Osteochondral lesions of the talus
Background
An osteochondral lesion (OCL) of the talus is a relatively common type of injury to the ankle joint. In order for the ankle joint to move smoothly, the bones are covered by a smooth, tough layer of cartilage that absorbs shock and minimizes friction. An osteochondral lesion or osteochondritis dessicans (OCD) is a patch of damage to the cartilage layer and some of the bone underneath it. This problem can occur after trauma, such as spraining or breaking the ankle. It also affects some adolescents and teens because of a temporary interruption in blood supply. Not all OCLs are symptomatic, but they can cause pain, swelling, and make it hard to walk. With prolonged delay in diagnosis, these areas can lead to more wear and tear changes and accelerate potentially arthritis.
Diagnosis
To diagnose an osteochondral lesion of the talus requires a history and physical exam by an orthopedic surgeon with expertise in foot and ankle conditions. A X-ray can detect some OCLs, but the best test is an MRI.
MRI of the ankle with red arrow showing the osteochondral lesion.
Treatment
The first line treatment includes temporary immobilization in a surgical boot, physical therapy or anti-inflammatory medication. Injections such as platelet-rich-plasma (PRP) or cortisone are also options for individualized cases.
In some instances when these treatments fail, surgery may be needed to repair the damage in your ankle. The exact type of surgery depends on the size and location of the lesion. One newer procedure allows for repair of the cartilage damage using your own stem cells (BMAC), taken from the bone marrow of the pelvis. This is mixed with Biocartilage- a material composed of tiny particles of cadaveric cartilage that provide a scaffold for cells to grow. The entire surgery is performed through two pokehole incisions at the front of ankle with a specialized joint camera (arthroscope) and instruments. Additional removal of scar tissue and other procedures of the ankle can be performed at the same time.
After an initial period of rest, physical therapy and rehab starts to get you back to your daily and desired recreational activities.
This treatment technique does not need to steal cartilage from the other joints in your body and promotes the growth of a stable, new fibrocartilage layer. Read more about cutting edge research related to this technique compared to the older microfracture technique: Comparison of Functional and Radiographic Outcomes of Talar Osteochondral Lesions Repaired With Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate vs Microfracture. https://pubmed.ncbi.nlm.nih.gov/33472436/
If you have an osteochondral lesion of the talus or frequently experience ankle pain and swelling, it's important to take it seriously and get evaluated as soon as possible. With the right care, you can get back to walking, running, and activities without pain.
