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New treatment may lead to faster recovery for patients with osteochondral ankle lesions

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A new technique for treating a common ankle condition could cut recovery time in half compared with the standard surgical treatment, according to a study published in the journal Orthopedics.

Osteochondral lesions of the ankle bone, sometimes called osteochondritis dessicans or osteochondral fractures, are common injuries that are typically caused by ankle sprains. These injuries may include blistering of the cartilage layers, cyst-like lesions within the bone underlying the cartilage, or fracture of the cartilage and bone layers, according to the American Orthopaedic Foot & Ankle Society.

Surgical procedures are often used to stimulate cartilage growth, including grafts or scraping, which require six to eight weeks of no walking, plus another six weeks in a surgical boot.

The minimally invasive strategy trialled by surgeons at Mount Sinai in New York involves injecting bone substitute material into the injury.

“This technique is a completely new way of looking at a common orthopaedic condition which is typically seen in younger patients and athletes, and this minimally invasive approach could make recovery much easier,” said lead investigator Dr Ettore Vulcano, Assistant Professor of Orthopaedics at the Icahn School of Medicine at Mount Sinai. “This is the first published study looking at the use of injectable bone substitute to treat the pain instead of cartilage grafts, and if results continue to be positive this technique can substantially change the way surgeons treat this debilitating condition.”

Dr Vulcano and a team of researchers studied 11 patients with osteochondral defects who underwent the subchondroplasty procedure, which entails making micro-incisions to inject calcium phosphate bone substitute into the bone. During the healing process, real bone replaces the hard-setting bone substitute material.

“I do not believe the actual cartilage lesion is the source of pain,” Dr Vulcano explained. “Therefore, my hypothesis was that if I address the bone bruising with bone substitute without even touching the cartilage or trying to regenerate cartilage, the patient will get pain relief.”

Patient follow-up showed that 90% of the patients could bear weight on their ankle immediately after the procedure and had excellent pain relief. One patient could run without pain after only three weeks.

A year after treatment, 10 of the 11 patients said that they would have the procedure again.

Traditional surgery also has a 90% success rate, but patients are not allowed to bear weight on the foot for up to two months.

“Further studies are needed to assess the long-term effectiveness of this procedure, but this may represent an additional method to treat a difficult condition with a quick recovery,” Dr Vulcano concluded.