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 an Ankle Surgery Alternative using Interventional Orthopedics you’re not going to see anywhere else on earth other than at select qualified Regenexx Network providers.
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.
This particular patient had a nasty cartilage lesion in the top part (tibial part) of the main ankle joint. The story did not begin with looking for an ankle surgery alternative, as the patient never knew such a thing existed. The story actually began with the the fact that though their cartilage was intact, it was poor cartilage, or Chondromalacia, for which traditional orthopedic care was sought. In hopes of correcting the situation, a surgeon performed two common orthopedic surgeries: a debridement of the cartilage, which means they 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 the patient with a hole in the cartilage and a pit in the bone. The 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, the patient now had issues both in the bone and in the joint to deal with.
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 the bone lesion (subchondroplasty) as well as into the ankle joint right where the 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 the 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 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!
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…