The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. The top of the talus is dome-shaped and is completely covered with cartilage (connective tissue that allows the ankle to move smoothly). An osteochondral lesion is an injury to the cartilage and underlying bone of the talus or tibia within the ankle joint. Osteo refers to bone chondral refers to cartilage.
OCDs are typically caused by an injury, such as an ankle sprain or at times an ankle fracture. If the cartilage does not heal properly following the injury, it softens and begins to break. Occasionally a broken piece of the damaged cartilage and bone will float in the ankle joint. An OCD lesion is comparable to a pot hole on the highway, once it begins the pathology will progress unless treatment is initiated.
The injury is typically extensive; however, it may take months to years to develop active symptoms.
- Chronic pain deep in the ankle, typically worse when placing weight on the foot especially during sports or physical activity, the pain decreases when resting.
- Occasional clicking or catching feeling in the ankle when walking/running.
- Sensation of the ankle locking or giving out.
- Swelling to the ankle joint and pain with range of motion.
To diagnose this injury, your surgeon will ask about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine the source of pain, clicking, or limitation of motion within that joint.
Sometimes the surgeon will inject the joint with a local anesthetic and cortisone (pain-relieving medication) to see if the pain goes away, and to determine that the pain is coming from inside the joint.
X-rays will be ordered. An MRI may be ordered to determine the extent of the lesion as well as determine surgical planning should surgery be warranted. At times a CT Scan will be ordered if arthritis is noted our to evaluate the exact depth of the lesion.
Non Surgical Treatment
Treatment depends on the severity of the OCD lesion. If the lesion is stable (without loose pieces of cartilage or bone) and if symptoms are mild conservative treatment may be considered.
- Immobilization/Rest. Depending on the type of injury, immobilization may be initiated with the use of a short leg cast or removable walking boot to protect the talus. Range-of-motion exercises (non weight bearing) may be recommended.
- Ice. Apply an ice pack to the painful area as well as behind the knee placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in reducing the pain and inflammation in the early stage of the conditions.
- Physical therapy. Range-of-motion and strengthening exercises are helpful once the lesion is healed. Physical therapy may also include techniques to reduce pain and swelling.
- Ankle brace. Wearing an ankle brace may help protect the patient from re-injury if the ankle is unstable.
Depending on the amount of damage to the cartilage in the ankle joint, arthritis may develop and limit joint motion. Treatment for this may be different then in the early stages of the OCD lesion.
If non-surgical approaches fail to relieve the symptoms of an OCD, surgery may be necessary. Your surgeon will select the best procedure to repair the OCD lesion which may involve removal of the loose bone and cartilage fragment as well as arthroscopically cleaning the joint of any inflammation.
Surgery is typically an outpatient procedure (day surgery) and scheduled at your convenience.
A splint or boot will be placed on your surgical foot/ankle after surgery. No weight to the surgical foot/ankle is advised until your surgeon encourages weight bearing (typically 6 weeks post surgery).