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 is common enough to treat injuries conservatively, modifying sports activities and monitoring how the injury develops. However, if significant pain is present, surgery is often the only beneficial way to improve the situation.
At Schoen Clinic, our specialists can offer you a whole range of medical treatment, from ankle joint surgery to pain management and rehabilitation.
Surgical treatment methods
- Ankylosis of the ankle joint (arthrodesis)
- Removal of loose pieces of cartilage
- Transplantation of knee joint cartilage into the ankle joint
- Insertion of membranes for new cartilage formation
- Fixation of the membrane using tissue adhesive
- Joint replacement: Artificial ankle joint
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 will be able to put weight on your foot again with almost no limitations.
Ankylosis is beneficial for younger, active patients. In most cases, if we limit the reinforcement to the destroyed joint parts, a large amount of mobility can be preserved in your hind foot. This procedure can be carried out via arthroscopic (keyhole) surgery for many patients. 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.
Transplantation of knee joint cartilage into the ankle joint
Sometimes, not enough new cartilage forms after an arthroscopy procedure and in these cases, as well as more severe injuries, major ankle joint surgery will be required. One treatment option involves transplanting the body’s own cartilage from another joint into the injured ankle e.g. cartilage from your knee joint would then be removed to act as a gliding layer in your ankle joint. This procedure requires good access to the cartilage surfaces i.e. 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. This procedure will only be used in special circumstances when no other solution is available in order to avoid any potential damage to healthy knee joints.
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. Via 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.
Removal of loose pieces of cartilage
We can generally operate on smaller cartilage injuries with a diameter of up to 1cm 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. Approximately, 80- 95% of our patients continue to feel significantly better after this procedure, even five years later they will experience little or no pain at all in the ankle joint.
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 will then diffuse from the bone marrow within this scaffold. This special membrane environment supports their transformation into cartilage-like tissue. In this procedure, a small incision will be made to open the joint, the damaged cartilage will be removed, followed by smoothing of the cartilage and bone edges. The surgeon will then drill 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.
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 can assist you in maintaining mobility in your ankle joint. In fact, between 85 and 90% of inserted replacements are still intact even after ten years. In the unlikely event that the artificial ankle joint locks up, we can typically replace this with a new one in a second operation. If this isn’t possible, your ankle joint can be reinforced via surgery.