OCD Lesions of Talus
Introduction
The ankle joint of made up of 3 bones; the tibia (including the medial malleolus), the fibula (including the lateral malleolus) and the talus. The talus sits inside the joint and allows the up and down motion of the ankle. The cartilage lining of the joint is crucial to allow smooth, pain-free motion of the joint.
OCD stands for Osteochondral Defect. This means that there is a defect of the cartilage and/or bone in a joint, and in this case the ankle joint.
What Causes an OCD Lesion?
The cartilage lining of the talus can be damaged or bruised even from a simple ankle sprain. The talus twists inside the ankle joint and actually hits against the rest of the bones of the ankle. This impact can cause chips of cartilage and bone that may be seen at the time of injury. More commonly, this injury causes a deep bruise and leads to softening of the cartilage that isn’t seen for months or years later. It may lead to a small crack in the cartilage and a cyst forming in the talus bone. This is what is referred to as an osteochondral defect of the talus (OCD, OLT).
These injuries are often difficult to see on x-rays and other imaging such as MRI is needed.
Signs & Symptoms
Patients with osteochondral lesions have a variety of symptoms ranging from mild pain to locking or catching pain. The most common symptoms are:
- Pain around the ankle joint
- Swelling
- Mechanical symptoms such as catching or locking
- Ankle effusion (excess fluid in the joint)
Non-Surgical Treatment & Rehabilitation
The treatment depends on the severity of the osteochondral defect. Initial treatment typically consists of activity modification and rest, ankle bracing and physical therapy. Some lesions are fairly stable and may even be asymptomatic.
When Is Surgery Needed?
The more severe types of defects often have persistent pain and may require surgery. Certain OCDs are amenable to arthroscopic surgery. This is a procedure were very small instruments and camera are used to clean out the ankle joint, remove the loose pieces of cartilage and perform a drilling of the cyst to stimulate the body to heal it.
Larger OCDs or ones that have failed the arthroscopic procedure may require cartilage grafting or replacement. This can be from your own cartilage elsewhere in your body, from cadaver donor or newer synthetic scaffolds. The right procedure for you will be discussed in depth with Dr. DeMill.
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