{"id":4519,"date":"2023-01-15T02:08:54","date_gmt":"2023-01-15T02:08:54","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/management-of-ankle-osteochondral-lesions-it\/"},"modified":"2023-01-26T14:08:48","modified_gmt":"2023-01-26T14:08:48","slug":"management-of-ankle-osteochondral-lesions-it","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/it\/management-of-ankle-osteochondral-lesions-it\/","title":{"rendered":"Gestione delle lesioni osteocondrali della caviglia"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\"><b>Redattrice principale <\/b>&#8211; <a title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\">Ewa Jaraczewska<\/a> sulla base del corso di <a class=\"external text\" href=\"https:\/\/members.physio-pedia.com\/instructor\/helene-simpson\/\" rel=\"nofollow\">Helene Simpson<\/a><br \/>\n<b>Principali collaboratori<\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\"><bdi>Ewa Jaraczewska<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Lucinda hampton\" href=\"\/User:Lucinda_hampton\"><bdi>Lucinda Hampton<\/bdi><\/a> e <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson<\/bdi><\/a><\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenuti<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Definitions\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Definizioni<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Healing_of_Osteochondral_Lesions\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">Guarigione delle <b>lesioni osteocondrali<\/b><\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-3\"><a href=\"#Aetiology_of_Osteochondral_Lesions\"><span class=\"tocnumber\">2.1<\/span> <span class=\"toctext\">Eziologia delle <b>lesioni osteocondrali<\/b><\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-4\"><a href=\"#Osteochondral_Lesions_of_the_Ankle\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">Lesioni osteocondrali della caviglia<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Classification_System_for_Osteochondral_Lesions_of_the_Talar_Cartilage\"><span class=\"tocnumber\">3.1<\/span> <span class=\"toctext\">Sistema di classificazione per le lesioni osteocondrali della cartilagine dell&#8217;astragalo<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-6\"><a href=\"#Clinical_Presentation\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">Presentazione clinica<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-7\"><a href=\"#Diagnostic_Procedures\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">Procedure diagnostiche<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-8\"><a href=\"#Outcome_Measures\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">Misure di outcome<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-9\"><a href=\"#Comprehensive_Rehabilitation\"><span class=\"tocnumber\">7<\/span> <span class=\"toctext\">Riabilitazione completa<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-10\"><a href=\"#General_principles_in_rehabilitation_management\"><span class=\"tocnumber\">7.1<\/span> <span class=\"toctext\">Principi generali della gestione della riabilitazione<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-11\"><a href=\"#Special_Concerns\"><span class=\"tocnumber\">7.2<\/span> <span class=\"toctext\">Preoccupazioni particolari<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-12\"><a href=\"#Shear_forces\"><span class=\"tocnumber\">7.2.1<\/span> <span class=\"toctext\">Forze di taglio<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-13\"><a href=\"#Compressive_forces\"><span class=\"tocnumber\">7.2.2<\/span> <span class=\"toctext\">Forze di compressione<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-14\"><a href=\"#Slow_Recovery\"><span class=\"tocnumber\">7.2.3<\/span> <span class=\"toctext\">Recupero lento<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-15\"><a href=\"#Monitor_pain\"><span class=\"tocnumber\">7.2.4<\/span> <span class=\"toctext\">Monitoraggio del dolore<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-16\"><a href=\"#Compensatory_movements\"><span class=\"tocnumber\">7.2.5<\/span> <span class=\"toctext\">Movimenti compensatori<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-17\"><a href=\"#Ankle_Osteochondral_Lesions_Treatment_Strategies.5B11.5D\"><span class=\"tocnumber\">7.3<\/span> <span class=\"toctext\">Strategie di trattamento delle lesioni osteocondrali della caviglia <sup>(11)<\/sup><\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-18\"><a href=\"#Stage_1\"><span class=\"tocnumber\">7.3.1<\/span> <span class=\"toctext\">Fase 1<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-19\"><a href=\"#Stage_2\"><span class=\"tocnumber\">7.3.2<\/span> <span class=\"toctext\">Fase 2<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-20\"><a href=\"#Stage_3\"><span class=\"tocnumber\">7.3.3<\/span> <span class=\"toctext\">Fase 3<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-21\"><a href=\"#Stage_4\"><span class=\"tocnumber\">7.3.4<\/span> <span class=\"toctext\">Fase 4<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-22\"><a href=\"#Resources\"><span class=\"tocnumber\">8<\/span> <span class=\"toctext\">Risorse<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-23\"><a href=\"#References\"><span class=\"tocnumber\">9<\/span> <span class=\"toctext\">Citazioni<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Definitions\" class=\"mw-headline\">Definizioni<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Definitions\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Definitions\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 394px;\"><a class=\"image\" href=\"\/File:Three-types-of-cartilage-hyaline-elastic-and-fibrocartilage.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/39\/Three-types-of-cartilage-hyaline-elastic-and-fibrocartilage.png\/392px-Three-types-of-cartilage-hyaline-elastic-and-fibrocartilage.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/39\/Three-types-of-cartilage-hyaline-elastic-and-fibrocartilage.png\/588px-Three-types-of-cartilage-hyaline-elastic-and-fibrocartilage.png 1.5x, https:\/\/www.physio-pedia.com\/images\/3\/39\/Three-types-of-cartilage-hyaline-elastic-and-fibrocartilage.png 2x\" alt=\"\" width=\"392\" height=\"296\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>I 3 tipi di cartilagine<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>La <a title=\"Cartilage\" href=\"\/Cartilage\">cartilagine<\/a> \u00e8 un tessuto connettivo che presenta i seguenti componenti:<sup id=\"cite_ref-:3_1-0\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup><\/p>\n<ul>\n<li>Polisaccaridi (componente cellulare composta da sostanza fondamentale)<\/li>\n<li>Proteine fibrose<\/li>\n<li>Fluido interstiziale con acqua come componente principale<\/li>\n<\/ul>\n<p>La cartilagine riceve il suo nutrimento per diffusione dai tessuti circostanti, poich\u00e9 non ha un apporto diretto di <a title=\"Blood Physiology\" href=\"\/Blood_Physiology\">sangue<\/a>, <a title=\"Lymphatic System\" href=\"\/Lymphatic_System\">vie linfatiche<\/a> o <a title=\"Neurone\" href=\"\/Neurone\">nervi<\/a>.<sup id=\"cite_ref-:3_1-1\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup><\/p>\n<p>Esistono tre tipi di tessuti cartilaginei: la cartilagine ialina, la fibrocartilagine e la cartilagine elastica.<sup id=\"cite_ref-:3_1-2\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup> Ogni tipo di tessuto cartilagineo ha una composizione e una funzione diversa:<\/p>\n<ol>\n<li>\n<div class=\"floatright\"><a class=\"image\" href=\"\/File:Extracellular_Matrix_Components_of_Cartilage.jpeg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/42\/Extracellular_Matrix_Components_of_Cartilage.jpeg\/364px-Extracellular_Matrix_Components_of_Cartilage.jpeg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/42\/Extracellular_Matrix_Components_of_Cartilage.jpeg\/546px-Extracellular_Matrix_Components_of_Cartilage.jpeg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/4\/42\/Extracellular_Matrix_Components_of_Cartilage.jpeg\/728px-Extracellular_Matrix_Components_of_Cartilage.jpeg 2x\" alt=\"Extracellular Matrix Components of Cartilage.jpeg\" width=\"364\" height=\"199\"><\/a><\/div>\n<p><a title=\"Cartilage\" href=\"\/Cartilage\">Cartilagine ialina<\/a>: \u00e8 un tessuto connettivo situato alle estremit\u00e0 delle ossa. Le sue cellule principali sono i condrociti. Il loro ruolo \u00e8 quello di mantenere la <a title=\"Extracellular Matrix\" href=\"\/Extracellular_Matrix\">matrice extracellulare<\/a> della cartilagine, responsabile della funzione biologica e meccanica della cartilagine. La matrice extracellulare della cartilagine ialina contiene:<sup id=\"cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\">(2)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Collagen\" href=\"\/Collagen\">Collagene<\/a> di tipo II (10-20%)<\/li>\n<li>Proteoglicani (1-10%)<\/li>\n<li>Acqua (65-85%)<\/li>\n<\/ul>\n<\/li>\n<li>La <a title=\"Cartilage\" href=\"\/Cartilage\">fibrocartilagine<\/a> \u00e8 un &#8220;tessuto di transizione tra la cartilagine ialina e il tessuto connettivo denso e regolare&#8221;.<sup id=\"cite_ref-:3_1-3\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup> Questo tipo di tessuto si trova nella sinfisi pubica, nell&#8217;anulus fibroso del disco intervertebrale, nei tendini e nei legamenti.<sup id=\"cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\">(3)<\/a><\/sup> Contiene:<sup id=\"cite_ref-:3_1-4\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup>\n<ul>\n<li>Alti livelli di collagene di tipo I<\/li>\n<li>Collagene di tipo II<\/li>\n<li>Una piccola componente di sostanza fondamentale<\/li>\n<\/ul>\n<\/li>\n<li><a title=\"Cartilage\" href=\"\/Cartilage\">Cartilagine elastica<\/a>: \u00e8 un tessuto connettivo cartilagineo flessibile che pu\u00f2 resistere a ripetuti piegamenti.<sup id=\"cite_ref-:3_1-5\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup> \u00c8 costituita da:<sup id=\"cite_ref-:3_1-6\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup>\n<ul>\n<li>Collagene di tipo II<\/li>\n<li>Fibre elastiche<\/li>\n<li>Grandi condrociti<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p>L&#8217;<a title=\"Osso\" href=\"\/Bone\">osso subcondrale<\/a> si trova al di sotto della cartilagine ialina e della &#8220;cement line&#8221; (ossia il confine tra la cartilagine calcificata e l&#8217;<a title=\"Osso\" href=\"\/Bone\">osso<\/a> subcondrale<sup id=\"cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\">(3)<\/a><\/sup>). \u00c8 responsabile del supporto meccanico (compreso l&#8217;assorbimento degli urti) e nutrizionale della cartilagine (l&#8217;osso subcondrale contiene vasi che interagiscono direttamente con lo strato di cartilagine ialina).<sup id=\"cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\">(4)<\/a><\/sup>. Il meccanismo di perfusione dei vasi dell&#8217;osso subcondrale \u00e8 responsabile della distribuzione del 50% dei nutrienti alla cartilagine.<sup id=\"cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\">(5)<\/a><\/sup><\/p>\n<p>Le <b>lesioni osteocondrali<\/b> sono difetti che interessano la struttura della superficie cartilaginea e dell&#8217;osso subcondrale sottostante. Quando inizia la fase di guarigione della lesione e si forma il tessuto, il nuovo tessuto \u00e8 spesso una fibrocartilagine. Tuttavia, questo tipo di cartilagine presenta svantaggi meccanici rispetto alla cartilagine ialina. In alcuni casi, la cartilagine ialina si forma durante il processo di riparazione, ma il meccanismo di formazione della cartilagine ialina rispetto alla fibrocartilagine \u00e8 sconosciuto.<sup id=\"cite_ref-:3_1-7\" class=\"reference\"><a href=\"#cite_note-:3-1\">(1)<\/a><\/sup><\/p>\n<h2><span id=\"Healing_of_Osteochondral_Lesions\" class=\"mw-headline\">Guarigione delle <b>lesioni osteocondrali<\/b><\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Healing of Osteochondral Lesions\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=2\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Healing of Osteochondral Lesions\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=2\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Le lesioni osteocondrali hanno una scarsa capacit\u00e0 di guarigione.<sup id=\"cite_ref-:4_6-0\" class=\"reference\"><a href=\"#cite_note-:4-6\">(6)<\/a><\/sup> Uno studio condotto su animali<sup id=\"cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\">(7)<\/a><\/sup> dimostra che le lesioni osteocondrali attraversano le seguenti fasi di guarigione:<sup id=\"cite_ref-:4_6-1\" class=\"reference\"><a href=\"#cite_note-:4-6\">(6)<\/a><\/sup><\/p>\n<ul>\n<li>Settimana 1-2: riparazione iniziale della fibrina &#8211; il sito danneggiato inizia a riempirsi di un coagulo di sangue e di tessuto fibroso, inizia il reclutamento di cellule mesenchimali<\/li>\n<li>Settimana 4-8: inizia la formazione della cartilagine adiacente alla cartilagine danneggiata<\/li>\n<li>Settimane 8-12: inizia la formazione ossea attraverso l&#8217;ossificazione endocondrale<\/li>\n<li>Settimana 18: continua la formazione di nuovo osso<\/li>\n<li>Settimana 26: completamento del processo di guarigione<\/li>\n<\/ul>\n<h3><span id=\"Aetiology_of_Osteochondral_Lesions\" class=\"mw-headline\">Eziologia delle <b>lesioni osteocondrali<\/b><\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Aetiology of Osteochondral Lesions\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=3\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Aetiology of Osteochondral Lesions\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=3\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Le lesioni osteocondrali possono essere causate da:<\/p>\n<ul>\n<li>Trauma (80% dei casi)<sup id=\"cite_ref-:5_8-0\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<li>Malallineamento articolare<sup id=\"cite_ref-:0_9-0\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/li>\n<li>Lassit\u00e0 <a title=\"Ligament\" href=\"\/Ligament\">legamentosa<\/a> (38% dei pazienti)<sup id=\"cite_ref-:5_8-1\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<li>Instabilit\u00e0 (39% dei pazienti)<sup id=\"cite_ref-:5_8-2\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<li><a title=\"Genetics and Health\" href=\"\/Genetics_and_Health\">Predisposizione genetica<\/a><sup id=\"cite_ref-:0_9-1\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/li>\n<li>Fattori <a class=\"mw-redirect\" title=\"Endocrine Disorders\" href=\"\/Endocrine_Disorders\">endocrini<\/a> <sup id=\"cite_ref-:5_8-3\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><sup id=\"cite_ref-:0_9-2\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/li>\n<li><a title=\"Avascular Necrosis\" href=\"\/Avascular_Necrosis\">Necrosi avascolare<\/a><sup id=\"cite_ref-:0_9-3\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/li>\n<li>Fattori metabolici<sup id=\"cite_ref-:5_8-4\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<\/ul>\n<p>Tre tipi di trauma portano allo sviluppo di lesioni osteocondrali: compattazione, taglio o avulsione.<\/p>\n<h2><span id=\"Osteochondral_Lesions_of_the_Ankle\" class=\"mw-headline\">Lesioni osteocondrali della caviglia<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Osteochondral Lesions of the Ankle\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=4\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Osteochondral Lesions of the Ankle\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=4\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Osteochondral-injury-of-talus-staging-illustration.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/a\/ab\/Osteochondral-injury-of-talus-staging-illustration.png\/300px-Osteochondral-injury-of-talus-staging-illustration.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/a\/ab\/Osteochondral-injury-of-talus-staging-illustration.png\/450px-Osteochondral-injury-of-talus-staging-illustration.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/a\/ab\/Osteochondral-injury-of-talus-staging-illustration.png\/600px-Osteochondral-injury-of-talus-staging-illustration.png 2x\" alt=\"\" width=\"300\" height=\"300\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Lesioni osteocondrali dell&#8217;astragalo: stadiazione<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>Secondo Ferkel et al.,<sup id=\"cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\">(10)<\/a><\/sup> un&#8217;alta percentuale di pazienti con <a title=\"Instabilit\u00e0 cronica della caviglia\" href=\"\/Chronic_Ankle_Instability\">instabilit\u00e0 della caviglia<\/a> laterale sviluppa una patologia intra-articolare. Nell&#8217;<a title=\"Ankle and Foot\" href=\"\/Ankle_and_Foot\">articolazione della caviglia<\/a>, le lesioni osteocondrali si verificano nell&#8217;<a title=\"Astragalo\" href=\"\/Talus\">astragalo<\/a>. Le lesioni della cartilagine dell&#8217;astragalo e dell&#8217;osso subcondrale possono portare a un distacco parziale o completo del frammento. Le lesioni osteocondrali possono essere caratterizzate come:<\/p>\n<ul>\n<li>Condrale (solo cartilagine)<\/li>\n<li>Condrale-subcondrale (cartilagine e osso)<\/li>\n<li>Subcondrale (cartilagine sovrastante intatta)<\/li>\n<li>Cistica<\/li>\n<li>Stabile o instabile<\/li>\n<li>Non dislocata o dislocata<\/li>\n<\/ul>\n<h3><span id=\"Classification_System_for_Osteochondral_Lesions_of_the_Talar_Cartilage\" class=\"mw-headline\">Sistema di classificazione per le lesioni osteocondrali della cartilagine dell&#8217;astragalo<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Classification System for Osteochondral Lesions of the Talar Cartilage\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=5\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Classification System for Osteochondral Lesions of the Talar Cartilage\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=5\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>I seguenti sistemi di classificazione per le lesioni osteocondrali sono utilizzati principalmente per la ricerca. Clinicamente i fattori pi\u00f9 importanti sono la localizzazione e la profondit\u00e0 della lesione. In generale, pi\u00f9 la lesione \u00e8 grande, pi\u00f9 diventa problematica.<sup id=\"cite_ref-:6_11-0\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p>\n<ul>\n<li>Il sistema di classificazione di Berndt e Harty<sup id=\"cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\">(12)<\/a><\/sup> rimane il sistema pi\u00f9 comunemente utilizzato per classificare le lesioni osteocondrali radiografiche. Il sistema \u00e8 il seguente:<sup id=\"cite_ref-:1_13-0\" class=\"reference\"><a href=\"#cite_note-:1-13\">(13)<\/a><\/sup>\n<ul>\n<li>Stadio I: con il piede in posizione di inversione, il bordo laterale \u00e8 compresso contro la faccia del perone e il legamento collaterale rimane intatto<\/li>\n<li>Stadio II: con la progressiva inversione del piede, si verifica la rottura del legamento laterale e inizia l&#8217;avulsione del frammento<\/li>\n<li>Stadio III: il frammento \u00e8 completamente staccato ma rimane in posizione<\/li>\n<li>Stadio IV: lo spostamento di un frammento staccato avviene in seguito all&#8217;inversione<\/li>\n<\/ul>\n<\/li>\n<li>Loomer et al.<sup id=\"cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\">(14)<\/a><\/sup> hanno aggiunto un quinto stadio al sistema di classificazione di Berndt e Harty:<sup id=\"cite_ref-:1_13-1\" class=\"reference\"><a href=\"#cite_note-:1-13\">(13)<\/a><\/sup>\n<ul>\n<li>Fase I -IV come sopra<\/li>\n<li>Stadio V: presenza di una cisti subcondrale<\/li>\n<\/ul>\n<\/li>\n<li>Ferkel et al.<sup id=\"cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\">(15)<\/a><\/sup> hanno sviluppato un sistema di classificazione basato sulla tomografia computerizzata (TAC):<sup id=\"cite_ref-:2_16-0\" class=\"reference\"><a href=\"#cite_note-:2-16\">(16)<\/a><\/sup>\n<ul>\n<li>Stadio I: lesione cistica con la cupola dell&#8217;astragalo (tetto intatto)<\/li>\n<li>Stadio IIa: lesione cistica con comunicazione alla superficie della cupola dell&#8217;astragalo<\/li>\n<li>Stadio IIb: lesione aperta della superficie articolare con un frammento sovrastante non dislocato<\/li>\n<li>Stadio III: lesione non dislocata con lucentezza<\/li>\n<li>Stadio IV: frammento dislocato<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Hepple et al.<sup id=\"cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\">(17)<\/a><\/sup> hanno sviluppato un sistema di classificazione basato sulla risonanza magnetica (RM).<sup id=\"cite_ref-:2_16-1\" class=\"reference\"><a href=\"#cite_note-:2-16\">(16)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"center\">\n<div class=\"thumb tnone\">\n<div class=\"thumbinner\" style=\"width: 502px;\"><a class=\"image\" href=\"\/File:OCL_MRI_classification.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/7\/7e\/OCL_MRI_classification.png\/500px-OCL_MRI_classification.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/7\/7e\/OCL_MRI_classification.png\/750px-OCL_MRI_classification.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/7\/7e\/OCL_MRI_classification.png\/1000px-OCL_MRI_classification.png 2x\" alt=\"\" width=\"500\" height=\"368\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p><small>Classificazione delle lesioni osteocondrali basata sulla risonanza magnetica. Adattata da AA, Sesin C, Rosselli M. Osteochondral defects of the talus with a focus on platelet-rich plasma as a potential treatment option: a review. BMJ Open Sport Exerc Med. 2018 Feb 1;4(1):e000318.<\/small><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h2><span id=\"Clinical_Presentation\" class=\"mw-headline\">Presentazione clinica<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Clinical Presentation\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=6\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Clinical Presentation\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=6\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>I pazienti con lesioni osteocondrali della caviglia riferiscono dolore profondo alla caviglia associato al carico del peso corporeo, limitazioni del range di movimento, compromissione della funzionalit\u00e0, rigidit\u00e0 e sensazione di blocco. Inoltre, il paziente potrebbe avvertire dolenzia e gonfiore intorno alla caviglia mediale e laterale.<sup id=\"cite_ref-:5_8-5\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup> L&#8217;esame spesso rivela limitazioni del range di movimento delle articolazioni astragalo-calcaneare e astragalo-navicolare, un&#8217;alterata stabilit\u00e0 legamentosa della caviglia e un malallineamento del retropiede.<sup id=\"cite_ref-:1_13-2\" class=\"reference\"><a href=\"#cite_note-:1-13\">(13)<\/a><\/sup> <sup id=\"cite_ref-:5_8-6\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/p>\n<h2><span id=\"Diagnostic_Procedures\" class=\"mw-headline\">Procedure diagnostiche<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Diagnostic Procedures\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=7\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Diagnostic Procedures\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=7\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li><a title=\"X-Rays\" href=\"\/X-Rays\">Radiografia<\/a> &#8211; proiezioni antero-posteriore (AP) e laterale completate in carico<sup id=\"cite_ref-:5_8-7\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<li>La <a title=\"MRI Scans\" href=\"\/MRI_Scans\">risonanza magnetica<\/a> cattura l&#8217;integrit\u00e0 dei tessuti molli e dell&#8217;osso cancelloso subcondrale<sup id=\"cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\">(18)<\/a><\/sup><\/li>\n<li>La <a title=\"CT Scans\" href=\"\/CT_Scans\">TAC<\/a> offre una migliore risoluzione per evidenziare le patologie ossee, ma fornisce meno informazioni sui tessuti molli e sull&#8217;usura della cartilagine articolare<sup id=\"cite_ref-:5_8-8\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<li>La TAC SPECT \u00e8 in grado di fornire informazioni sia dalla RM che dalla TAC; \u00e8 importante considerare la quantit\u00e0 di radiazioni a cui il paziente viene esposto con la TAC SPECT<sup id=\"cite_ref-:5_8-9\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<li>L&#8217;artroscopia della caviglia consente di visualizzare direttamente l&#8217;intera articolazione<sup id=\"cite_ref-:5_8-10\" class=\"reference\"><a href=\"#cite_note-:5-8\">(8)<\/a><\/sup><\/li>\n<\/ul>\n<h2><span id=\"Outcome_Measures\" class=\"mw-headline\">Misure di outcome<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Outcome Measures\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=8\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Outcome Measures\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=8\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li><a title=\"Lower Extremity Functional Scale (LEFS)\" href=\"\/Lower_Extremity_Functional_Scale_(LEFS)\">Lower Extremity Functional Scale<\/a> (LEFS)<\/li>\n<li><a title=\"Foot and Ankle Ability Measure\" href=\"\/Foot_and_Ankle_Ability_Measure\">Foot and Ankle Ability Measure<\/a> (FAAM)<\/li>\n<li><a class=\"external text\" href=\"http:\/\/www.orthoscores.com\/scorepages\/foot_and_ankle_disability_index_fadi.html\" rel=\"nofollow\">The Foot &amp; Ankle Disability Index Score<\/a> (FADI)<\/li>\n<li><a title=\"Foot Function Index (FFI)\" href=\"\/Foot_Function_Index_(FFI)\">Foot Function Index<\/a> (FFI)<\/li>\n<\/ul>\n<h2><span id=\"Comprehensive_Rehabilitation\" class=\"mw-headline\">Riabilitazione completa<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Comprehensive Rehabilitation\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=9\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Comprehensive Rehabilitation\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=9\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<h3><span id=\"General_principles_in_rehabilitation_management\" class=\"mw-headline\">Principi generali della gestione della riabilitazione<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: General principles in rehabilitation management\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=10\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: General principles in rehabilitation management\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=10\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Manca un&#8217;evidenza di alta qualit\u00e0 per un protocollo di trattamento specifico per la gestione delle lesioni osteocondrali della caviglia.<sup id=\"cite_ref-:6_11-1\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup> Pertanto, quando si stabiliscono gli obiettivi, si pianifica il trattamento e si scelgono gli interventi, il professionista clinico deve considerare le fasi biologiche della guarigione. La riabilitazione dipender\u00e0 anche dalle dimensioni della lesione e dalla sua localizzazione. In generale, il programma di riabilitazione dovrebbe:<sup id=\"cite_ref-:6_11-2\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p>\n<ul>\n<li>Essere completo e includere l&#8217;allenamento funzionale multimodale<\/li>\n<li>Includere un minimo di sei settimane di allenamento riabilitativo supervisionato<\/li>\n<li>Lavorare sul controllo posturale, sull&#8217;<a title=\"Balance Training\" href=\"\/Balance_Training\">equilibrio<\/a> e sulla <a title=\"Propriocezione\" href=\"\/Proprioception\">propriocezione<\/a><\/li>\n<li>Incorporare l&#8217;intera <a title=\"Kinetic Chain\" href=\"\/Kinetic_Chain\">catena cinetica<\/a> per migliorare la <a title=\"Strength Training\" href=\"\/Strength_Training\">forza<\/a> complessiva<\/li>\n<li>Includere attivit\u00e0 volte a mantenere il <a title=\"Range of Motion\" href=\"\/Range_of_Motion\">range di movimento<\/a><\/li>\n<li>Includere misure di protezione dell&#8217;articolazione della caviglia facendo indossare al paziente un tutore con lacci<\/li>\n<li>Continuare a monitorare il paziente per un aumento inspiegabile del dolore fino a 2 anni<\/li>\n<\/ul>\n<h3><span id=\"Special_Concerns\" class=\"mw-headline\">Preoccupazioni particolari<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Special Concerns\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=11\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Special Concerns\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=11\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Nella gestione delle lesioni osteocondrali della caviglia, \u00e8 importante applicare le seguenti considerazioni riabilitative:<sup id=\"cite_ref-:6_11-3\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p>\n<ol>\n<li><b>Evitare le forze di taglio<\/b><\/li>\n<li><b>Evitare le forze di compressione<\/b><\/li>\n<li><b>Avere un ritmo adeguato nelle attivit\u00e0 a causa della lentezza del recupero<\/b><\/li>\n<li><b>Monitorare il dolore<\/b><\/li>\n<li><b>Prevenire lo sviluppo di movimenti compensatori<\/b><\/li>\n<\/ol>\n<h4><span id=\"Shear_forces\" class=\"mw-headline\">Forze di taglio<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Shear forces\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=12\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Shear forces\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=12\">fonte di modifica<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Le forze di taglio sono spesso la causa di fondo delle lesioni osteocondrali nell&#8217;instabilit\u00e0 cronica della caviglia.<\/p>\n<blockquote><p>Evitare le forze di taglio per oltre tre mesi.<sup id=\"cite_ref-:6_11-4\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p><\/blockquote>\n<h4><span id=\"Compressive_forces\" class=\"mw-headline\">Forze di compressione<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Compressive forces\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=13\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Compressive forces\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=13\">fonte di modifica<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>La fibrocartilagine non \u00e8 forte come la cartilagine ialina.<\/p>\n<blockquote><p>Ritardare il <a title=\"Sostegno del peso\" href=\"\/Weight_bearing\">carico<\/a> completo fino a sei settimane, in base a specifici fattori clinici.<sup id=\"cite_ref-:6_11-5\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p><\/blockquote>\n<h4><span id=\"Slow_Recovery\" class=\"mw-headline\">Recupero lento<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Slow Recovery\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=14\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Slow Recovery\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=14\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>La riparazione della cartilagine richiede tempo.<\/p>\n<blockquote><p>Procedere con cautela con le fasi 1 e 2 e mantenere un carico parziale.<sup id=\"cite_ref-:6_11-6\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p><\/blockquote>\n<h4><span id=\"Monitor_pain\" class=\"mw-headline\">Monitoraggio del dolore<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Monitor pain\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=15\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Monitor pain\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=15\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<blockquote><p>Individualizzare il trattamento e rispettare il <a title=\"Pain Assessment\" href=\"\/Pain_Assessment\">dolore<\/a> del paziente.<sup id=\"cite_ref-:6_11-7\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p><\/blockquote>\n<h4><span id=\"Compensatory_movements\" class=\"mw-headline\">Movimenti compensatori<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Compensatory movements\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=16\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Compensatory movements\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=16\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<blockquote><p>Correggere gli schemi motori difettosi.<sup id=\"cite_ref-:6_11-8\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/p><\/blockquote>\n<h3><span id=\"Ankle_Osteochondral_Lesions_Treatment_Strategies(11)\"><\/span><span id=\"Ankle_Osteochondral_Lesions_Treatment_Strategies.5B11.5D\" class=\"mw-headline\">Strategie di trattamento delle lesioni osteocondrali della caviglia<sup id=\"cite_ref-:6_11-9\" class=\"reference\"><a href=\"#cite_note-:6-11\">(11)<\/a><\/sup><\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Ankle Osteochondral Lesions Treatment Strategies(11)\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=17\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Ankle Osteochondral Lesions Treatment Strategies(11)\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=17\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<h4><span id=\"Stage_1\" class=\"mw-headline\">Fase 1<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Stage 1\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=18\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Stage 1\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=18\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<ul>\n<li>Fare le cose con calma<\/li>\n<li>Muovere l&#8217;articolazione tibio-tarsica, ma NON esporla a forze di compressione o di taglio<\/li>\n<li>Incorporare il fitness cardiovascolare<\/li>\n<li>Mantenere un carico parziale<\/li>\n<\/ul>\n<p>Esempi di esercizi:<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n<li class=\"gallerybox\" style=\"width: 285px;\">\n<div style=\"width: 285px;\">\n<div class=\"thumb\" style=\"width: 280px;\">\n<div style=\"margin: 150px auto;\"><a class=\"image\" href=\"\/File:OCL_stage_1.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/4f\/OCL_stage_1.png\/250px-OCL_stage_1.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/4f\/OCL_stage_1.png\/375px-OCL_stage_1.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/4\/4f\/OCL_stage_1.png\/500px-OCL_stage_1.png 2x\" alt=\"\" width=\"250\" height=\"80\"><\/a><\/div>\n<\/div>\n<div class=\"gallerytext\">\n<p>Esercizi delicati in flessione dorsale e plantare della caviglia<\/p>\n<\/div>\n<\/div>\n<\/li>\n<li class=\"gallerybox\" style=\"width: 285px;\">\n<div style=\"width: 285px;\">\n<div class=\"thumb\" style=\"width: 280px;\">\n<div style=\"margin: 134px auto;\"><a class=\"image\" href=\"\/File:OCL.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/00\/OCL.png\/250px-OCL.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/00\/OCL.png\/375px-OCL.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/0\/00\/OCL.png\/500px-OCL.png 2x\" alt=\"\" width=\"250\" height=\"112\"><\/a><\/div>\n<\/div>\n<div class=\"gallerytext\">\n<p>Esercizi per gli arti inferiori con carico parziale e allineamento corretto<\/p>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<h4><span id=\"Stage_2\" class=\"mw-headline\">Fase 2<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Stage 2\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=19\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Stage 2\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=19\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<ul>\n<li>Questa fase si concentra sulla funzione<\/li>\n<li>\u00c8 considerata una fase di pre-partecipazione<\/li>\n<li>Il focus \u00e8 sui dettagli<\/li>\n<li>Progredire dal carico parziale a quello completo e stare in piedi su due piedi<\/li>\n<li>Aumentare il carico e la complessit\u00e0 del movimento<\/li>\n<\/ul>\n<p>Esempio di esercizi:<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n<li class=\"gallerybox\" style=\"width: 285px;\">\n<div style=\"width: 285px;\">\n<div class=\"thumb\" style=\"width: 280px;\">\n<div style=\"margin: 100px auto;\"><a class=\"image\" href=\"\/File:Phase_2_OCL.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/c\/cf\/Phase_2_OCL.png\/250px-Phase_2_OCL.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/c\/cf\/Phase_2_OCL.png\/375px-Phase_2_OCL.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/c\/cf\/Phase_2_OCL.png\/500px-Phase_2_OCL.png 2x\" alt=\"\" width=\"250\" height=\"180\"><\/a><\/div>\n<\/div>\n<div class=\"gallerytext\">\n<p>Progressione verso il carico completo con un corretto allineamento<\/p>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<h4><span id=\"Stage_3\" class=\"mw-headline\">Fase 3<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Stage 3\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=20\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Stage 3\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=20\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<ul>\n<li>Attivit\u00e0 per il fitness<\/li>\n<\/ul>\n<p>Esempi di esercizi:<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n<li class=\"gallerybox\" style=\"width: 285px;\">\n<div style=\"width: 285px;\">\n<div class=\"thumb\" style=\"width: 280px;\">\n<div style=\"margin: 16.5px auto;\"><a class=\"image\" href=\"\/File:Phase_3_OCL.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/43\/Phase_3_OCL.png\/250px-Phase_3_OCL.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/43\/Phase_3_OCL.png\/375px-Phase_3_OCL.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/4\/43\/Phase_3_OCL.png\/500px-Phase_3_OCL.png 2x\" alt=\"\" width=\"250\" height=\"347\"><\/a><\/div>\n<\/div>\n<div class=\"gallerytext\">\n<p>Esercizi basati sul SEBT<\/p>\n<\/div>\n<\/div>\n<\/li>\n<li class=\"gallerybox\" style=\"width: 285px;\">\n<div style=\"width: 285px;\">\n<div class=\"thumb\" style=\"width: 280px;\">\n<div style=\"margin: 97.5px auto;\"><a class=\"image\" href=\"\/File:Phase_III_ocl.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/a\/a6\/Phase_III_ocl.png\/250px-Phase_III_ocl.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/a\/a6\/Phase_III_ocl.png\/375px-Phase_III_ocl.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/a\/a6\/Phase_III_ocl.png\/500px-Phase_III_ocl.png 2x\" alt=\"\" width=\"250\" height=\"185\"><\/a><\/div>\n<\/div>\n<div class=\"gallerytext\">\n<p>Attivit\u00e0 per il fitness: step down\/step up<\/p>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<blockquote><p><i>Prima di passare alla fase 4, il paziente deve:<\/i><\/p>\n<ul>\n<li><i>Ottenere buoni punteggi nello <a title=\"Star Excursion Balance Test\" href=\"\/Star_Excursion_Balance_Test\">Star Excursion Balance Test (SEBT)<\/a><\/i><\/li>\n<li><i>Avere un range di movimento completo e indolore in flessione dorsale sotto carico<\/i><\/li>\n<li><i>Eseguire il test del saltello a una gamba sola senza dolore e con un buon allineamento<\/i><\/li>\n<li><i>Dimostrare un ragionevole controllo motorio nei movimenti mediali posteriori<\/i><\/li>\n<\/ul>\n<\/blockquote>\n<h4><span id=\"Stage_4\" class=\"mw-headline\">Fase 4<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Stage 4\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=21\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Stage 4\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=21\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<ul>\n<li><a class=\"external text\" href=\"https:\/\/blog.nasm.org\/fitness\/developing-power-in-everyday-athletes-with-plyometrics\" rel=\"nofollow\">Pliometria<\/a><\/li>\n<\/ul>\n<h2><span id=\"Resources\" class=\"mw-headline\">Risorse<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Resources\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=22\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Resources\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=22\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ol>\n<li>Saccomanni B. <a class=\"external text\" href=\"https:\/\/www.mathewsopenaccess.com\/scholarly-articles\/osteochondral-lesions-of-talus-a-comprehensive-review.pdf\" rel=\"nofollow\">Osteochondral Lesions of Talus: A Comprehensive Review.<\/a> Mathews J Orthop. 2018; 3(1): 021.<\/li>\n<li>Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG. <a class=\"external text\" href=\"https:\/\/online.boneandjoint.org.uk\/doi\/epub\/10.1302\/0301-620X.96B2.31637\" rel=\"nofollow\">Osteochondral lesions of the talus: aspects of current management.<\/a> Bone Joint J. 2014 Feb;96-B(2):164-71.<\/li>\n<li class=\"mw-empty-elt\">\n<\/li>\n<\/ol>\n<h2><span id=\"References\" class=\"mw-headline\">Citazioni<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;veaction=edit&amp;section=23\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=Management_of_Ankle_Osteochondral_Lesions&amp;action=edit&amp;section=23\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-:3-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:3_1-0\">1.0<\/a><\/sup> <sup><a href=\"#cite_ref-:3_1-1\">1.1<\/a><\/sup> <sup><a href=\"#cite_ref-:3_1-2\">1.2<\/a><\/sup> <sup><a href=\"#cite_ref-:3_1-3\">1.3<\/a><\/sup> <sup><a href=\"#cite_ref-:3_1-4\">1.4<\/a><\/sup> <sup><a href=\"#cite_ref-:3_1-5\">1.5<\/a><\/sup> <sup><a href=\"#cite_ref-:3_1-6\">1.6<\/a><\/sup> <sup><a href=\"#cite_ref-:3_1-7\">1.7<\/a><\/sup><\/span> <span class=\"reference-text\">Armiento AR, Alini M, Stoddart MJ. <a class=\"external text\" href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0169409X18303193?via%3Dihub\" rel=\"nofollow\">Articular fibrocartilage &#8211; Why does hyaline cartilage fail to repair?<\/a> Adv Drug Deliv Rev. 2019 Jun;146:289-305.<\/span><\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-2\">\u2191<\/a><\/span> <span class=\"reference-text\">Lakin BA, Snyder BD, Grinstaff MW. <a class=\"external text\" href=\"https:\/\/www.annualreviews.org\/doi\/full\/10.1146\/annurev-bioeng-071516-044525\" rel=\"nofollow\">Assessing cartilage biomechanical properties: techniques for evaluating the functional performance of cartilage in health and disease. Annual review of biomedical engineering<\/a>. 2017 Jun 21;19:27-55.<\/span><\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-3\">\u2191<\/a><\/span> <span class=\"reference-text\">Li G, Yin J, Gao J, Cheng TS, Pavlos NJ, Zhang C, et al. <a class=\"external text\" href=\"https:\/\/link.springer.com\/article\/10.1186\/ar4405\" rel=\"nofollow\">Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes<\/a>. Arthritis Res Ther. 2013;15(6):223. <\/span><\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-4\">\u2191<\/a><\/span> <span class=\"reference-text\">Hu Y, Chen X, Wang S, Jing Y, Su J. <a class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/s41413-021-00147-z.pdf\" rel=\"nofollow\">Subchondral bone microenvironment in osteoarthritis and pain<\/a>. Bone research. 2021 Mar 17;9(1):1-3.<\/span><\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-5\">\u2191<\/a><\/span> <span class=\"reference-text\">Imhof H, Sulzbacher I, Grampp S, Czerny C, Youssefzadeh S, Kainberger F. Subchondral bone and cartilage disease: a rediscovered functional unit. Investigative radiology. 2000 Oct 1;35(10):581-8.<\/span><\/li>\n<li id=\"cite_note-:4-6\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:4_6-0\">6.0<\/a><\/sup> <sup><a href=\"#cite_ref-:4_6-1\">6.1<\/a><\/sup><\/span> <span class=\"reference-text\">Lydon H, Getgood A, Henson FMD. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6376560\/\" rel=\"nofollow\">Healing of Osteochondral Defects via Endochondral Ossification in an Ovine Model<\/a>. Cartilage. 2019 Jan;10(1):94-101.<\/span><\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-7\">\u2191<\/a><\/span> <span class=\"reference-text\">Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1993 Apr;75(4):532-53. <\/span><\/li>\n<li id=\"cite_note-:5-8\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:5_8-0\">8.00<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-1\">8.01<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-2\">8.02<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-3\">8.03<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-4\">8.04<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-5\">8.05<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-6\">8.06<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-7\">8.07<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-8\">8.08<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-9\">8.09<\/a><\/sup> <sup><a href=\"#cite_ref-:5_8-10\">8.10<\/a><\/sup><\/span> <span class=\"reference-text\">Krause F, Anwander H. <a class=\"external text\" href=\"https:\/\/eor.bioscientifica.com\/view\/journals\/eor\/7\/6\/EOR-22-0024.xml\" rel=\"nofollow\">Osteochondral lesion of the talus: still a problem?<\/a>. EFORT open reviews. 2022 Jun 1;7(6):337-43.<\/span><\/li>\n<li id=\"cite_note-:0-9\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:0_9-0\">9.0<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-1\">9.1<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-2\">9.2<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-3\">9.3<\/a><\/sup><\/span> <span class=\"reference-text\">Mosca M, Grassi A, Caravelli S. Osteochondral Lesions of Ankle and Knee. Will Future Treatments Really Be Represented by Custom-Made Metal Implants?. Journal of Clinical Medicine. 2022 Jul 1;11(13):3817.<\/span><\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-10\">\u2191<\/a><\/span> <span class=\"reference-text\">Ferkel RD, Chams RN. Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int. 2007 Jan;28(1):24-31.<\/span><\/li>\n<li id=\"cite_note-:6-11\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:6_11-0\">11.0<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-1\">11.1<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-2\">11.2<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-3\">11.3<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-4\">11.4<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-5\">11.5<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-6\">11.6<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-7\">11.7<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-8\">11.8<\/a><\/sup> <sup><a href=\"#cite_ref-:6_11-9\">11.9<\/a><\/sup><\/span> <span class=\"reference-text\">Simpson H. Osteochondral Lesions Course. Plus2022<\/span><\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-12\">\u2191<\/a><\/span> <span class=\"reference-text\">Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 1959 Sep;41-A:988-1020.<\/span><\/li>\n<li id=\"cite_note-:1-13\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_13-0\">13.0<\/a><\/sup> <sup><a href=\"#cite_ref-:1_13-1\">13.1<\/a><\/sup> <sup><a href=\"#cite_ref-:1_13-2\">13.2<\/a><\/sup><\/span> <span class=\"reference-text\">Badekas T, Takvorian M, Souras N. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3764304\/\" rel=\"nofollow\">Treatment principles for osteochondral lesions in foot and ankle<\/a>. Int Orthop. 2013 Sep;37(9):1697-706. <\/span><\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-14\">\u2191<\/a><\/span> <span class=\"reference-text\">Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T. Osteochondral lesions of the talus. Am J Sports Med. 1993 Jan-Feb;21(1):13-9. <\/span><\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-15\">\u2191<\/a><\/span> <span class=\"reference-text\">Ferkel RD, Sgaglione NA, DelPizzo W. Arthroscopic treatment of osteochondral lesions of the talus: long-term results. Orthop Trans. 1990;14:172\u2013173.<\/span><\/li>\n<li id=\"cite_note-:2-16\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:2_16-0\">16.0<\/a><\/sup> <sup><a href=\"#cite_ref-:2_16-1\">16.1<\/a><\/sup><\/span> <span class=\"reference-text\">Elghawy AA, Sesin C, Rosselli M. <a class=\"external text\" href=\"https:\/\/bmjopensem.bmj.com\/content\/4\/1\/e000318\" rel=\"nofollow\">Osteochondral defects of the talus with a focus on platelet-rich plasma as a potential treatment option: a review.<\/a> BMJ Open Sport Exerc Med. 2018 Feb 1;4(1):e000318.<\/span> <\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-17\">\u2191<\/a><\/span> <span class=\"reference-text\">Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999 Dec;20(12):789-93.<\/span><\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-18\">\u2191<\/a><\/span> <span class=\"reference-text\">Sophia Fox AJ, Bedi A, Rodeo SA. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3445147\/\" rel=\"nofollow\">The basic science of articular cartilage: structure, composition, and function. Sports Health<\/a>. 2009 Nov;1(6):461-8. <\/span><\/li>\n<\/ol>\n<\/div>\n<p><!-- NewPP limit report Cached time: 20230109192436 Cache expiry: 0 Dynamic content: true Complications: () CPU time usage: 0.144 seconds Real time usage: 0.153 seconds Preprocessor visited node count: 522\/1000000 Post\u2010expand include size: 67\/2097152 bytes Template argument size: 0\/2097152 bytes Highest expansion depth: 3\/40 Expensive parser function count: 0\/100 Unstrip recursion depth: 0\/20 Unstrip post\u2010expand size: 16008\/5000000 bytes --><br \/>\n<!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 13.471 1 Special:Contributors\/Management_of_Ankle_Osteochondral_Lesions 100.00% 13.471 1 -total --><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Redattrice principale &#8211; Ewa Jaraczewska sulla base del corso di Helene Simpson Principali collaboratori &#8211; Ewa Jaraczewska, Jess Bell, Lucinda Hampton e Kim Jackson Contenuti 1 Definizioni 2 Guarigione delle lesioni osteocondrali 2.1 Eziologia delle lesioni osteocondrali 3 Lesioni osteocondrali della caviglia 3.1 Sistema di classificazione per le lesioni osteocondrali della cartilagine dell&#8217;astragalo 4 Presentazione [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-4519","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4519","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/comments?post=4519"}],"version-history":[{"count":4,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4519\/revisions"}],"predecessor-version":[{"id":4684,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4519\/revisions\/4684"}],"wp:attachment":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/media?parent=4519"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}