25A #1A SUR -45 Medellin, Antiqua, Colombia, 050022. Singh JA, et al. Often patients seek second opinions because they have been told they need an ankle fusion by a doctor elsewhere who may not be familiar with the latest research on ankle replacement. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Neal Blitz, DPM, FACFAS, is a board-certified doctor of podiatric medicine and creator of the Bunionplasty procedure. _____________ Ulici A, Balanescu R, Topor L, Barbu M. The modern treatment of the simple bone cysts. Severe blood vessel injuries may actually result in an amputation, while nerve injuries may create a permanent numbness in the foot. In: Campbell's Operative Orthopaedics. Barg, A. While the artificial ankle can wear out and may need to be replaced, research shows 90% are still functioning well 10 years after surgery. ", University of Michigan Health System: "Total Ankle Replacement.". The ankle is one of the most injury prone areas of the body. Pros and cons of ankle ligament repair for a serious injury? This is an extreme injury that is difficult to treat. 2016;3(1):3. doi:10.1186/s40634-016-0038-4, Barg A, Wimmer MD, Wiewiorski M, Wirtz DC, Pagenstert GI, Valderrabano V. Total ankle replacement. By Neal Blitz, DPM, FACFAS Outcomes vary on study design, the specific type of surgery, and patient demographics. The skin may not heal well and require nursing care for several weeks, or even surgical revision. This allows the bones to fuse together naturally through a process called bone remodeling. It is therefore necessary to be careful given the risks posed by sports that put strain on the ankle. Surgery options include repair or reconstruction of the damaged ligaments. Philadelphia, Pa.: Elsevier; 2017. http://www.clinicalkey.com. Contact Us / Make an Appointment. The second is a full tear, but the ligament is still intact. This may be because the person is overweight or has another condition such as severe nerve damage; paralysis; a history of infection or diabetes; or avascular necrosis -- a condition in which the blood supply to the joint is cut off, which causes the ankle bone tissue to die. Cons. Ankle replacement is a newer option. John R. Schultz M.D. Some of the nasty complications include nerve damage and additional surgery. Although some people may be concerned that the fusion will affect their normal gait, most who need the surgery will have already lost significant range of motion in the joint and won't notice a difference. 2019 Oct;101-B(10):1256-62.doi:10.1302/0301-620X.101B10.BJJ-2019-0207.R1, Lawton CD, Butler BA, Dekker RG, et al. On the other, ankle fusion is safer and more reliable, with half as many people needing additional surgery compared to arthroplasty.. Current concepts in osteoarthritis of the ankle: review. Ankle Arthrodiastasis. Ligament and tendon reconstruction is an open surgery involving at least one incision. Although unlikely and rare, some people experience blood vessel injuries or nerve injuries after the ankle fusion surgery has been completed. The peroneal tendon is a common tendon used in ankle reconstruction. The issues that someone may be facing within their ankle joint are immediately relieved after the fusion has been completed. "I typically recommend that patients consult with their primary care physicians before ankle replacement to be sure that they are as healthy as they can possibly be," Easley says. Our medical and scientific team continues research to improve therapies and offer additional treatment options. We thus talk of ankle instability responsible for pain and feelings of giving way. American Academy of Orthopaedic Surgeons: "Arthritis of the Foot and Ankle. Ankle replacement surgery is the replacement of a damaged ankle joint with an artificial implant. While attractive to younger people who want to avoid more invasive procedures, ankle arthrodiastasis is effective for only about half of people. Still, it doesn't destroy underlying tissues and may help preserve future treatment options. Your doctor will consider a few things before recommending surgery, such as: Easley says avid runners, or people who plan to do high-impact activities, are not considered good candidates for the surgery. Some athletes wear a sleeve or tights that go below the knee for compression and comfort. Lets dig in. ", American Orthopaedic Foot & Ankle Society: "Position Statement: The Use of Total Ankle Replacement for the Treatment of Arthritic Conditions of the Ankle," "Total Ankle Arthroplasty. To prevent fractures in weakened areas of boneparticularly fluid-filled subchondral cysts inside the ankle jointa bone marrow injection (using cells harvested from the patient) may be recommended.. Disclaimer: Cell therapy offers no guarantees and is not promoted as a cure. Dr. Schultz trained at George Washington School of 303-429-6448 There are no other methods besides surgery to repair this type of injury. Platelet-rich plasma (PRP) is extracted from a patient's own blood and then injected into the ankle joint to promote healing and reduce inflammation. While the artificial ankle can wear out and may need to be replaced, research shows 90% are still functioning well 10 years after surgery. Shakked RJ, Karnovsky S, Drakos MC. Once the stem cells are injected into the problematic area, they go straight to work. In the event of arterial damage, vascular surgery may be necessary. However, loosening of the components can occur. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). The only patients that need surgery are patients that have completely torn their ankle ligament and it is retracted as well. When conservative therapiessuch as ankle braces, cushioned insoles, anti-inflammatory drugs, cortisone injections, and physical therapyfail to provide relief, surgery may be considered if the pain and loss of mobility seriously impair your quality of life. The Best Walking Shoes for Plantar Fasciitis of 2023. If ankle fusion is recommended, it is important to weigh the pros and cons to decide if it's the best option for you as an individual. Any personal information provided is for internal and medical use with our medical providers only. Ankle ligament surgery involves significant pain, recovery, and rehabilitation The PAL procedure, a precise injection of bone marrow concentrate into damaged ligaments is a safe, effective nonsurgical alternative to Brostrom ankle surgery that does not require extensive rehabilitation or have the surgical risks. Curr Rev Musculoskelet Med. Ramdass B, Koka PS. November 1, 2016. Ligaments are thick bands of connective tissue that connects bone to bone. The recovery period is shorter than ankle fusion - typically three to six weeks in a cast followed by physical therapy. Allscripts EPSi. Dtsch Arztebl Int. Health A-Z . Your email address will not be published. ligaments are tough, non-stretchable fibers that hold the bones together. Arthrosc Tech. I suffered a complete non-displaced fracture of the anterior process of the calcaneous. Patients can spend up to 10 to 12 weeks in a cast. 2017;12:76. doi:10.1186/s13018-017-0576-1. Trocadro office, 9 rue Le tasse, 75116 Paris, SUBWAY: Line 6, Trocadro ou Passy stop and Line 9, Trocadro stop, BUS : Bus 32, Scheffer stop and Bus 22, Scheffer stop. Modern prosthetics are composed of porous metallic materials stabilized with or without cement., Although prosthetic designs have improved in recent decades, ankle replacement remains challenging because of the joints multidirectional physiology. According to a 2017 review in the Journal of Orthopedic Surgery and Research, 26.9% of people who underwear ankle fusion surgery experienced complications versus 19.7% of those who had an ankle replacement. Fusing together the major bones of the lower leg (the tibia and fibula) with the talus bone of the ankle increases stability and eliminates bone-on-bone friction, thereby decreasing pain. That spares the other parts of your knee and ankle that can wear out following ankle fusion. Foot and ankle pain. Foot & Ankle International. Weisman MH, et al. Operative treatment of lateral ligament instability. The worst type of ankle ligament tear is one where the ligament is completely torn and retracted. By fusing the ankle, more strength is added to the joint. J Orthop Surg Res. After the ligament is properly attached from surgery, stem cell injections can lead to a faster and more complete recovery. In: StatPearls [Internet]. Steroid injections often reduce joint inflammation, helping preserve joint structure and function. One of the ways to address this situation is through an ankle fusion surgery. The rotator cuff is a key group of muscles and tendons that helps facilitate upper body movement. Almost all ankle sprains can be treated without surgery. Your surgeon can provide you with any additional explanations and will be available to discuss the advantages, disadvantages and risks of each specific case with you. Tendon repair is done to bring back normal movement to a joint. A new nonsurgical technique that utilizes a patients own bone marrow-concentrate cells is an effective alternative to heal ankle ligament injuries. Alsousou J, Thompson M, Harrison P, Willett K, Franklin S. Effect of platelet-rich plasma on healing tissues in acute ruptured Achilles tendon: a human immunohistochemistry study. On the left, the red circle identifies the anterior talofibular ligament which is crimped and loose. ACL surgery can be delayed until the child is closer to reaching skeletal maturity; however, this comes with a risk of future meniscus or cartilage injury. 01 40 50 75 75 If your condition isn't well-controlled, that increases the chances of complications, including the risk of infection. Many are often limited by the condition of their ankle as it is, so having a similar range of motion or gait without the pain can help to make life a lot better for some. Thats why asking your surgeon how many ankle fusions or ankle replacements they have performed is an important question when considering surgery. Mark E. Easley, MD, associate professor of orthopaedic surgery, Duke University School of Medicine, Durham, North Carolina. When browsing on our website, information can be registered or read on your terminal, according to your choices. The MRI on the right illustrates the complete healing of the ATF ligament after PAL treatment. DOI: 10.1177/107110078700700614. Fortunately, a large number of ankle ligament injuries are only partial-thickness, or full-thickness tears without retractions. A study performed at the Columbia University Irving Medical Center showed that ligaments and tendons healed better when stem cells were introduced. In one study the complication rate was 29% and involved wound healing, nerve injuries, blood clots (3), complex regional pain syndrome and recurrent instability (4). The results of this technique are nevertheless very encouraging as a stable ankle with improved function is recovered in over 90 % of cases. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545158/, 2. As long as the disadvantages are properly managed, however, this surgery is a highly effective way to regain the ability to walk without pain once again. For people with less cartilage damage, minimally invasive resurfacing surgery may be used to remove bone spurs that are causing pain. It can be difficult to diagnose the level of tear let alone recommend the necessary treatment plan. After going through with the ankle fusion surgery and getting their strength back, they can begin walking and doing all of the things they used to do before their joint started limiting their motion. They do not know what else to do. The amount of freedom that this surgery can provide people simply cannot be ignored. There are three ligaments that prevent the ankle and the foot twisting inwards: the anterior and posterior talofibular ligaments, which connect the fibula to the talus, and the calcaneofibular ligament, which stretches between the fibula and the calcaneus (figure 1 and 2). If non-surgical methods don't provide relief, ankle replacement might be your next step. The majority of ankle ligament injuries do not require surgery. Since suffering a right ankle injury six games his sophomore year, Boutte did not produce at the same level he was at pre-injury. For athletes, a recent study showed that they were able to return to personal training in about two months. Ankle fusion is a very effective surgery, albeit one that comes with risks. These ligaments are instrumental in keeping your ankle and foot strong, stable and steady when you . Follow all of your provider's instructions about pain medicines and wound care. There may not be any specialists near some communities that can perform this surgery either, requiring sometimes large travel costs in addition to the surgery costs. There are different levels of torn ligaments. Modern surgery techniques dont even require screws or metalwork. Patient reviews and testimonials on this site should not be construed as a statement about the effectiveness of our treatments in general, they are individual perceptions that may or may not apply to everyone. Required fields are marked *, Download our free ebook "A Patients Guide to Regenerative Medicine and Advanced Cell Depending on the severity of symptoms, surgical options can range from arthroscopic ("keyhole") procedures to more invasive ones such as total replacement of the ankle joint. If in doubt as to whether it is the right option for you, do not hesitate to seek a second opinion from an orthopedic specialist. Other surgeries may be performed at the same time, most often arthroscopic surgery of the ankle joint. According to the extent of the bleeding, drainage may be necessary. "Big operations carry risks," Easley says, "such as infection and major wound healing problems that could potentially make the ankle worse than prior to surgery, although this risk is low, occurring in less than 2%-3% of cases.". Surgery is not the only method for repairing torn ankle ligaments. It depends upon the severity of the tear. Ankle fusion and ankle replacement can relieve ankle pain and restore motion when nonsurgical treatments arent effective. Explains that the anterior cruciate ligament (a.c.l) is one of four major ligaments of the human knee. Click here. Ankle Ligament Rupture; Ankle Sprain; Ankle Sprain and Achilles Tendon Sprain or Rupture; . A stable ankle reduces the risk of cartilage deterioration. The second is a full tear, but the ligament is still intact. pros of ankle ligament surgery - Some potential benefits of ankle ligament surgery include: Improved stability and function of the ankle joint Reduced pain and discomfort Increased ability to participate in physical activities Reduced risk of further injury to the ankle. If the damage is extensive or difficult to access, open surgery may be performed using a larger incision. Accessed Feb. 19, 2017. The cartilage surrounding the joint will begin to roughen and deteriorate as well, causing pain and significantly impeding movement. Blisters, a rash, or other wounds will stop the ankle fusion surgery until the area is able to properly heal. If there were other injuries such as trauma to the cartilage, return to training was longer, at 12 weeks on average, and return to sports was 15 weeks. It avoids the lengthy rehabilitation and risks associated with ankle ligament surgery. Severely damaged ankle joints may need to have the bones fused together or even replaced with an artificial joint. 1987;7(6):362-8. Many people end up just spraining their ankles, but there are those who end up tearing their ankle ligaments. In this procedure, the surgeon roughens the ends of the damaged bones and then fastens them together with metal plates and screws. It might also ease occasional pain that you get when you're not moving your joint. Duke has been involved with the research and development of ankle replacement devices and have access to all the prosthetics. To make up for this, nearby joints may move more which increases the risk of developing arthritis in these joints. An incision is made to access the joint. 4. Stem cell injections can encourage the ankle ligament to heal on its own without the need for any intervention. What is ankle ligament surgery? Some sports or daily activities are impossible in the absence of effective external lateral ligaments, and can lead to instability accidents and cause cartilage damage. Foot Ankle Int. Secondary scar tissue can also develop and interfere with joint function. He teaches as an Assistant Professor of Orthopedics at Emory School of Medicine in Atlanta, Georgia. 2017 Jun;25(6):1908-1915. doi: 10.1007/s00167-016-4207-x. He says most people are doing well 3 months after surgery, but full recovery might take anywhere from 6 months to a year. How it helps arthritis, migraines, and dental pain. Whats Wrong And How To Fix It, A Common Ankle Ligament Tear w/ Dr. Pitts, Ligaments of the Ankle A Tutorial with Dr. Schultz [VLOG], Brostrom Ankle Surgery: Reasons To Avoid This Surgery, See if you're a Candidate for Regenexx Procedures. Risks associated with ankle ligament surgery include bleeding, infection, and surgical failure. Plus, there is not just one type of ankle ligament tear. FOR MORE INFORMATION ON OUR COOKIES POLICY AND TO CONFIGURE THEM, The procedure involves stretching out the ankle joint to increase the space between the talus and tibia bones. Thank you, {{form.email}}, for signing up. Cushioned heel is great for shock absorption. doi:10.1177/2473011418S00049. If joint cartilage has been severely diminished in the joint space, a cartilage repair may be considered. For ankle replacement, the pros are pain relief, faster recovery time, preservation of motion, more natural motion, and patient satisfaction is often faster than ankle fusion. 5. Patients can manage and may even do better if they pursue non-surgical treatment options. Bone marrow concentrate contains cells that can facilitate a local repair response by bringing other cells into the area as well as turning into ligament cells (6). Anesthesia for the surgery even has its own set of risk factors. This surgery involves removing the inflamed cartilage and surgically joining two or more ankle bones together. The main benefits to the patient are to decrease pain and increase function. CAN YOU TREAT A MENISCUS TEAR WITHOUT SURGERY? When pain caused by ankle arthritis is severe and unrelenting, surgeons will often consider a type of surgery called ankle arthrodesis, also known as ankle fusion., Pain from ankle arthritis is caused when cartilage that caps the bones in your joints begins to wear away. Current advancements in ankle arthrodiastasis. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. The majority of ankle ligament injuries do not require surgery. Verywell Health's content is for informational and educational purposes only. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The replaced ligament is no better than the original ligament and can rupture again. Although these procedures can provide significant relief, bone spurs can reform over time. Most of the time, the necessary daily intake for these vitamins and supplements mentioned above, can be obtained through a healthy and well-balanced diet. doi: 10.1016/S0140-6736(15)60334-8. If you as a patient are unaware that there are other options besides surgery and physical therapy then you might be putting yourself through unnecessary pain. It is turned up and inserted in the calcaneus at the distal insertion of the calcaneofibular ligament (figure 7). Easley suggests that before you decide on surgery, try treatments such as bracing, injection with corticosteroid drugs, and changing your activities. This reconstructs the calcaneofibular ligament (figures 8 and 9). J Orthop Surg Res. The same can be realized with ankle ligaments. Surgical complications include wound healing, nerve damage, and blood clots. The pain and feeling of instability should disappear very rapidly after the operation. extensive time spent in a cast after surgery. In this minimally invasive surgery, a lighted scope and narrow instruments are inserted through small incisions in the ankles. It restores a lifestyle. Most people who choose ankle fusion want a permanent solution to their ankle pain so they dont have to think about it again. The bones will then be permanently fixed with plates, nails, screws, or other hardware. Foot Ankle Orthop. Many MRI reports do not fully disclose if the ankle ligament tear is retracted or not. The condition of the muscles is a major element to be taken into consideration before pushing the ankle to the limit, in particular in sport. It may be necessary to wait until the 6th month before a return to team sports and competition. The American Orthopaedic Foot & Ankle Society recommends you try non-surgical options for pain relief before getting an ankle replacement. To watch a ultrasound-guided ankle injection please click on the video below. How do I know if I have a damaged rotator cuff? A strip of periosteum, which is the membrane covering the bone, is harvested on the fibula. An incision is made on the lateral side of the ankle. There are several options for this. After the joint is opened, a surgical saw removes articular cartilage surfaces. Your University of Michigan surgeon will inform you of the pros and cons of plantar fasciitis surgery, and will let you know why surgery is the best option. The knees, hips, and the other ankle joint in particular are prone to more wear and this can create additional damage over time that may also need to be addressed. The sliding surfaces are lined with cartilage. This treatment is considered an alternative to traditional treatments like surgery, physical therapy, or anti-inflammatory medication. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. This content does not have an English version. 2018 Sep;10(3):368-73. doi:10.4055/cios.2018.10.3.368, Potter MJ, Freeman R. Postoperative weightbearing following ankle arthrodesis: a systematic review. 2016;35:239. The procedure, also known as ankle arthroplasty, replaces the arthritic ankle joint with a metal and plastic prosthesis. Here's what you need to know if you are considering one of these ankle surgeries. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. This helps to decrease the possibilities of an infection setting in during the healing process and encourages faster healing to occur. Almost all ankle sprains can be treated without surgery. Slideshow: Knee Surgery Recovery Timeline, Slideshow: Ankle Replacement Recovery Timeline, Taking Care of Your Joints After Ankle Replacement, Whether you have arthritis in other joints of your foot. In people with severe osteoarthritis ("wear-and-tear arthritis"), much or all of this cartilage will be lost., Ankle fusion is a surgical procedure that removes the surfaces of the ankle joint so that the tibia and talus bones can fuse together. Keep an open mind and ask as many questions as you need to make a fully informed choice. You can resume gentle sports activities like cycling and swimming after the 3rd month. Whether the surgery is open or arthroscopic, the operation itself tends to follow the same steps:. When conservative treatments for ankle arthritis fail to provide relief, it may be time to consider surgery. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Ankle arthroscopy with microfracture for osteochondral defects of the talus. 2012;5(4):469-73. Read our, Causes of Ankle Pain and Treatment Options, Bimalleolar and Trimalleolar Ankle Fractures, What To Do When You Have No Cartilage in Your Knee, What to Know About Big Toe Bone Spur Surgery (Cheilectomy), Osteoarthritis Ankle: Symptoms, Causes, and Treatment, Psoriatic Arthritis in Feet: What it Looks Like, Medial Malleolus Fracture and Broken Ankle Treatment, More Arthritis Types & Related Conditions, Extended indications for foot and ankle arthroscopy, The modern treatment of the simple bone cysts, Ankle arthrodesis: a systematic approach and review of the literature, Ankle arthroscopy with microfracture for osteochondral defects of the talus, Outcomes following the treatment of talar osteochondral lesions with BioCartilage and bone marrow aspirate concentrate mixture, Current advancements in ankle arthrodiastasis, Joint sparing treatments in early ankle osteoarthritis: current procedures and future perspectives, Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. 2005 - 2023 WebMD LLC, an Internet Brands company. In return, there is less range of motion experienced. Bone Joint J. For arthroscopic surgery, three tiny incisions would be made to insert the video-assisted scope (called the arthroscope) and specialized surgical tools. 2016 Nov 18;7(11):700-8. doi:10.5312/wjo.v7.i11.700, Kim JG, Ha DJ, Gwak HC, et al. Best for Foot Pain . COVID-19; Arthritis; Type 2 Diabetes; Heart Disease; Digestive Health If the healthcare professional does not have the correct information then there is no chance they can make the correct recommendation. J Med Life. In addition, many surgeons do not actually look at the MRI and rely on the radiologists report. Your foot and ankle ligament and tendon reconstruction will be performed in a hospital or outpatient surgery setting. It typically is performed when there is a sizable, well-defined defect in the cartilage of the ankle. Recovery times are invariably longer and require more extensive physical therapy and rehabilitation. You might be interested:TOP 10 CAUSES OF CARTILAGE LOSS. The type of surgery that's right for you depends on your age, your level of activity, and the severity of your joint damage or deformity. Each ankle surgeryhas pros and cons, and not every procedure is suitable for every person. The best evidence from studies done so far suggest that reconstruction has better results than either a direct repair or the checkrein procedure. WebMD does not provide medical advice, diagnosis or treatment. 2023 Dotdash Media, Inc. All rights reserved. After an ankle fusion surgery, a padded plaster cast is placed on the joint to protect it. Procedures vary depending on your diagnosis and the ligaments and tendons that need repair. In: Campbell's Operative Orthopaedics. In such cases, additional surgery may be required. Every week we share news and updates to keep you informed about the latest in cell therapy and regenerative medicine, how cell therapy can improve your quality of life, innovative new therapies, and more. Because the artificial ankle joint is designed to more closely mimic the natural movement of the ankle, you can walk with a more natural gait and experience less pain and a greater range of motion. This operation is carried out under regional or general anaesthesia. That is a long time to be out on the sidelines. You can put weight on your foot once the cast is removed. A persons overall health and lifestyle habits are also evaluated. Ankle arthrodesis. BioXcellerator Quality: BioXcellerators laboratory, has been designed to comply with both regulatory cGMP standards for quality and meet internationally recognized ISO standards that cover safety, air quality, and processing infusions that contain human cells. Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Surgery on an ankle may be needed to treat fracture (broken bone), arthritis, tendonitis and problems that can't be resolved with therapy and medications. With that said, ankle fusions tend to have a higher rate of complications, including bone nonunion (when bones fail to fuse), or malunion (when bones heal in the wrong position). Over time, this weakness can cause instability within the joint. Ankle ligaments play a large part in ankle injuries as a whole. Injuries to the ankle ligaments, such as sprains or tears, can cause instability and pain in the ankle. This procedure also aims to help a patient reduce pain related to their injury and ankle sprains, as well as to avoid early arthrosis. The pros and cons of ankle fusion surgery show that it can be beneficial to many who are under the age of 60 and are struggling with joint problems. Your anaesthesiologist will decide with you the best type of anaesthesia according to your state of health. 2018 Feb;2018:2473011418S00049. ACL is the abbreviation for the Anterior Cruciate Ligament. A Surgical Option for People With Severe Ankle Arthritis. The external lateral ligaments are located on the lateral side of the ankle and connect the fibula to the talus and the calcaneus. Surgeons tend to do the surgeries in which they have the most experience. The purpose of this procedure is to stabilize the ankle, improve the ankle's mechanics and restore full function. Success rates tend to be lower than with knee and hip replacements., There are pros and cons to ankle replacement. Best Responsive Support for Both Men and Women: Asics Novablast 3. Iowa Orthop J. The injury is such an issue that about 20% of sports related injuries are caused from ankle injuries. DOI: 10.3113/FAI.2009.0213. Outcomes following the treatment of talar osteochondral lesions with BioCartilage and bone marrow aspirate concentrate mixture. Because they have extensive experience with all of the latest artificial ankle joints, they are also able to recommend total ankle replacements to people who would otherwise not be considered candidates. Surgery for an ankle fracture is done if the bones in the ankle are unstable and need more support to heal. Knee Surg Sports Traumatol Arthrosc.

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