Ankle Cartilage Injuries & Surgery

At Schoen Clinic, you can receive comprehensive advice from our foot and ankle specialists and discuss which treatment is best for your symptoms.


We'll help you get back on your feet again

Jogging, climbing or hiking? No problem when your ankle is okay. But when ankle pain arises, you can no longer rely on your foot to take the strain. The culprit is often a cartilage injury in the upper ankle joint. If pieces of cartilage come off in the joint, this can cause the joint to weaken (arthritis).

Why do we have cartilage?

Your upper ankle joint is made up of three bones: the shin bone, the fibula and the ankle bone. It’s stabilised by the tendons and ligaments. Between your joint bones is a very smooth and elastic layer of joint cartilage. This ensures that your bones don’t painfully rub against each other and lets you move around smoothly.

Ankle Cartilage Damage

Ankle cartilage injuries: potential causes

Localised cartilage injuries of the ankle joint and general joint wear (arthritis) are different. Localised cartilage injuries are often caused by circulatory disorders, joint developmental disorders or trauma due to rolling over on the joint or slipping. While localised cartilage injuries predominantly affect younger people, arthritis is typically a disorder in the later stages of life.

Symptoms may be evident after an accident, particularly for athletes, or you may suddenly feel like the area around the ankle cartilage injury is blocked without an accident having happened. Even if the pain is tolerated well or intermittent, we recommend visiting a consultant as soon as possible.

Ankle cartilage injury: symptoms indicating an injury

Symptoms vary according to the type of your cartilage injury. Not every cartilage injury causes pain, either, because the cartilage itself doesn’t have any pain fibres and therefore cannot feel anything. 

With an advanced cartilage injury, every movement or step will cause pain. Sports are completely out of the question. A feeling of the area around your joint being blocked may also occur. This is a sign that pieces of cartilage have come loose from the joint surface and are blocking the joint, like a pebble between two gears.

In case of ankle pain, swelling, a limitation in movement and reduced endurance, we offer specialist foot consultations at Schoen Clinic.


Diagnosis: find the exact causes of your symptoms

During an initial consultation, our specialist will ask you targeted questions to uncover initial evidence of a potential cartilage injury. In a subsequent examination, we’ll assess the shape of your foot, the mobility of your ankle joint, the stability of your ligaments and the sensitivity to pressure. X-rays of your ankle joint will also be taken, sometimes of your foot while standing as well. This allows us to carry out a precise analysis of your bones and the positioning of your joints under stress.

MRI visualises the circulatory system

Magnetic resonance imaging (MRI) of your hind foot is normally required to let us see exactly where the damage is located. It allows us to see how advanced the damage to your cartilage is as well. Using these images, we can also assess the circulation of the surrounding bone. If we establish that you have severe bone damage, we may carry out computer tomography (CT) in addition.

Ankle Cartilage Surgery

Ankle cartilage injuries: surgery only in exceptional cases

We can decide how urgent the need for treatment is based on the MRI images. Not all cartilage injuries create an unavoidable increased risk of arthritis. It’s often enough to modify sports activities and monitor how the injury develops. However, if significant pain is present, surgery is often the only beneficial way to improve the situation.
Schoen Clinic our specialists can offer you a whole range of medical treatment, from ankle joint surgery to rehabilitation.

Surgical treatment methods

Ankylosis of the ankle joint (arthrodesis)

This involves removing the destroyed cartilage from your joint and securely screwing your ankle bone onto the shin bone. Both bones will have merged together stably after six to twelve weeks, and you’ll be able to put weight on your foot again with almost no limitations. 

Ankylosis is therefore only beneficial for younger, active patients. By limiting the reinforcement to the destroyed joint parts, in most cases, a large amount of mobility can be preserved in your hind foot. For a lot of patients, this procedure can be carried out through arthroscopy. And today, ankylosis is carried out in such a way that changing over to an artificial ankle joint would still be possible at some point in the future.

Removal of loose pieces of cartilage

We can generally operate on smaller cartilage injuries with a diameter of up to 1 cm through arthroscopy. In this procedure, the surgeon removes the loose pieces of cartilage using minimally invasive methods, thereby taking special care to protect tissue. They then drill into the underlying bone. Through these holes, stem cells can diffuse from the bone marrow into the defective zone and create a fibrous cartilage layer. Your body can then create replacement cartilage in the joint after the operation. 80 to 95% of our patients continue to feel significantly better after this procedure, even five years later. They have little to no pain at all in the ankle joint.

Transplantation of knee joint cartilage into the ankle joint 

Sometimes, not enough new cartilage forms after an arthroscopy procedure. In this case, as well as for more severe injuries to your cartilage, major ankle joint surgery will be required. One treatment possibility involves transplanting the body’s own cartilage from another joint into the injured ankle. Cartilage from your knee joint for example would then be removed to act as a gliding layer in your ankle joint straight away. This attachment requires good access to the cartilage surfaces, meaning that as part of this procedure, most of the inner ankle will need to be separated to create enough space. Once the cartilage has been implanted, the inner ankle is screwed together again. Because you don’t want to damage your healthy knee joint by having cartilage removed, this procedure is still only used in special circumstances, where other solutions are not available.

Insertion of membranes for new cartilage formation

Larger cartilage defects are now typically treated using special high-tech membranes. These permeable pieces of skin promote and support new cartilage formation in your joint. They can be introduced to the membrane as cartilage without cells. The stem cells diffuse from the bone marrow within this scaffold. The special membrane environment supports their transformation into cartilage-like tissue. 

In the procedure, we open your joint through a small incision. We then remove the damaged cartilage and smooth the cartilage and bone edges. Your surgeon then drills several small holes into the free-lying bone to let stem cells escape the bone marrow. This procedure has been successfully used in different joint regions for over ten years and significantly supports cartilage regeneration.

Fixation of the membrane using tissue adhesive

If there is a hole in your bone due to a cyst, we fill in this area using the body’s own bone material or bone grafts from the heel bone, tibia head or pelvic crest. It’s similar to dental treatment, where a hole in a tooth is closed via filling. The artificial membrane is then fixed using tissue adhesive. Through this method, the escaping stem cells can distribute themselves equally on the membrane and rebuild themselves as replacement cartilage tissue. One benefit is that cartilage defect treatment using membranes can typically be carried out without separating the inner ankle.

Joint replacement: artificial ankle joint

Similar to the knee and hip joint, we can also replace your upper ankle joint with an artificial one. This lets you maintain mobility in your ankle joint. Between 85 and 90% of inserted replacements are still intact even after ten years. But if the artificial ankle joint locks up, we can typically replace this with a new one (second operation). If this isn’t possible, your ankle joint is reinforced through surgery.

Rehabilitation & Aftercare

Moving gets you back on your feet quicker

Surgery is the first step to having a functioning joint again. Through outpatient physiotherapy, we fully focus on getting you to be able to move again without pain and put weight on your joint. You’ll first need to immobilise your operated leg for at least six weeks. Afterwards, you’ll restore your carrying capacity step-by-step together with our physiotherapists. Although this will take another four to six weeks, it will be worth it. The regenerated cartilage will be very soft at the beginning. If you build up your capacity too quickly, this can jeopardise the success of surgery. You’ll support a speedy recovery process through physiotherapy exercises. How much your cartilage can regenerate depends on several factors, including your age, weight and individual regeneration potential. It sometimes takes several months before the final results are achieved. However, we’ll guide you along this journey and initiate the best supporting measures for you.

Individual rehabilitation concept

At Schoen Clinic, we promise to offer the best treatment for you. Our treatment concept will therefore be built on different building blocks we put together for you individually, in agreement with your consultant.

So you can be mobile again as quickly as possible, your aftercare will begin just one day after surgery when you first step out of bed. 

Mobilisation: first passive, then active

Regular movement of your joint without strain greatly supports the healing phase. Your body produces more joint fluid, creating cartilage cells which form almost like new ones. These cells can also use this fluid to sustain themselves. During your stay in hospital, you’ll learn what you can do to best promote cartilage regeneration.


Mr Ali Abbasian

Consultant Orthopaedic Surgeon MBBS FRCS(Tr&Orth)

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Mr Kumar Kunasingam

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Mr Stefan Weitzel

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Dr Philip Batty

Consultant Sport and Exercise Physician MB ChB, MRCGP, FFSEM

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