Ankle Cartilage Replacement Graft

Ankle Cartilage Replacement Graft - The best part about medicine and advancements for for foot and ankle surgeons are the new biologic products entering the market. Over the last 5 years I have been using the human placental graft cells (Amnionic fluid and cells) for tissue repair, implanting it intra articularly after ankle arthroscopic procedures to optimize healing and promote cartilage growth. Now there is an additional biologic material that can not only cover large areas of denuded cartilage, but incorporate into live cartilage with the right preparation of the subchondral bone after an open or arthroscopic joint debridement procedure. The tissue processing and biology of Cariform inherently supports cartilage restoration. And the tissue quality is ensured through advanced, state-of-the-art testing. Once the surgeon has performed the proper testing on the patient prior to an arthroscopic or open procedure (X-rays, MRI), the Caritform graft is shipped to the surgical hospital 24 hours prior to the surgery. Usage is simple after the solution reached room temperature, but if there is a decision to not use Cariform, the cryopreservation has a 2-year shelf life so it can be used later, in another case or even by another surgeon at the center where it was originally shipped. On this patient, there was approximately 1/3 of the cartilage detached on the inferior, medial surface of the tibial plafond. After debridement of all the detached cartilage and preparation via subchondral micro fracture or drilling, the Cartiform graft is applied with a special glue that sets up in approximately 2-3 minutes. The decision was made to open the medial arthroscopic portal to visualize the application of the graft and glue. In addition to the tibial plafond lesion, there was an adjacent medial talar dome lesion, but the decision was made to not put another graft on this lesion due to the fact that the opposing forces with partial weight bearing could shear off both grafts or adhere together with the final step of total circumference glue application. After 4-6 weeks of non weight bearing and 1 week of range of motion and mild strength training of the ankle, the patient will begin to weight bear fully at 8 weeks. Then the final decision to apply a second Cartiform graft to the talar dome lesion will be based on patient symptomotology and function.