I’ve heard there’s a new way to get healthy cartilage to grow back in damaged joints. I have a bum ankle that got tore up in a car accident several years ago. I know surgery is involved and I’d have to wear a cage contraption around the lower leg. Would this work for someone like me?

You may be talking about a new technique called distraction arthroplasty for ankle arthritis. It is a step in the direction of preserving joint motion, especially in young patients.

Distraction arthroplasty is done by using an external frame with rods that stretch the ankle apart. The frame looks like a circular cage around the ankle and lower leg. A thin wire is placed through the joint and acts as a guide wire until the device is fully in place. Then the wire is removed.

The patient ends up with a cage that has two rings (one at the top, one at the bottom) and two rods in between the top and bottom rings. The rods are lengthened a little bit at a time pulling the joint apart. The joint only separates a tiny amount (up to three millimeters which is about one tenth of an inch).

The separation combined with increased pressure from walking stimulate the joint cartilage to produce new, healthy chondrocytes (cartilage cells). As for the question: who can benefit from this procedure? There aren’t a lot of published studies to help answer this question. What is known so far is based on small studies with only 20 to 24 patients.

Right now, it looks like younger patients who still have a fairly mobile ankle joint are better candidates than older adults with a stiff joint. Patients must be motivated to follow the surgeon’s directions following the procedure. Keeping active despite any persistent pain or discomfort is an important part of the post-operative plan. Rehab under the direction of a physical therapist is an important part of the recovery process.

The only way to know for sure what’s best for you is to see your surgeon for an examination and evaluation. There may be some simpler management tools that could help you. This particular procedure can only be done on an ankle with good alignment without deformities.

Surgery can be done to get the joint ready for the distraction arthroplasty technique so it’s not a quick and easy fix. The advantage is that joint motion is preserved (saved) until such time as more permanent approaches are required (e.g., fusion) that might sacrifice motion.