, Saxby T. Osteochondral lesions of the talus results: results of repeated arthroscopic debridement. Foot Ankle Int. 2007;28(6):669–73.CrossRefGoogle Scholar
  47. 47.
    Frey C, van Dijk CN. Arthroscopy of the great toe. Instr Course Lect. 1999;48:343–6.PubMedGoogle Scholar
  48. 48.
    Bojanic I, Smoljanovic T, Kubat O. Osteochondritis dissecans of the first metatarsophalangeal joint: arthroscopy and microfracture technique. J Foot Ankle Surg. 2011;50(5):623–5.CrossRefGoogle Scholar
  49. 49.
    Kuyucu E, Mutlu H, Mutlu S, Gulenc B, Erdil M. Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint. J Orthop Res. 2017;12(1):68.CrossRefGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Mike Carmont
    • 1
    • 2
  • Martin Hägglund
    • 3
  • Helder Pereira
    • 4
    • 5
  • Pieter D’Hooghe
    • 6
  • Manuel J. Pellegrini
    • 7
  • Jon Karlsson
    • 2
  1. 1.Department of Trauma and Orthopaedic SurgeryPrincess Royal Hospital, Shrewsbury and Telford Hospital NHS TrustShropshireUK
  2. 2.Department of Orthopaedic SurgerySahlgrenska Academy, University of GothenburgGothenburgSweden
  3. 3.Division of Physiotherapy, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
  4. 4.Orthopedic Department of Póvoa de VarzimVila do Conde Hospital CentrePóvoa de VarzimPortugal
  5. 5.ICVS/3B’s – PT Government Associate Laboratory Minho UniversityBragaPortugal
  6. 6.Department of Orthopaedic SurgeryAspetar - Orthopaedic and Sports Medicine Hospital, Aspire ZoneDohaQatar
  7. 7.Department of Orthopaedic SurgeryHospital Clínico Universidad de ChileIndependenciaChile

Personalised recommendations