Ankle Osteochondral Lesion
Joint cartilage damage or injury
Osteochondral lesion of the talus (OLT) involves an area of cartilage damage that separates from the underlying bone, usually the talus. These lesions may be incidental or post-traumatic. They may be acute or chronic. The degree of symptoms experienced may vary from asymptomatic to aching and pain experienced on every step. The size, location and depth of the lesion can help determine treatment required. Ultimately the aim of treatment is to reduce or eradicate pain associated with the lesion, to allow the patient to return to normal activities. Non painful lesions may not require any treatment other than observation.
This minimally-invasive procedure is performed to stimulate the growth of fibrocartilage in an injured joint. Fibrocartilage is a tough, dense, fibrous material that can fill in areas where smooth, glassy cartilage has become damaged or worn away. This procedure may be performed with general or regional anesthesia.
Many are related to trauma, chronic instability of the ankle joint or recurrent ankle sprains. Other causes include repetitive micro trauma, avascular necrosis (loss of blood supply to the bone), congenital or spontaneous necrosis of the bone.
May depend on the specific or associated underlying cause, such as:
- Recurrent instability
- Difficulty walking on uneven ground, difficulty playing sports
- Catching within the joint
- Natural History
Symptoms may wax and wane, or worsen.
If repetitive, there is risk of fracture, cartilage damage, injury to the peroneal tendons.
Eventually ankle joint arthritis may ensue which results in loss of articular or joint cartilage leading to progressive stiffness/pain/swelling.
Weight-bearing X-rays are required. MRI and/or CT scans may be required.
- There may be other reasons for the symptoms, such as peroneal tendinitis, arthritis, soft tissue or bony impingement
- Initial management is based upon the patient’s age, chronicity of the lesion, associated injuries, stability of the lesion and symptoms
- Non-operative measures:
- Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
- Footwear modification: lateral heel wedge, flared sole
- Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling, swimming.
- Physiotherapy: strengthening of peroneal tendons, proprioception including wobble board and/or stretches
- Weight loss management
- External lace up ankle brace support or taping
- Protected weight-bearing may be required
- Surgery Risks
All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:
- Infection: superficial wounds or deep infections
- Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
- Nerve damage: tingling, numbness or burning
- Ongoing pain
- Stiffness of the ankle joint
- General or anaesthetic risks including to the heart and lung
- Drug reactions/allergy
- Scarring or tethering of the skin
- Calf weakness
- Revision surgery
- Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery
- Post Op Guides
- Ankle Arthrodesis
- Ankle Arthroscopy
- Ankle Fracture
- Calcaneal Fracture
- Flatfoot Reconstruction
- Hallux Rigidus – Arthrodesis
- Hallux Rigidus – Arthroplasty
- Hallux Valgus Surgery
- Lapidus Procedure
- Lateral Ligament Instability
- Midfoot Arthrodesis
- Midfoot Fractures Surgery
- Subtalar Joint Arthrodesis
- Tibiotalocalcaneal Fusion
- Total Ankle Arthroplasty