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State of the Art
Restorative procedures for articular cartilage in the ankle: state-of-the-art review
  1. Yoshiharu Shimozono1,
  2. Francesca Vannini2,
  3. Richard D Ferkel3,
  4. Norimasa Nakamura4,5,
  5. John G Kennedy1
  1. 1 Orthopedic Surgery, NYU Langone Health, New York City, New York, USA
  2. 2 Clinic 1, Rizzoli Orthopaedic Institute, Bologna, Italy
  3. 3 Orthopedic Surgery, Southern California Orthopedic Institute, Van Nuys, California, USA
  4. 4 Department of Orthopaedic Surgery, Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Osaka, Japan
  5. 5 Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
  1. Correspondence to Dr Yoshiharu Shimozono, NYU Langone Health, NYU Orthopedic Hospital, New York City, NY 10002, USA; yshimozono13{at}


Articular cartilage is a highly specialised connective tissue that serves to lubricate joint surfaces and distribute loads across the joint. Injury to articular cartilage is a significant cause of pain and dysfunction that may eventually lead to osteoarthritis or degenerative arthrosis. Management of these injuries is complicated by the complex architecture and poor vascularity of this tissue. The field of articular cartilage restoration has evolved rapidly over the past several decades and current techniques offer promising results. However, despite the fast pace of progress in the treatment and repair of articular cartilage injury, a clear gold standard in management has yet to emerge. Current techniques for managing cartilage injuries discussed in this review include bone marrow stimulation, osteochondral transplantation, chondrocyte implantation, cell-based transplantation, biological augmentation and scaffold-based therapies. Heterogeneity in study design, including surgical procedures, lesion and patient characteristics, cell collection, biologics preparation protocols and outcome measures limits interpretation of results presented in the literature. Therefore, standardisation across research protocols and collaboration among centres will be necessary. This ‘state-of-the-art review’ presents the indications and techniques for managing ankle articular cartilage lesions, as well as future directions and geographical differences in management.

  • cartilage
  • ankle
  • biologics
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  • Contributors YS wrote the paper/draft and made tables. FV wrote the paper/draft and provided figures. RDF wrote the paper/draft and provided figures. NN and JGK reviewed the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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