DenovoNT Ankle Results at 13 months



My experience with foot and ankle surgery for cartilage repair is limited and certainly not comparable to the large number of cases I have performed in the knee.  The demand for cartilage repair of the talus, the main bone supporting the ankle, is large and growing. It is likely that a large number of these problems have been caused by sports in youth, and that small areas of cartilage loss (“osteochondritis”) have enlarged with the aging of the patient.  Even so-called simple ankle sprains can do this. Ankle problems can be quite severe as the surface area of the talus is quite small in proportion to body weight and thus the amount of stress per square cm is far greater than, for example, the knee.  This is another way of saying that small holes in the dome of the talus really can hurt, and large defects are a major handicap.


Historically it has been felt than some approaches to the ankle require osteotomies, the cutting of bone, in order for the surgeon to see well. Although this can sometimes be true, in my lecture travels around the country I learned that just a small incision coupled with distraction of the ankle may be sufficient to expose the entire top of the talus. This is where the problem lies.


Therefore, the knee experience with Denovo NT led me to try this technique on the ankle.

Here is the pre-op MRI view of a large talar dome lesion, which was very painful in an active 31 year old man.


The patient is 6 foot 4 inches tall and weighs 250 pounds, attesting to the amount of force this relatively small bone is under. (Under load that would be well over 1000 lbs. per square inch).







Here is the post op view at 13 months:



I think you can easily see the lesion is filled in with cartilage. The patient at this point is pain free and back to all activities.


This is quite an amazing result and is holding up nicely now at 15 months. Although the story is an anecdote, and I do not yet have sufficient number of cases to apply statistics, I think anecdotes are OK if they are true and if there is no known downside to the repair. In other words, should this type of cell-based repair ever fail, all options are still available to this patient; no bridges are burned.  This fact is important in all phases of regenerative medicine.