The talus is the bone of the ankle joint connects the leg to the foot. Unlike most bones, there is no muscle that is attached to the talus; therefore, its position is highly dependent on the position of the neighboring bones. Much of the talus bone is covered in cartilage and the blood supply is not as rich as many other bones in the body. As a result, injuries to the talus are sometimes more difficult to heal than similar injuries in other bones. The tibia and fibula bones sit right above and to either side of the talus bone, forming the ankle joint which is responsible for much of the up and down motion of the foot and ankle.
Osteochondral lesion also referred to as osteochondritis dessicans or osteochondral fractures are injuries to the bottom bone of the ankle joint (talus) where a thin layer of the bone, along with the overlying cartilage, comes loose from the end of a bone. Osteochondral lesions occur most often in men, especially after a traumatic injury to the ankle joint such as a severe ankle sprain. If the loosened piece of bone and cartilage stay close to where it separated, the fracture may heal by itself and the individual may have very few or no symptoms of osteochondral lesion. However, if the fragment comes completely loose and gets caught between moving parts of the ankle joint or if the pain is severe and persistent, surgery may be required to avoid further complications.
Osteochondral lesions can occur after just one traumatic injury or as a result of a series of traumatic episodes. The following signs and symptoms may raise a concern for osteochondral lesions:
- Prolonged pain in the affected ankle joint triggered by any physical activities
- Popping or locking of the ankle joint
- Overall joint weakness with a sensation of the joint "giving way"
- Restricted or decreased range of motion of the ankle joint
- Swelling and tenderness of the skin around the ankle joint
If the initial pain and swelling caused by an ankle sprain persists after proper treatment (Rest, Ice, Compression, Elevate), it is highly advised to see a physician immediately to rule out osteochondral lesions.
Osteochondral lesions can be diagnosed with a combination of physical examination as well as imaging studies. Imaging is necessary to confirm the diagnosis; at the very least, your physician will order X-rays of just your injured ankle or both in order to compare the two. Occasionally, plain X-rays may show an osteochondral lesion, but additional imagine such a CT scan or MRI scan might be required in order to identify the proper course of treatment.
Upon confirmation of the diagnosis, treatment of osteochondral lesions may consist of either non-operative or operative methods. The goal of the treatment is to restore normal function of the affected ankle joint, relive pain, and reduce the risk of further damage. The approach will likely depend on the severity of the osteochondral lesion, the individual's medical condition, as well as the presence of other injuries.
Non-operative Treatment of Osteochondral Lesions – The main goal of non-operative treatment is to allow the injured bone and cartilage to heal. This approach is appropriate for certain lesions and usually involves immobilization and restricted weight bearing which may then be followed with physical therapy and gradual weight bearing progression.
Operative Treatment of Osteochondral Lesion – Other lesions might require an operative treatment in order to restore normal function and shape of the talus, and ultimately, the ankle joint. The main goal of this approach is to minimize, if not eliminate, symptoms and limit the risk of arthritis. Depending on the location and nature of the osteochondral lesion, surgery may be done either by opening the skin or arthroscopically.
Treatments may include the removal of the injured cartilage and bone (debridement), fusion of the injured fragment, microfracture or drilling on the lesion, or grafting of bone and cartilage. The physician will discuss these options and decide the best course of action.
Recovery time after an osteochondral lesion depends on the nature of the lesion and the treatment approach. Most approaches require a time of restricted movement and minimal weight bearing for weeks or in some cases, months. Surgical procedures, such as grafting, might require a longer period of recovery.
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