Knees and hips seem to be on everyone’s minds these days, but surgical alternatives are equally important for all joints. Interestingly, especially for ankles, as they carry the weight of those knees and hips and backs and shoulders and necks, and everything else above them. This is the story of unsuccessful and damaging surgeries, and a new Ankle Surgery Alternative using Interventional Orthopedics you’re not going to see anywhere else on earth other than at select qualified Regenexx Network providers.
How Does The Ankle Work?
The main Ankle joint, or Talocrural joint is a hinge joint containing synovial fluid that connects the ends of the Tibia and Fibula bones in the leg with the end of the Talus bone in the foot. The connection point between the tibia and the talus is larger and bears a greater proportion of the weight than the connection between the smaller fibula and the talus.
An elaborate system of very strong ligaments articulate the movement of the foot at the ankle including the deltoid ligament, and the three lateral ligaments; the anterior talofibular ligament, the posterior talofibular ligament and the calcaneofibular ligament.
Because of the enormous weight in motion that the ankle joint handles, it is particularly prone to sprains in which the ligaments are stretched, or damaged. Untreated sprains cause ankle instability, which can then lead to arthritis, bone spurs, and bone marrow lesions.
The Story Begins
This particular patient happened to be a Cirque du Soleil performer with a nasty cartilage lesion in the top part (tibial part) of the main ankle joint. The story did not begin with her looking for an ankle surgery alternative, as she never knew such a thing existed. The story actually began with the fact that she had intact but poor cartilage, or Chondromalacia, for which she sought traditional orthopedic help. In hopes of correcting the situation, a surgeon performed two common orthopedic surgeries: a debridement of the cartilage, which means she removed it, and then an ankle Microfracture surgery, which is a surgery in which they poke holes in the bone hoping to encourage new cartilage growth. Neither surgery had the desired result and instead left her with a hole in the cartilage and a pit in the bone. Her body’s response to those newly created problems was to develop a large bone cyst adjacent to the pit and large bone marrow lesions. Despite, and because of the two surgeries, she now had issues both in the bone and in the joint to deal with.
Interventional Orthopedics: A New Ankle Surgery Alternative
The image you see above is of a procedure using a small 15 gauge special needle to place stem cells into the exact location of her bone lesion (subchondroplasty) as well as into the ankle joint right where her cartilage was in trouble. Looking at these images, I realized that this this type of exacting work through needles with stem cells is simply not available elsewhere. Though many clinics now offer stem cells, most would inject the stem cells blindly somewhere in the vicinity of the ankle joint, and those with more experience and training might use an ultrasound to get them into the joint. However, the problem is ultrasound is not capable of seeing inside the joint at this depth or inside bone, so there would simply be no way to accurately place the cells in the joint or place cells into her bone lesion.
The video below demonstrates the the precise nature of, and the different types of injections we use to treat different issues in each joint.
The upshot? Like we see all too often, common orthopedic surgeries often create more problems than they solve. This new ankle surgery alternative exemplifies both the Regenexx Difference and the potential of Interventional Orthopedics to replace more invasive surgeries with innovative and less invasive and exacting injection procedures, or as in this case, clean up the messes they create!