Treatment methods

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 has specialised in treating cartilage damages to the ankle joint for many years, and can therefore offer you a whole range of medical treatment, from ankle joint surgery to rehabilitation.

Surgical treatment methods

Ankle cartilage injuries: surgery

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 in 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 in 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, especially if 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. Our 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 to you 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.

Ankylosis of the ankle joint (arthrodesis)

If none of the procedures above can be considered, we can reinforce your ankle joint. 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.