Tiny screw that banishes agony of sprained ankles

TENS of thousands of people sprain an ankle each year and now a new implant can help repair the damage. Steve Loader, 46, a director of a road repairs firm, had the operation, as he tells CAROL DAVIS.

THE PATIENT

IWAS playing hockey one afternoon ten years ago when I went over on my l eft ankle. Pain shot through it, and I limped to the edge of the pitch.

By the evening my ankle was swollen, bruised and painful, so I saw my GP, who sent me to a physiotherapist — I was told to use ice and compression bandages, and to keep it elevated.

The swelling went down in a couple of weeks. But every few months I’d feel a sharp twinge of pain in my ankle. And it got steadily worse until five years ago I was getting several twinges a day.

I had to give up hockey, and even playing football for five minutes with my son Oliver. I saw another physio, who watched me walk and said my ankle was crooked. I was wearing down the outside of my left shoe as I was putting my weight on the outside of my foot. He explained that with a sprained ankle, the joint slips sideways, tearing ligaments that connect bones. And sometimes they don’t heal properly. I had months of physio to strengthen the ligaments, which helped.

But by 2009 even having a duvet covering my ankle hurt. My mother sent me an article about a consultant orthopaedic surgeon, Andy Goldberg. I saw him privately last July. He sent me for a CT scan which showed that the injury had damaged a corner of cartilage and bone, just 14 mm (½ in) across, and fluid from the joint was seeping into the bone, forming a cyst which caused pain.

Usually they repair damaged ankle joints by replacing the whole thing or fusing it so the bones don’t move and rub against each other, but Mr Goldberg said he could use a new screw- shaped device, called HemiCAP, to replace just the lost patch of cartilage. He explained it would fix into the ankle bone on one side of the joint. The screw has a rounded head, which glides smoothly against the other bone. I woke from the 90-minute operation with my leg in plaster. Elizabeth took me home the next day, and I used crutches for six weeks. I can now run again and walk for hours without pain.

THE SURGEON

ANDY GOLDBERG is consultant orthopaedic surgeon at the Royal National Orthopaedic Hospital in London. ANYTHING that forces the ankle to twist abnormally can cause a sprain — sporting injuries or even going over on your ankle wearing high heels. This twisting can partially tear ligaments which, in some cases, don’t heal.

A sudden sprain can also partly dislocate the joint so the talus (ankle bone) bangs against the tibia (shinbone), creating a defect in the cushioning cartilage and chipping away the bone — this occurs in up to 20 per cent of ankle sprains. One new treatment for a bad sprain is HemiCAP, which was developed in Sweden four years ago. It’s exciting because we replace just the damaged section of bone and cartilage — like repairing a cigarette burn in a carpet, rather than replacing the whole carpet. HemiCAP is made from a metal alloy and looks like a screw with a curved top the size of a €1 piece — the top is shiny and smooth, so glides within the joint. It fixes into the ankle bone and the underside of the screw-head is rough, like a nail file, so the patient’s bone grows into this textured surface and fixes it into the joint more strongly. This could work for patients with a damaged area less than 2.5 cm in diameter — HemiCAP is 2 cm to 2.5 cm across.

First, I make a 6 cm incision on the inside of the ankle, and use surgical saws and chisels to break part of the shinbone, exposing the ankle joint. I drill out damaged cartilage and bone, and drive the screw into the ankle bone. Then I fix the round top to it. Then I repair the shinbone using two screws, and close the wound with stitches. The patient’s own cartilage should grow over the HemiCAP in a few months, leaving an ankle that glides smoothly and without pain.

ANY DRAWBACKS?

‘THIS is a fairly big operation that involves an osteotomy (cutting) of the tibia to treat cartilage damage within the ankle joint,’ says Nick Harris, a consultant orthopaedic surgeon. ‘Like all implants it may loosen or sink into the bone, potentially leaving a huge defect that makes other options, including fusion and ankle replacement, more difficult since so much bone has been lost.’

THE operation costs around €15,000 privately.