By Mr Andy Goldberg OBE
Consultant Orthopaedic Surgeon

Articular cartilage is the thin shock absorber of the ankle. Like all joint surfaces the ankle is lined by cartilage which allows smooth gliding motion and transmits forces from the floor to the body. When the articular cartilage becomes damaged, as a result of trauma (ankle sprains or fractures) or as a result of loss of blood supply (osteochondritis dissecans) then the body has a limited repair potential.

In the ankle joint fluid under high pressure can also become forced under the cartilage and into the bone creating a bone cyst, which causes a deep dull ache and prevents sufferers from running, jogging or playing any sports and sometimes even from carrying out everyday activities such as walking to work.

This damage can also lead to further breakdown of the joint resulting in early osteoarthritis. Joint replacement in active, younger patients often gives inferior outcomes and will result in early failure due to the higher demands being placed upon the implant.

The Cartilage Transplantation and the Foot and Ankle Units at the world-renowned Royal National Orthopaedic Hospital, Stanmore have over the last fifteen years pioneered the technique of cartilage transplant in the United Kingdom.  Over 1500 cases have been performed in the knee and ankle with good success rates. In knees it has been shown that the onset of osteoarthritis, which affects 25% of people over 50, might also be delayed, and hence may even reduce the need for joint replacement. 

Patients presenting to the Unit are assessed fully and then investigations such as MRI scans or CT scans will be arranged. If non operative measures have failed then following careful counselling, surgery may be considered.

There are a host of surgical treatments available and the merits and risks of each will be discussed with you carefully. The traditional treatment is known as microfracture in which tiny holes are made in the bone to encourage healing of the damaged area using the patient’s own stem cells. A much newer treatment involves harvesting a much larger volume of the patients’ own stem cells from the patient’s hip.  The cells are the spun down at high speed in a specialised machine in the operating room. This provides a concentrated volume of nucleated cells, including stem cells, which are then transplanted and secured back into the ankle joint in the same procedure.  Other techniques use small metallic implants (Hemicap) and sometimes ligament stabilisation (Brostrum repair) or a controlled break of the bone (an osteotomy) is necessary to gain access but these additional procedures are only carried out where essential.

Mr Andrew Goldberg is leading on several studies at the RNOH, which alongside his colleagues Mr Nick Cullen and Mr Dishan Singh, assess new ankle treatments with the hope of improving quality of life and prolonging the development of ankle arthritis.

Cassie's Story - Innovative surgery for ankle arthritis using stem cells and resurfacing

For more information please contact the Royal National Orthopaedic Hospital Private Patient Unit: 020 8909 5712/13

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