In larger osteochondral lesions in the ankle joint - most of them occurring posteromedially - the methods of microfracture and abrasion generally produce mediocre and unsatisfactory results (7). Even though no long-term results are as yet available regarding the functionality of autologous cartilage transplantations in the ankle joint, the short to medium-term results of all published studies to date are excellent (8,9,22). These transplants provide the option of placing hyaline joint cartilage exactly at the site of the lesion and of compensating for osseous defects. Through modification of the technique originally described by Hangody, improvement of press-fit behaviour, and the use of larger cylinders to reconstruct the talus edges, most defects can be anatomically completely restored. Our own internationally recognized studies have been able to provide excellent documentation of the superiority of this procedure with good to excellent results in 93% of cases, to a large extent with freedom from pain and full functionality.
Small cartilage-bone cylinders are harvested from unaffected areas of the knee joint and inserted into specially prepared holes in the defective area of the ankle joint. However, the method is technically quite challenging, particularly if executed arthroscopically, and requires a high degree of surgical expertise and experience.
Arthroscopic image of
cartilage damage in the ankle joint
Defective cartilage cylinder from the
ankle joint next to a replacement
cylinder from the knee joint
1 year after the transplantation, an
anatomical reconstruction of the defect at the
trochlea of the astragalus is apparent.
Before your operation
Do not put your joint under unnecessary strain, because this will extend your recovery period after the operation.
Arrange treatment dates with your physiotherapist or masseur, beginning about 4-5 days after the operation. If the operation is to be carried out under general anaesthesia, you must not eat or drink for six hours beforehand (‘nil by mouth’). Remember to stop taking aspirin or similar medication (including ASS 100) at least 1 week prior to the operation.
After your operation
The following are general guidelines:
Elevate. Rest until wound is completely healed (5-10 days). Cool the joint repeatedly with a dry ice-pack (for about 15 minutes). As soon as pain and swelling permit, increase your mobility. Immobilization is generally not required!
Medication
Anti-inflammatory and analgesic tablets (diclofenac or paracetamol) prevent inflammation and control pain.
Recommended dosage: 3 x 1 tablet per day for 7-14 days
Antithrombotic injections (e.g. Fragmin) to prevent thromboses are to be administered for at least as long as you use crutches to ease the load on your foot. They are to be injected into the abdominal skin once a day as shown.
Aftercare
Stitches are generally removed after about 8-10 days. Active and passive mobilization of the joint starts immediately after the operation, with reduced weight-bearing. The transition to full weight-bearing follows after about four weeks, combined with an intensive physiotherapeutic exercise regime. After a minimum of about 4 months, sporting activities can be resumed.