You might be interested:TOP 10 CAUSES OF CARTILAGE LOSS. The rotator cuff is a key group of muscles and tendons that helps facilitate upper body movement. An incision is made on the lateral side of the ankle. The same can be realized with ankle ligaments. Compared with ankle replacement, ankle fusion: For an ankle replacement, the surgeon removes the ends of the damaged bones and fits a plastic-and-metal replacement joint onto them. Stories and news about treatment advances that improve your health and quality of life, Copyright 2004-2023 Duke University Health System. Ankle ligament reconstruction (ALR) typically is an outpatient surgery, meaning you can go home the same day as the procedure. By fusing the ankle, more strength is added to the joint. However, new treatments exist that can help manage this rare complication more easily. 2018 Feb;2018:2473011418S00049. Singh JA, et al. J Am Acad Orthopaed Sur. In: Kelley and Firestein's Textbook of Rheumatology. Office hours: 7am 5pm. We can pick the most appropriate one for each patient. Thats why asking your surgeon how many ankle fusions or ankle replacements they have performed is an important question when considering surgery. This means a persons walking gait becomes a little different and this can be awkward or even socially uncomfortable for some. It is a permanent fix for the problem. Total joint replacement for severe rheumatoid arthritis. From now on, to reach us, please do not contact +33 (0)1 43 62 22 25. Often patients seek second opinions because they have been told they need an ankle fusion by a doctor elsewhere who may not be familiar with the latest research on ankle replacement. For example, ATF ligament is the ligament that connects the talus bone to the fibular bone. It may not be the right treatment option for highly active people or those with severe injuries. Normal walking is recovered at the end of the 2nd month. The concerns. Running can be envisaged after the 4th month. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Ankle arthrodesis: a systematic approach and review of the literature. This may be because the person is overweight or has another condition such as severe nerve damage; paralysis; a history of infection or diabetes; or avascular necrosis -- a condition in which the blood supply to the joint is cut off, which causes the ankle bone tissue to die. There are new nonsurgical techniques that utilize a patients own bone marrow-concentrate cells to heal ankle ligament injuries. Ankle ligaments are used to protect and stabilize the joint while allowing the ankle to move. There are no other methods besides surgery to repair this type of injury. ACL surgery can be delayed until the child is closer to reaching skeletal maturity; however, this comes with a risk of future meniscus or cartilage injury. During the healing process, the damaged bones fuse together into one combined bone. Procedure. The most common reason is a skin problem that occurs at the surgical site. Best Walking Shoe for Both Men and Women: Hoka Bondi 8. But, patients are backed into a corner if physical therapy has done little for their ankle ligaments. There can be a number of reasons why a surgery may be delayed or canceled. In this minimally invasive surgery, a lighted scope and narrow instruments are inserted through small incisions in the ankles. What is ankle replacement surgery? Education is the name of the game. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Accessed Feb. 19, 2017. That is one of the many reasons why patients receive unnecessary ankle ligament surgery. Driving and returning to work can be envisaged in the 3rd month, depending on your profession; office work can be sooner. When pain caused by ankle arthritis is severe and unrelenting, surgeons will often consider a type of surgery called ankle arthrodesis, also known as ankle fusion., Pain from ankle arthritis is caused when cartilage that caps the bones in your joints begins to wear away. "Big operations carry risks," Easley says, "such as infection and major wound healing problems that could potentially make the ankle worse than prior to surgery, although this risk is low, occurring in less than 2%-3% of cases.". Mayo Clinic, Rochester, Minn. Dec. 28, 2016. Pros and cons of ankle ligament repair for a serious injury? Foot & Ankle International, 2011. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Almost all ankle sprains can be treated without surgery. There are different levels of torn ligaments. Verywell Health's content is for informational and educational purposes only. risk of blood clots and nerve damage. However, loosening of the components can occur. The second is a full tear, but the ligament is still intact. Add onto this the issue of ankles commonly being set at right angles, which is an unnatural resting position for some, and there can be skin breakdown over time that must be treated. A healthcare provider will watch you for a few hours after your surgery. The Bone and Joint Journal, 2014. The artificial joint helps the ankle retain more-natural movement, so there's less risk of arthritis developing in nearby joints. The peroneal tendon is a common tendon used in ankle reconstruction. DOI: 10.3113/FAI.2009.0213. High-impact activities such as running and jumping can damage an artificial ankle joint. This is similar to many other conventional medical treatments but it has scientific support. Required fields are marked *, Download our free ebook "A Patients Guide to Regenerative Medicine and Advanced Cell Lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. Ankle fusion and ankle replacement can relieve ankle pain and restore motion when nonsurgical treatments arent effective. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). possibility . Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Ankle ligaments provide important support to the ankle and are susceptible to injury. What is ankle ligament surgery? Tendon injury may occur anywhere in the body where there are tendons. Any medical procedure has certain risks that are associated with it. These simple braces can be worn as long as they continue to provide relief. Small blood clots can form and block the veins in the legs resulting in phlebitis, which will require an anti-coagulant treatment for several weeks. Shakked RJ, Karnovsky S, Drakos MC. Trocadro office, 9 rue Le tasse, 75116 Paris, SUBWAY: Line 6, Trocadro ou Passy stop and Line 9, Trocadro stop, BUS : Bus 32, Scheffer stop and Bus 22, Scheffer stop. treated 463 patients with disc herniation using the inside-out technique with extreme lateral access. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Accessed Feb. 19, 2017. Can run a little small. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Requires fewer restrictions in activity during recovery, Participate in high-impact sports or work. Ankle arthritis is a condition in which the cartilage of the ankle joint deteriorates, causing pain and restricting movement. A lot of healthcare professionals just read the report and do not look at the images themselves. Your orthopaedic foot and ankle surgeon will evaluate your overall health, age, and activity level to help you decide whether ankle replacement or ankle fusion is best for you. Ankle surgery may be an option when more-conservative treatments don't relieve ankle pain caused by severe arthritis. If there were other injuries such as trauma to the cartilage, return to training was longer, at 12 weeks on average, and return to sports was 15 weeks. It is most effective when pain is due to contact between bone spurs and the arthritis has not yet caused significant cartilage . This results in positive patient outcomes. As a top running shoe for those who suffer from plantar fasciitis during testing from the Good Housekeeping Textiles Lab . It is therefore necessary to be careful given the risks posed by sports that put strain on the ankle. The best evidence from studies done so far suggest that reconstruction has better results than either a direct repair or the checkrein procedure. The type of surgery that's right for you depends on your age, your level of activity, and the severity of your joint damage or deformity. This content does not have an Arabic version. This lack of flexibility can put significant strain on the knee and foot joints, making them more prone to arthritis in the future. There may not be any specialists near some communities that can perform this surgery either, requiring sometimes large travel costs in addition to the surgery costs. Below are MRIs before and after bone marrow concentrate treatment. Kneecap pain. 13th ed. CAN YOU TREAT A MENISCUS TEAR WITHOUT SURGERY? 2016;3(1):3. doi:10.1186/s40634-016-0038-4, Barg A, Wimmer MD, Wiewiorski M, Wirtz DC, Pagenstert GI, Valderrabano V. Total ankle replacement. In this article, we will explore the details of PRP . It is usually considered when there is minimal degeneration of the ankle joint or misalignment of the ankle bones. And, your physical therapist will tell . The objective of the reconstruction is to recover a perfectly stable ankle to be able to carry out all types of activities, thus preventing cartilage damage and the deterioration of the joint. Surgery is usually successful, Easley says. These two injuries are the best that a patient can hope for. 1. It avoids the lengthy rehabilitation and risks associated with ankle ligament surgery. You have ankle instability Injuries to the ankle ligaments, such as sprains or tears, can cause instability and pain in the ankle. Fill out the form below and one of our Patient Advocates will follow up with you to answer all your questions. On the other, ankle fusion is safer and more reliable, with half as many people needing additional surgery compared to arthroplasty.. The threads on the anchor are passed through the free end of the strip and tied together to fix it to the bone. 01 77 71 25 57 Surgical complications include wound healing, nerve damage, and blood clots. Azar FM, et al. A stable ankle reduces the risk of cartilage deterioration. On the left, the red circle identifies the anterior talofibular ligament which is crimped and loose. Surgeons remove pieces of cartilage or bone debris from the joint space. Boutte only had 29 more receiving yards this season . At the 8-12 week mark, x-rays are taken of the ankle to make sure that the bones have fused properly. Best for High Arches: Oofos OOah Sport Shoes. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. When this is not possible a tendon from a different site is harvested and used to construct a new ligament. Secondary scar tissue can also develop and interfere with joint function. Surg Technol Int. Surgery for an ankle fracture is done if the bones in the ankle are unstable and need more support to heal. He is empathetic and very caring. Describes the a.c.l tear as a partial or complete tear of the anterior cruciate ligament. Whether the surgery is open or arthroscopic, the operation itself tends to follow the same steps:. http://www.uptodate.com/home. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Clinical Rheumatology. [emailprotected] Some sports or daily activities are impossible in the absence of effective external lateral ligaments, and can lead to instability accidents and cause cartilage damage. Whats Wrong And How To Fix It, A Common Ankle Ligament Tear w/ Dr. Pitts, Ligaments of the Ankle A Tutorial with Dr. Schultz [VLOG], Brostrom Ankle Surgery: Reasons To Avoid This Surgery, See if you're a Candidate for Regenexx Procedures. When conservative treatments for ankle arthritis fail to provide relief, it may be time to consider surgery. Depending on the type of ankle fusion surgery that occurs, the fibula bone can become enlarged and wind up creating shoe wear problems. There may not only be other surgical and non-surgical options to consider, but there are also different ankle fusion techniques that some surgeons use over others. Ankle arthritis is a condition in which the cartilage of the ankle joint deteriorates, causing pain and restricting movement. Contact a BioXcellerator Patient Advocate to see if new treatments are available for your condition. BioXcellerator headquarters is located in Phoenix, Arizona. Progressive arthritis can lead to bone cysts and the formation of bone spurs (osteophytes). Ruetten et al. pros of ankle ligament surgery - Some potential benefits of ankle ligament surgery include: Improved stability and function of the ankle joint Reduced pain and discomfort Increased ability to participate in physical activities Reduced risk of further injury to the ankle. Another advantage of PRP injections is that they can strengthen the muscles around your knee. With the input of your healthcare provider and physical therapist, you can gradually transition to activities that place more weight on the ankle until you are deemed fully recovered. The therapy accelerates the healing process. This video has been medically reviewed by Oluseun Olufade, MD. If the bones of the ankle dont create a beneficial union as expected, this may further increase the risks of this happening. Total ankle arthroplasty versus ankle arthrodesisa comparison of outcomes over the last decade. The ankle ligaments are susceptible to injury including strain and tears. Mayo Clinic does not endorse companies or products. Blisters, a rash, or other wounds will stop the ankle fusion surgery until the area is able to properly heal. In: Campbell's Operative Orthopaedics. Orthopaedic Surgery 734-936-5780; Podiatry 734-647-5871; Physical Medicine and Rehabilitation (PMR), 734-936-7175 Even so, only 5.4% of ankle fusion surgeries required revision surgery compared to 7.9% of ankle replacements., If ankle fusion is recommended, it is important to weigh the pros and cons to decide if it's the best option for you as an individual., Greater ability to bear weight without pain, Less appropriate for active people compared to ankle replacement, One in 20 people require revision surgery. One of the most common methods for ankle ligament surgery is to drill holes in the ankle bones. The stem cells are able to transform into the right ligament cells and release the proper chemicals and chemical signals in order to initiate healing. 2015;10(1):84-8. https://www.ncbi.nlm.nih.gov/pubmed/25274564. The MRI on the right illustrates the complete healing of the ATF ligament after PAL treatment. Health A-Z . The nerves and arteries around the ankle may be damaged accidently. The clots will gradually turn into a type of scar tissue calledfibrocartilage. For people with less cartilage damage, minimally invasive resurfacing surgery may be used to remove bone spurs that are causing pain. Philadelphia, Pa.: Elsevier; 2017. http://www.clinicalkey.com. Your ankle is a hinge joint that allows motion up and down, and from side to side. Advertising revenue supports our not-for-profit mission. Download your copy today! Ankle arthrodesis: a systematic approach and review of the literature. Arthroscopic repair of chronic lateral ankle instability. David Ozeri, MD, is a board-certified rheumatologist from Tel Aviv, Israel specializing in arthritis, autoimmune diseases, and biologic therapies. These patients can likely avoid ankle ligament surgery. Ultrasound is used to precisely inject cells. The movement of the ankle is permanently stopped. J Med Life. This is an extreme injury that is difficult to treat. The main drawback is the finite lifespan of the implants, meaning the components may need to be revised in the future. Steroid injections often reduce joint inflammation, helping preserve joint structure and function. Surgery options include repair or reconstruction of the damaged ligaments. But you'll need to weigh the risks and benefits before making a final decision about surgery. Ankle replacement can give you relief from pain and make it easier for you to get around. Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. FOR MORE INFORMATION ON OUR COOKIES POLICY AND TO CONFIGURE THEM, The injury is such an issue that about 20% of sports related injuries are caused from ankle injuries. The powder, comprised of collagen, proteins, and growth factors, is mixed with stem cells harvested from the patients blood or bone marrow and transferred to tiny holes drilled in the talus bone., The final surgical option is an osteochondral graft. Best Women's: Tory Burch Good Luck Shoes. You can also read:CAN YOU TREAT A MENISCUS TEAR WITHOUT SURGERY? An anchor is screwed to the tip of the fibula at the proximal insertion of this ligament. Your email address will not be published. The pros and cons of ankle fusion surgery show that it can be beneficial to many who are under the age of 60 and are struggling with joint problems. How Is Physical Therapy Used After a Total Ankle Replacement? Even stepping off a curb incorrectly can injure your ankle ligaments. 5. There are over 1 million ankle injuries each year in the United States alone. 5. Neal Blitz, DPM, FACFAS, is a board-certified doctor of podiatric medicine and creator of the Bunionplasty procedure. In this context, the natural progression is the gradual deterioration of the joint. The procedure, also known as ankle arthroplasty, replaces the arthritic ankle joint with a metal and plastic prosthesis. Easley suggests that before you decide on surgery,. World J Orthop. Allscripts EPSi. You will need to get around either on crutches or with some other assistive mobility device. Ankle ligament surgery, also known as ankle ligament reconstruction, is a surgical procedure that is used to repair or reconstruct one or more of the ligaments in the ankle. Some athletes wear a sleeve or tights that go below the knee for compression and comfort. People regain a much wider range of motion; most return to active lifestyles. Depending on the severity of the condition, surgery may either be arthroscopic or open.. Fortunately, a large number of ankle ligament injuries are only partial-thickness, or full-thickness tears without retractions. There may be injuries that occur because of the fusion. If non-surgical methods don't provide relief, ankle replacement might be your next step. A ligament is a thick band of connective tissue that connects bone to bone. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). In such cases, additional surgery may be required. Ankle ligament surgery involves significant pain, recovery, and rehabilitation The PAL procedure, a precise injection of bone marrow concentrate into damaged ligaments is a safe, effective nonsurgical alternative to Brostrom ankle surgery that does not require extensive rehabilitation or have the surgical risks. Ankle arthrodesis. World J Orthop. the tear happens more frequently in soccer, basketball, and volleyball but can . After going through with the ankle fusion surgery and getting their strength back, they can begin walking and doing all of the things they used to do before their joint started limiting their motion. It's most often done as an outpatient surgery, so you can go home the same day. Cushioned heel is great for shock absorption. A persons overall health and lifestyle habits are also evaluated. Ligament and tendon reconstruction is an open surgery involving at least one incision. Barbari SG, Brevig K, Egge T. Reconstruction of the lateral ligamentous structures of the ankle with a modified Watson-Jones procedure. A new nonsurgical technique that utilizes a patients own bone marrow-concentrate cells is an effective alternative to heal ankle ligament injuries. 3. You will have crutches to help you move around throughout this period, putting no weight on your foot. Singh JA, et al. For ankle fusion, the surgeon roughens the ends of the damaged bones and then fastens them together with metal plates and screws. Hsu A, Gross CE, Lee S, Carreira DS. It may create healing complications and other unknown risks. Arthritis Foundation: "Osteoarthritis," "Surgery for Ankle Pain". Choosing the right ankle surgery, Current concepts in osteoarthritis of the ankle: review, Ankle arthrodesis: a systematic approach and review of the literature, Ankle arthrodesis: a comparison of anterior approach and transfibular approach, Postoperative weightbearing following ankle arthrodesis: a systematic review, Total ankle arthroplasty versus ankle arthrodesisa comparison of outcomes over the last decade. Arthritis can affect this joint as well as other joints in the foot. Choosing the right ankle surgery. The worst type of ankle ligament tear is one where the ligament is completely torn and retracted. 1987;7(6):362-8. This is one of the major stabilising ligaments within the knee. For individuals with severe bone damage and loss of mobility, joint replacement surgery may be the more appropriate option., Ankle arthrodesis can be performed either as an open surgery or minimally invasive arthroscopic surgery. There are three ligaments that prevent the ankle and the foot twisting inwards: the anterior and posterior talofibular ligaments, which connect the fibula to the talus, and the calcaneofibular ligament, which stretches between the fibula and the calcaneus (figure 1 and 2). Ankle fusion (arthrodesis) involves cleaning the worn-out ankle joint and fusing the bones together with screws, plates, and bone grafts. Ankle Arthrodiastasis. If fusion has occurred, you can resume certain physical activities as swimming or stationary bicycling. That spares the other parts of your knee and ankle that can wear out following ankle fusion. 25A #1A SUR -45 Medellin, Antiqua, Colombia, 050022. People regain a much wider range of motion; most return to active lifestyles. Ankle Ligament Tears There are different levels of torn ligaments. Foot and ankle ligament repair is a procedure typically done to treat serious sprains or instability in the ankle. "I typically recommend that patients consult with their primary care physicians before ankle replacement to be sure that they are as healthy as they can possibly be," Easley says. J Exp Orthop. After an ankle fusion surgery, a padded plaster cast is placed on the joint to protect it. You will wear the resin cast for 6 weeks. There are three major types of ankle ligament injuries. Many patients actually do not need ankle ligament surgery in order for their ankle ligaments to return to normal function. People with ankle replacements are advised against high-impact activities such as running and jumping. The results of this technique are nevertheless very encouraging as a stable ankle with improved function is recovered in over 90 % of cases. Stem cell injections can encourage the ankle ligament to heal on its own without the need for any intervention. For arthroscopic surgery, three tiny incisions would be made to insert the video-assisted scope (called the arthroscope) and specialized surgical tools. It is pretty easy to see why; a simple wrong step on the pavement can cause extreme discomfort. There are three major ligaments on the outside of the ankle that stabilize the joint. To make up for this, nearby joints may move more which increases the risk of developing arthritis in these joints. Fusing together the major bones of the lower leg (the tibia and fibula) with the talus bone of the ankle increases stability and eliminates bone-on-bone friction, thereby decreasing pain. As long as the disadvantages are properly managed, however, this surgery is a highly effective way to regain the ability to walk without pain once again. The ankle itself may become stronger once it is fused, but the end result is the possibility of additional wear and tear on other joints. You are going to undergo ankle ligament reconstruction. Exostectomy refers specifically to the removal of motion-blocking osteophytes.. This procedure also aims to help a patient reduce pain related to their injury and ankle sprains, as well as to avoid early arthrosis. In general, he says, surgeons favor ankle replacement surgery for people over age 55. Cons. The skin may not heal well and require nursing care for several weeks, or even surgical revision. Best Responsive Support for Both Men and Women: Asics Novablast 3. By Neal Blitz, DPM, FACFAS A haematoma may appear around the area operated on due to bleeding. We thus talk of a sprained ankle, which can be more or less serious and require immobilization for the ligament to heal. Foot Ankle Int. Our medical and scientific team continues research to improve therapies and offer additional treatment options. After the splint is removed, a short fiberglass cast is applied and worn for the next 4 to 8 weeks. Ulici A, Balanescu R, Topor L, Barbu M. The modern treatment of the simple bone cysts. 5. Outcomes vary on study design, the specific type of surgery, and patient demographics. COVID-19; Arthritis; Type 2 Diabetes; Heart Disease; Digestive Health 2014;35:1250. Firestein GS, et al. 4. This content does not have an English version. Severely damaged ankle joints may need to have the bones fused together or even replaced with an artificial joint. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. If the healthcare professional does not have the correct information then there is no chance they can make the correct recommendation. People who have severe ankle damage from arthritis or a past injury may be candidates for ankle fusion. The majority of ankle ligament injuries do not require surgery. This reconstructs the calcaneofibular ligament (figures 8 and 9). Yasui Y, Hannon CP, Seow D, Kennedy JG. Have you sustained an ankle ligament injury and dont know exactly what type of tear you have? After the ligament is properly attached from surgery, stem cell injections can lead to a faster and more complete recovery. It also means that certain activities may no longer be available to the patient because of the lack of available movement, forcing certain lifestyle changes. Both are used to treat mild to moderate ankle arthritis and typically performed on an outpatient basis. Foot & Ankle International. The names of a given ligament are simply the names of the two bones that it spans across. Thank you, {{form.email}}, for signing up. John R. Schultz M.D. doi: 10.1016/S0140-6736(15)60334-8. Because the artificial ankle joint is designed to more closely mimic the natural movement of the ankle, you can walk with a more natural gait and experience less pain and a greater range of motion. Only part of the patient population that experiences a torn ankle ligament that is also retracted. doi:10.1016/j.eats.2016.09.013, Fansa A, Drakos M, Cabe T, et al. The goal of ankle fusion is to relieve pain and restore function to the affected ankle. J Orthop Surg Res. The threads on the anchor are passed through the free end of the strip and tied together to fix it to the bone. Duke has been involved with the research and development of ankle replacement devices and have access to all the prosthetics. A strip of periosteum, which is the membrane covering the bone, is harvested on the fibula. The occurrence of an infection, although rare (risk below 1 % in our establishment), is a serious complication and may require surgical revision and a course of antibiotics. Surgery on an ankle may be needed to treat fracture (broken bone), arthritis, tendonitis and problems that can't be resolved with therapy and medications. ____________________________________________________________________________, 1.Manganaro D, Alsayouri K. Anatomy, Bony Pelvis and Lower Limb, Ankle Joint. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. 2017;6(1):e167-74. 2017;12:76. doi:10.1186/s13018-017-0576-1. Almost all ankle sprains can be treated without surgery. Wynes J, Kaikis AC. By "better results" we mean fewer complications after the surgery, less pain, most normal motion, and improved proprioceptive function. It will stabilize the joint, ease the pain and prevent further injuries that might worsen the condition. Success rates tend to be lower than with knee and hip replacements., There are pros and cons to ankle replacement. That depends, and its a decision best made with your doctors guidance. Frequently, this procedure is performed once other non-surgical treatments, including physiotherapy, have proved ineffective. 2018;35(4):467-79. doi:10.1016/j.cpm.2018.05.006, Castagnini F, Pellegrini C, Perazzo L, Vannini F, Buda R. Joint sparing treatments in early ankle osteoarthritis: current procedures and future perspectives.
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