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How to treat a osteochondral lesion of the talus

What is cartilage damage in the ankle?

An osteochondral lesion (OCL) is an area of cartilage (joint surface) injury or damage. The underlying bone can also be affected, which is often the cause of pain. These lesions can be caused by injuries such as an ankle fracture and ankle sprain, but may also develop spontaneously due to repeated micro trauma (small injuries)

CT scan show lesion (Red arrow)

MRI scan shows the lesion (Red-arrow)

MRI scan shows the lesion (Red-arrow)

Red arrow shows the lucency (OCL) in the talus ankle joint)

How do you treat cartilage damage to the ankle?

If the lesion is small with no loose fragments in the ankle joint, the injury can be treated in a special boot for 6 weeks with increasing weight bearing and physiotherapy to strengthen the muscles around the ankle.

What are the surgical treatment options for cartilage damage to the ankle? 

There are many treatment options for OCLs, none however have been shown to be better than microfracture surgery. This procedure is often expensive and involve a period of non-weight bearing. Microfracture surgery have been shown to have good long-term outcomes with up to 80% improvement still at 20 years. The site of the injury does affect the outcome.

In severe cases where the cartilage of the whole ankle is affected, an ankle fusion or replacement can be considered.

What does microfracture surgery involve?

This procedure can be done arthroscopically (keyhole surgery) as a day case. Special instruments are used to remove the damaged cartilage and make very small holes in the bone beneath. This stimulates bleeding and release of bone-marrow which then allows the joint surface to heal.

Can I weight bear after microfracture/ bone marrow stimulation procedure?

You can start with immediate weight bearing and physiotherapy after the procedure. Often the first 10 days care should be taken to allow the wounds to heal.

How long does cartilage damage to the ankle take to heal?

Most osteochondral lesions (OCL) will heal between 4-6 weeks. Ongoing improvement can be expected up to 1 year after the surgery.

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