I’ve looked over all the different ways a hole in the talus bone of my ankle joint can be repaired surgically. I think I like the idea of using my own stem cells to generate new, normal cartilage. How well does this work?

When a joint is injured as a result of a joint sprain or fracture, there can be damage done to the layer of cartilage just above the joint surface. These are called osteochondral or chondral lesions and they occur in up to half of all ankle injuries. It sounds like this may be what you have.

There are several different surgical transplantation techniques to repair the cartilage (including stem cell transplantation) that have been developed and improved over the last 10 years. Treatment is designed to restore the cartilage and provide relief from painful symptoms.

The use of stem cells (taken from the patient’s own bone marrow) and then injected into the osteochondral lesion is under investigation. Early studies (with animals) are underway now but no conclusions have been reached yet regarding results. The stem cells are not used alone but along with another technique known as microfracture (tiny holes are drilled through the subchondral plate). Microfracture allows stem cells from inside the bone marrow to enter the defect and form fibrocartilaginous repair tissue.

Currently, microfracture is available as a repair technique for osteochondral defects, holes, or lesions. Stem cell transplantation is still in the experimental/research stage. There is one other biologic treatment to repair cartilage that you might be interested in knowing about. It is with the use of hyaluronic acid. Hyaluronic acid is a substance normally contained within the joint (synovial) fluid. It helps keep the joint surfaces moving smoothly.

Hyaluronic acid injections into the joint have been done after microfracture and compared with patients who had microfracture without the hyaluronic acid injections. Outcomes with a limited number of patients show that results are much improved in the microfracture plus hyaluronic acid injection group over the microfracture-only group.

As you might expect, there is a need to compare all of these approaches to see which one works best for different groups of patients. Outcomes of well-designed studies with carefully selected patients will go a long way in guiding future treatment plans for osteochondral lesions of the talus. Your orthopedic surgeon is the best one to advise you on which approach would be best for your particular injury.