New twist on ankle surgery

September 14, 2011 1:53:51 PM PDT
Better watch your step.

Every day in the U.S., there are 25,000 ankle sprains. Sprains happen when the ligaments in the ankle stretch or twist outside of their normal position. Usually, the pain only lasts a few days, but an ankle sprain can also lead to more chronic problems so painful that even surgery may not help. Now, a new kind of graft is helping these patients when nothing else works.

Sergeant first class Chris Withers has the intensity that comes with a career in army special operations. But, he had to trade these boots for this one after suffering an ankle injury in Iraq.

"I fell into a sinkhole, and it felt like an ankle sprain. It snapped, and I knew then it was hurting," Sgt. 1st Class Chris Withers, U.S. Army, told Ivanhoe.

Eight surgeries over seven-plus years didn't help his pain or the problem, a painful, penny-sized pothole in his left ankle joint.

"Typically, this is related to trauma, so if your ankle sprains or you twist it, two bones impact each other, and a little piece of bone and cartilage gets displaced," Selene Parekh, M.D., a orthopedic surgeon at Duke University, explained.

"24-7, I was in pain. Even while I was asleep, I was waking up in pain," Sgt. Withers said.

The turning point came from Duke orthopedic surgeon doctor Selene Parekh and new technology, a graft made from juvenile cadaver tissue, surgically placed to fill the hole.

"It's little pieces of cartilage, and we pick them up with tweezers, and we just place them into the base of the pothole, and we use human glue, and we glue that into the pothole," Dr. Parekh said.

Seven months after the allograft procedure, the cartilage became solid. The pothole is repaired.

"I didn't feel the pain anymore," Sgt. Withers said.

Now, Chris is on a mission, working hard, so he'll be ready to go back to work wherever the army needs him.

"As soon as I'm healed up, I'm gone, deployed somewhere," Sgt. Withers said.

Although it's too soon to know, doctors hope the new allograft will be a permanent fix for patients suffering from serious ankle lesions to help them avoid big surgeries like ankle replacement.

BACKGROUND: A sprained ankle is a common injury. About 25,000 people experience it each day in the United States. It can happen to athletes, non-athletes, children or adults. A sprained ankle can happen when a person takes part in sports or physical fitness activities, or it can happen when a person simply steps on an uneven surface. The ligaments of the ankle hold the ankle bones and joint in place. They protect the ankle joint from abnormal movements such as twisting, turning and rolling of the foot. A ligament is an elastic structure. They usually stretch within their limits and then go back to their normal position. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers. (SOURCE: American Academy of Orthopaedic Surgeons)

DIAGNOSING AN ANKLE SPRAIN: Doctors may order an X-ray to make sure the patient doesn't have a broken bone in the ankle or foot. If there is no broken bone, the doctor may be able to tell the patient the grade of his/her ankle sprain based on the amount of swelling, pain and bruising. The doctor may need to move the patient's ankle in various ways to see which ligament has been injured or torn. Sometimes, a doctor may order an MRI scan if he/she suspects a very severe injury to the ligaments, injury to the joint surface, a small bone chip, or another problem. The MRI can ensure the diagnosis is correct. (SOURCE: American Academy of Orthopaedic Surgeons)

ANKLE GRAFTS: Sometimes, ankle sprains and injuries can lead to chronic problems. Patients with these types of injuries may not benefit from traditional treatments or surgeries. Now, doctors are Duke University Medical Center are offering patients new technology -- a graft made from juvenile cadaver tissue. The graft is surgically placed to fill in "potholes" that patients have in their ankle joints. The idea is for the cartilage to solidify.

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