Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. May be due to micro trauma or a traumatic event. Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. Left untreated this can lead to degenerative changes to the ankle joint and evan necrosis of the talus.
Osteochondral lesion of Talus & Ankle
Causes:
Microtrauma- seen in runner or old age
Trauma- seen with ankle fractures and sprains
Foot Deformity- Cavus feet and flat feet can lead to uneven pressures in the ankle joint leading to early degenerative changes
Symptoms:
Dull aching pain in the ankle joint
Pain with range of motion of the ankle joint
Pain during ambulation
Joint effusion/swelling
Ligamentous laxity at the ankle joint
Foot deformity
History of ankle fractures or sprains
Treatment:
X-rays, MRI, CT and Bone scans may be performed to confirm the diagnosis of OCD (osteochondral lesion) and monitor its progression.
Conservative therapy:
This is reserved for lesions that are attached with minimal displacement. Cast/boot immobilization for 6 weeks, followed by gradual return to activity. Physical therapy is done to help with range of motion and peroneal tendon strengthening. Amniotic cell therapy may be used for chronic cases to help heal the lesion. Amniotic cell therapy contains growth factors and stem cells which have shown to accelerate healing.
Surgical Intervention:
There are multiple surgical interventions for those lesions that have failed conservative therapy or have OCD lesions which are displaced. Your surgeon may perform retrograde drilling of the lesion, ankle arthroscopy of the ankle joint, osteochondral transplant autograft/allograft. The surgeon may choose to perform lateral ankle stabilization surgery to prevent recurrence. The surgical procedure will be chosen by the surgeon based on the physical exam and radiographic findings.
