Ankle cartilage injuries

Get active and on your feet again

Love jogging, climbing or hiking? When your ankle is in great physical condition, being active on your feet is a walk in the park. But when ankle pain arises, you can no longer rely on your foot to take the strain. This is often the result of a cartilage injury in the upper ankle joint. If pieces of cartilage become loose in the joint, this can cause the joint to weaken.

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 is stabilised by the surrounding tendons and ligaments. Between your joint bones is a very smooth and elastic layer of joint cartilage. This ensures that your bones do not painfully rub against each other and lets you move around smoothly.

Ankle cartilage injury: Symptoms indicating an injury

Even if the pain is only intermittent or is tolerated well, we recommend visiting a consultant to confirm the diagnosis. Symptoms can vary and some cartilage injuries do not cause pain as the cartilage itself doesn’t contain any pain fibres.

With an advanced cartilage injury however, every movement or step will cause pain. Sports are almost certainly out of the question and may result in a feeling of the area around your joint being blocked. 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 cases of ankle pain, swelling, or limitation in movement and reduced endurance, our specialists at Schoen Clinic are here to help.

Ankle cartilage injuries: Potential causes

  • Circulatory disorders
  • Joint developmental disorders
  • 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
  • After an accident. Symptoms may be evident, particularly for athletes

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 will assess the shape of your foot, the mobility of your ankle joint, the stability of your ligaments and your sensitivity to pressure. X-rays of your ankle joint will also be taken allowing 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 determine exactly where and how advanced the damage to your cartilage is. Using these images, we can also assess the circulation of the surrounding bone. If we establish that you have severe bone damage, we may additionally carry out computer tomography (CT).

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.

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.

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.

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.

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.

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.

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.

Rehab After Cartilage Injury Surgery

Surgery is the first step to having a functioning joint again. Through outpatient rehabilitation, we fully focus on getting you to be able to move again and put weight on your joint. In the first six weeks your leg will be immobilised and for a further four to six weeks our expert physiotherapists will assist you to restore your carrying capacity step-by-step. Physiotherapeutic exercises will effectively support your recovery process to ensure the success of the surgery. How much your cartilage can regenerate depends on several factors i.e. your age, weight and individual regeneration potential. It sometimes takes several months before the final results are achieved.

Individual rehabilitation concept

At Schoen Clinic, we promise to offer a tailored solution for you. Therefore, in conjunction with your consultant, we will produce a treatment concept to assist you in obtaining the best results possible.

Mobilisation: First passive, then active

Regular movement of your joint without strain greatly supports the healing phase and results in your body producing more joint fluid which stimulates the creation of new cartilage cells. These cells can also use this fluid to sustain themselves. During your stay in hospital, you will learn from our specialists what you can do to best promote cartilage regeneration.

Ankle cartilage injuries: Our specialists

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

Ankle cartilage injuries: Our specialised hospital

From diagnosis to treatment and aftercare, your entire journey as our patient will be handled with care, quality and exceptional service.