Osteochondral Lesion of the Talus (Ankle)

Osteochondral Lesions of the Talus (Ankle)

The tibia and the fibula bones of the lower leg join with the talus bone to form the ankle joint. The talus bone is an important bone located between the tibia and fibula and the heel bone (calcaneus). OCL or OCD is the damage to the cartilage and the talus bone of the ankle joint. Usually, the inner or the medial portion of the ankle is affected.

Osteochondral (OCL) injuries of the ankle (Talus and Tibia) as well as other joints including the 1st MTP, subtalar and navicular are common. The division has more experience in this condition than any other facility in the US with over 100 publications reporting on outcomes. The division surgeons were pioneers in using concentrated bone marrow aspirate in OCL of the ankle and continues to be at the forefront of stem cell therpy, autologous osteochondral transplant (OATS) and other cartilage sparing techniques.

Where can I have Osteochondral Lesions?

Talus (talar dome: medial and lateral)
Tibia
1st MTP
Subtalar Joint
Navicular
Femur (Knee)

Causes of OCL of the Talus (Ankle)

OCL may be genetic or may be caused due to trauma, stress fractures in sports, severe sprain, local osteonecrosis, etc.

Symptoms of OCL of the Talus (Ankle)

OCL lesions are sometimes asymptomatic. Large lesions are associated with symptoms such as localized ankle pain and discomfort which worsens while walking or running, a clicking or popping sound, swelling, tenderness, weakness of the foot, etc.

Diagnosis of OCL of the Talus (Ankle)

Osteochondral lesions are diagnosed by a physical examination, X-ray, and CT and MRI scans. Plain X-ray images can reveal other fractures, bone spurs, and narrowing of the joint. A CT scan helps identify any bony fragments but is not very helpful to visualize bone edema or cartilage defects. MRI is the best imaging modality, which helps to visualize the cartilage and bone lesions as well as bone edema.

Treatment of OCL of the Talus (Ankle)

Non-surgical Method

Small lesions can be treated non-surgically involving the use of a cast, physical therapy, pain medications, strengthening exercises, etc.

Arthroscopy

An arthroscope is a narrow tube with a tiny video camera on one end. The structures inside the ankle are visible to your surgeon on a monitor in the operating room. Your doctor treats OCL by removing the damaged tissue followed by microfracture, which enables natural healing of the damaged bone and cartilage.

OATS Procedure

Large lesions are treated by the OATS procedure. OATS of the ankle is a surgical procedure to treat Osteochondral Lesions of the Talus (OCL) or Osteochondritis Dissecans (OCD). It involves the transfer of healthy cartilage to replace the damaged cartilage and restore the normal function of the foot. The cartilage can be taken from your ankle joint (autograft) for smaller defects. An allograft (graft from a donor) is considered for large defects. During an OATS procedure, multiple, tiny plugs of healthy bone and cartilage are transferred in a pattern that resembles a mosaic, hence, the procedure is also known as mosaicplasty.