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Arthroscopic Drilling for Ankle Lateral Instability

Damage to the cartilage in the ankle occurs much less often than similar injuries in the knee. When it does occur, damaging osteoarthritis (OA) can develop later. When the cartilage is pulled away from its attachment to the bone it's called a full-thickness defect.

In this study surgeons use arthroscopic drilling to treat stage 2 and 3 osteoarthritis (OA) of the ankle. All cases of OA were associated with full-thickness defects. OA can be caused by a previous injury such as an ankle sprain or fracture. It can also occur as a result of ankle deformity from paralysis.

Drilling into the bone and removing any fragments of cartilage helps stimulate healing of the cartilage in this area. The authors report this treatment method works better in the ankle than it does in the knee for several reasons.

First, the cartilage in the ankle is thinner and stiffer than in the knee. Faster healing with greater regeneration of cartilage cells occurs in the ankle. This may be because of unique biomechanical properties of the ankle.

After drilling, the surgeon reconstructed the lateral ligament to increase ankle stability. The operation is described in detail. The gracilis tendon from the knee was used as the donor graft to replace the torn ankle ligaments.

Results were measured by improvements in function and anatomic changes seen on X-rays. A second-look arthroscopy was also done one year later. Patients with stage 2 OA had nearly normal joint space after the drilling and stabilization of the ankle. Severe loss of joint space was still present in patients with stage 3 OA. The authors only recommend this treatment for stage 2 OA.

Masato Takao, MD, PhD, et al. Reconstruction of Lateral Ligament with Arthroscopic Drilling for Treatment of Early-Stage Osteoarthritis in Unstable Ankles. In The Journal of Arthroscopic and Related Surgery. October 2006. Vol. 22. No. 10. Pp. 119-1125.

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