Foot and Ankle Cartilage Repair

What is Foot and Ankle Cartilage Repair?

Foot and ankle cartilage repair is a surgical procedure to restore the damaged cartilage in the foot and ankle joint. Cartilage repair can be performed either through a single long incision called the open approach or via a minimally invasive approach called arthroscopy. Two or more small incisions are made in the foot and ankle joint and an arthroscope is made inserted to aid in the surgical repair. 

What are the Indications for Foot and Ankle Cartilage Repair?

Foot and ankle cartilage repair is considered only after non-surgical approaches such as diet, exercise and orthotics are unsuccessful in treating your foot and ankle joint problems. The common indications may include:

• Degeneration or prolonged wear and tear of the cartilage, or foot and ankle arthritis
• Structural abnormality of the foot and ankle joint
• Sports injury leading to cartilage damage
• Motor vehicular accident 
• Trauma
• Fracture or dislocation  

Pre-Surgical Preparation for Foot and Ankle Cartilage Repair

Before scheduling your foot and ankle cartilage repair, your doctor examines your ankle joint, its range of motion, your overall health condition, and lab reports.

• You may be asked to get a foot X-ray to understand the extent of cartilage damage and plan your surgery. 
• You may be given specific instructions to follow until your surgery. 
• You may have dietary restrictions until your surgery. 
• You may also be advised to quit smoking, if you do, and perform regular exercise. 

Foot and Ankle Cartilage Repair Procedure

Foot and ankle cartilage repair can be performed either as an open surgery or as an arthroscopic surgery. The common steps for cartilage repair include:

• You are placed in supine position on your back and the foot to be operated upon is elevated at a specific angle to allow a better view during the surgery.
• General or spinal anaesthesia may be administered which has a sleep-inducing effect. So you will not wake up or feel any pain during the procedure.
• One or two small incisions are made in your ankle either from the front (anterior) or side (lateral).
• Retractors may be used to separate the underlying muscles and expose the ankle joint.
• Once the cartilage has been accessed, your surgeon may perform one or more of the following procedures to repair the damaged cartilage: 
  • Debridement: The damaged cartilage and bone spurs are removed. 
  • Refixation: The healthy ends of the cartilage are sutured back together.
  • Bone Marrow Stimulation, also called Microfracture: In this procedure, after the damaged cartilage is removed, a specialized drilling tool is used to make numerous holes into the bone at the base of the cartilage. These holes act as channels through which blood and cartilage cells regenerate and fill the defect by forming a blood clot. In the next few months, the blood clot turns into a type of scar tissue called fibrocartilage.
  • Cartilage Reconstruction: The damaged tissue is replaced with healthy cartilage. The cartilage graft may be taken from another part of your body (autograft) or a donor tissue (allograft).
• In the end, the ankle joint is rotated to check the range of motion.
• Then, the retractors and other surgical instruments are removed.
• The overlying soft tissues and skin are closed with sutures.

Sterile waterproof bandages are applied to keep the surgical site clean and dry.

Post-Surgical Care for Foot and Ankle Cartilage Repair

You may be required to stay in the hospital for a night or two or until you can walk comfortably.

• You will be given medications to minimize post-operative pain, swelling, and discomfort in and around your ankle.
• Application of ice packs covered with a towel over the operated ankle also helps to reduce postoperative pain and swelling.
• You are advised to take adequate rest.
• Ensure minimal weight-bearing during the initial days.
• You may be told to use a cast, brace, or splint along with orthotic shoes for a specific period to ensure a safe recovery.
• Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
• You may begin physical therapy exercises as recommended by your surgeon to improve ankle range of motion.
• You can return to sports once the foot has regained its normal strength and function, and with your surgeon's approval.

You are required to visit your doctor for the first few weeks after the surgery to monitor your recovery.

What are the Risks and Complications of Foot and Ankle Cartilage Repair? 

As with any surgical procedure, foot and ankle cartilage repair may also have certain risks and complications. These may include:

• Anaesthesia side effects such as nausea and vomiting
• Infection
• Deep vein thrombosis: Formation of blood clots in the blood vessels of your leg
• Ankle joint deformity 
• Injury to the underlying nerves or blood vessels