Advancing Repairs of Ankle Injuries: Tiny Incisions, Shorter Recoveries

Ankle injuries can be challenging to treat — even if surgery is not required. Among the potentially toughest to repair goes by the medical term: osteochondral lesions of the talus (OCLT).

OCLT is a condition that involves the cartilage of the ankle joint – specifically the talus, one of the three bones merging into the ankle — the other two are the tibia and fibula. Cary B Chapman, M.D., orthopedic surgeon at Baptist Health Orthopedic Care, specializes in such ankle injuries. He has taken part in clinical studies to improve a minimally invasive procedure to repair the most serious OCLTs arthroscopically.

Cary B Chapman, M.D., orthopedic surgeon at Baptist Health Orthopedic Care.

“An osteochondral defect of the talus is basically like a pothole in the talus bone,” explains Dr. Chapman. “The talus bone is a bone inside the ankle that lets the ankle go up and down. So, when a patient sprains their ankle, the talus is kind of clunks around within the ankle joint, and a little piece of cartilage and or bone can be damaged.  A vast majority of these injuries are caused by sprains or trauma.”

The damaged cartilage in the ankle area can cause pain, and in some cases serious instability when walking. While ankle sprains themselves are extremely common — something like 30,000 a day occur in the U.S., these types of injuries comprise a small percentage of those injuries, he said. “Is it common in general? Probably not. But something that I commonly see? Yes,” said Dr. Chapman.

Treatment Depends on Size of Lesions

Whether standard surgery or minimally invasive procedures can repair the OCLT depends on the size of the lesions. The smaller lesions allow for more options. In some cases, non-surgical options are appropriate, including medication and physical therapy.

For cases with smaller lesions “that don’t have any other issues” a procedure called microfracture surgery might be the best option. “That’s when we would essentially clean out the pothole and we would drill very small holes into the base of the pothole,” explains Dr. Chapman. “The osteochondral defect would fill up with the patient’s blood which like the asphalt.”

However, this procedure requires about two months for the “repaving” of the “pothole” to take place and allow the patient to completely walk on it. “Typically, I have a patient off their foot for about a month, which allows their blood to be converted to something called fibrocartilage because we cannot make new cartilage.  This is followed by another month of partial weightbearing.”

Treating Larger Lesions

For the larger lesions, there are different options as well. Dr. Chapman focuses on one method, called the OATS (osteochondral autograph transfer) procedure.

“OATS is when we take a core of cartilage and bone from the patient’s knee and place it into the ankle,” said Dr. Chapman. “In many cases, we have to break the ankle bone open to access it.”

But the OATs procedure can have complications, and a longer, more painful recovery.  Problems such as nonunion of the ankle osteotomy and knee pain can occur.

Treating OCLT Arthroscopically

Dr. Chapman specializes in minimally invasive surgical treatments for chronic and acute foot and ankle injuries, ankle arthritis, ankle replacements, bunions, and hammer toe deformities. The latest advancement in treating the more serious OCLT cases involves a minimally invasive approach that Dr. Chapman is helping pioneer. The procedure is as state-of-the-art as it gets, involving tiny cameras, tiny incisions and tiny instruments that avoid complications of standard surgery.

“Instead of breaking the patient’s ankle bone, taking out that osteochondral defect, and then taking a corresponding piece of bone and cartilage from the knee, we can do this all arthroscopically,” explains Dr. Chapman. “That means two tiny incisions. We have a small camera and instruments that can scoop out the cyst or clean out this ‘pothole.’

Dr. Chapman then takes a bone graft from the patient’s heel bone through a small incision, “And through these very small cannulas (thin tubes), we can pack the cyst with bone graft, and then we’ll put, what’s essentially a donated cartilage on top of the bone graft. All of this is done arthroscopically.”

Whether it’s standard surgery, minimally invasive procedures or non-interventional treatments, the team at Baptist Health Orthopedic Care treats various types of foot and ankle conditions, from simple sprains to complex, traumatic injuries.