Ankle osteochondral lesion, also known as osteochondritis dissecans (OCD) of the ankle, is a condition that affects the smooth cartilage and underlying bone in the ankle joint. It is characterised by the detachment of a fragment of cartilage and bone from the underlying surface, leading to pain, swelling, and limited joint movement. This condition is most commonly seen in the talus bone, which is one of the bones that make up the ankle joint.
Here’s a breakdown of key points about ankle osteochondral lesions:
Causes
The exact cause of ankle osteochondral lesions is not always clear, but it’s often associated with repetitive stress, trauma, or a history of ankle injuries. In some cases, poor blood supply to the affected area can contribute to the development of the lesion.
Symptoms
The symptoms of ankle osteochondral lesions can vary, but they generally include pain, swelling, stiffness, and decreased range of motion in the affected ankle. Pain may worsen during activities that involve weight-bearing or impact on the ankle joint, such as walking, running, or jumping.
Diagnosis
Diagnosis involves a combination of clinical evaluation, medical history review, and imaging studies. X-rays, magnetic resonance imaging (MRI), and sometimes computed tomography (CT) scans are used to visualise the lesion, assess its size and location, and determine its impact on the joint.
Classification
Ankle osteochondral lesions are often classified based on their size, location, and stability. The classifications help guide treatment decisions. Lesions are graded from I to IV, with Grade I being the mildest and Grade IV representing a completely detached fragment within the joint.
Treatment
Treatment options for ankle osteochondral lesions depend on factors such as the size and stability of the lesion, the patient’s age, and their activity level. Conservative treatments may include rest, activity modification, pain management, physical therapy, and immobilisation. If conservative approaches are ineffective or if the lesion is unstable, surgical intervention may be considered.
Surgery
Surgical treatment aims to remove or repair the detached fragment, stimulate healing, and restore joint function. Different surgical techniques can be used, such as drilling tiny holes into the affected area to encourage blood flow, reattaching the fragment with screws or pins, or performing microfracture to promote cartilage regeneration.
This is how the talus osteochondral lesion looks like on ankle arthroscopy:
Cartilage repair using bone marrow aspiration concentrate is used:
Recovery
Recovery from ankle osteochondral lesion surgery can vary. It often involves a period of protected weight-bearing using crutches and a gradual progression to full weight-bearing as healing progresses. Physical therapy is a crucial part of rehabilitation to restore strength, range of motion, and functional mobility.
This is an example of a patient with osteochondral lesion on the superolateral talar dome:
The patient was treated with arthroscopic debridement of the osteochondral lesion, autogenous bone grafting and cartilage repair.
This was the x-rays taken a few months after surgery showing healing of the OCL:
