Lower extremity trauma resulting in ankle sprains and ankle fractures are very common. These conditions are treated accordingly and effectively but long term sequelae of such injuries are often overlooked. Osteochondral lesions of the talus is one such sequelae of these injuries.
The talus is one the bones of the foot which along with Tibia and fibula form your ankle joint. The cartilage covering the talus is on average 0.89 mm thick in comparison to the knee joint where it is 6 mm thick. Ankle joint is highly congruent and the talus is a major weight bearing bone. The impact of shear and compression forces causes a cartilage contusion and is often transmitted to the subchondral bone, thus causing subchondral microfractures. Ankle sprains and ankle fractures can also violate the cartilage of the talus directly.
Patients usually present with localized ankle pain and swelling. Pain is worse with physical activities such as running and high impact sports. Often a clicking or popping sound is heard and felt. Physical exam usually reproduces these findings.
X-rays usually do not give much information but can often show subtle changes in bone density in areas localized to pain. Advanced imaging such as MRI is required to confirm diagnosis. Lesions can be seen on the MRI images are very clear and can be small bone contusion type of injuries or as severe as complete detachment and displacement of the cartilage.
Treatment depends on the severity of the condition. Cast immobilization and physical therapy can often work in the younger patient population with non displaced injuries. Surgical intervention is often necessary when conservative measures fail or when there is a displaced cartilage defect. Multiple treatment options are available depending on the injury and severity.
Some Surgical Options we provide for OCD:
Arthroscopy with repair
BioCartilage® Allograft Cartilage Repair
Arthroscopy with allograft or autografts
Microfracture of OCD
These include arthroscopic debridement of the ankle joint and microfracture of the osteochondral defect to promote healing. The OATs procedure (osteochondral autologous allograft transfer is considered if the defect is greater than 20mm in size. The graft can be harvested from the knee. Cadaveric osteochondral allograft transfer is also an option for such injuries and has the benefit of having no donor site complications.
3-D printed Talus is the latest innovation in treating such injuries for larger defects or when there is necrosis of the talus. The implant used is the exact replica of the patient’s own talus.
Discuss your condition with our expert doctors and see what option is best for you.