Ankle > Osteochondral Lesion of the Talus

What is an Osteochondral Lesion of the Talus?

The word osteochondral refers to anything relating to cartilage and bone. The bone surfaces in your ankle are covered with a thick coating of articular (hyaline) cartilage. The cartilage cushions the contact between the bottom of your shinbone (tibia) and smaller lower leg bone (fibula), and the bone on the bottom of your ankle joint, called the talus. An osteochondral lesion in your ankle, commonly called OLT, affects the cartilage atop your talus that allows movement (articulation) and absorbs weight in your ankle joint. Osteochondral lesions are usually small "chip" fractures of the cartilage with an underlying portion of the talus attached to the cartilage. Osteochondral lesions can range from minor cartilage tears to major loose chips of bone and cartilage in your ankle joint. The two most common types of osteochondral lesions are classified according to the part of your talus that is damaged:

   Anteriorlateral - These lesions affect the outside portion of your talus, usually toward the front. They often are associated with ankle sprains.

   Posteriormedial - These lesions usually occur in the middle of your talus, toward the back. They typically are not related to other injuries and may occur because of a loss of blood supply to your ankle.

Any movement that causes your shinbone to come down too hard on your ankle can put you at risk for an osteochondral lesion. Sports that involve cutting and twisting, such as basketball or football, can cause osteochondral lesions along the outside of your talus, which is the bottom of the ankle joint. Hard, cutting motions may apply too much pressure to the cartilage on top of your talus and chip the normally smooth surface. Overuse, as can happen in sports like long distance running, also can damage cartilage in your ankle joint over time and cause an osteochondral ankle lesion. Only about 40 to 50 percent of osteochondral ankle lesions are associated with trauma. Another common cause of osteochondral ankle lesions, especially in the middle and back of your talus, remains unknown. Some people may fracture their ankle cartilage even though they cannot recall twisting or otherwise stressing their ankles. Some physicians believe a lack of blood supply to your ankle may weaken the middle and back of your talus and may put you at risk of suffering osteochondral lesions during regular everyday activities.

Considerations

The treatment of osteochondral ankle lesions is controversial, and physicians differ on how quickly they recommend surgery to repair cartilage on the top of your foot bone (talus). If left untreated, osteochondral ankle lesions typically continue to cause increased pain and swelling in your ankle, and activities may become harder to perform. MRI occasionally reveals osteochondral lesions in patients who have no complaints of pain or other symptoms. In general, osteochondral lesions do not heal on their own. Treatment is usually determined by the stability of the lesion and the amount of pain that it causes you. For small cartilage lesions, especially in younger patients, doctors typically prescribe immobilization with a removable cast, called a cam walker. In some cases, Your physicians may prescribe a cast. Patients over 30 years old may have difficulty recovering from an osteochondral lesion without surgery. As age, the amount of pain, and the size of your lesion increases, you become a more likely candidate for arthroscopic surgery. In some cases, arthroscopic surgery may be prescribed to make the final diagnosis if a MRI test is unclear. The links to the left explain standard osteochondral ankle lesion treatments in detail.

Though many people with mild or moderate ankle pain feel they can treat themselves at home, you should have your ankle evaluated by a physician, who can check for complications and decide on a specific treatment program for your ankle. There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

Your physician likely will ask about your activities, which may have caused your osteochondral ankle lesion, and about when the soreness or pain began. If you have had any prior ankle injuries, your physician will ask about the treatments you have tried in the past. You should reveal any previous history of ankle surgery at this time. Physicians generally suspect an osteochondral ankle lesion when patients have a history of weeks or months of swelling, catching, and pain in their ankles that affects them during activity and has not improved despite previous treatment. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You may also be asked about your physical and athletic goals – information that will help decide what treatment might be best for you in achieving those goals.

PHYSICAL EXAM

During the physical exam, your physician typically looks for swelling, or joint effusion, in your ankle. Physicians usually use their fingers to press areas all around your ankle to see if there are any areas of the talus that may be damaged. Your ankle may be moved up, down, side-to-side, and rotated to see if any positions are more painful.

TESTS

X-rays usually are ordered first to see whether your talus has been fractured. X-rays can show bone chips on the bone surface. However, MRI (magnetic resonance imaging) tests commonly are needed to create images of your cartilage and any associated soft tissue damage to ligaments or tendons. A final diagnosis often cannot be made until MRI results come back, which usually takes about one week. In some cases, MRI may not fully reveal the osteochondral lesion. Arthroscopic surgery may be necessary to let your physician conclusively determine the extent of your osteochondral lesion.

   Imaging techniques