Ankle cartilage injuries, including osteochondritis dissecans (OCD) and traumatic chondral defects, affect the talar dome (the dome-shaped surface of the talus that articulates with the tibia). The condition often follows ankle sprains or fractures and produces persistent pain and swelling that does not resolve with normal sprain recovery. Treatment depends on lesion size, location, and stability.
What Are Ankle Cartilage Injuries and OCD?
The talar dome is covered with articular cartilage that, in conjunction with the tibial plafond, allows smooth ankle motion. Cartilage injuries of the ankle present in several patterns:
- Traumatic chondral defects from acute ankle fracture or severe sprain
- Osteochondral lesions of the talus (OLT), often involving both cartilage and underlying bone
- OCD lesions, where subchondral bone loses its blood supply and the overlying cartilage is at risk of separation
- Loose bodies when fragments separate completely from the joint surface
OCD and OLT lesions of the talus most commonly affect the medial talar dome (more posterior) and lateral talar dome (more anterior).
Causes and Risk Factors
- Prior ankle sprain or fracture
- Acute trauma with a shear or impaction force on the talar dome
- Chronic ankle instability with repetitive cartilage loading
- Idiopathic onset (no clear inciting event) in a subset of patients
- Possible genetic predisposition for OCD in some cases
- Skeletally immature athletes with overuse loading
Symptoms
- Persistent ankle pain after a sprain that should have resolved
- Catching or locking sensation in the ankle
- Recurrent swelling with activity
- Limitations with cutting and impact activity
- Dull, deep ankle pain that is difficult to localize
Diagnosis
Dr. Chudik’s evaluation includes the prior injury history and the pattern of persistent symptoms. Physical examination assesses range of motion, joint line tenderness, and any mechanical signs. X-rays may show OCD lesions in established cases but can miss early disease. MRI is the imaging study of choice and characterizes lesion size, depth, stability, and overlying cartilage status. CT is occasionally added for surgical planning. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is appropriate for stable lesions and early symptoms:
- Activity modification and short-term immobilization in a boot
- Anti-inflammatory medication
- Physical therapy for ankle motion and strengthening
- Bracing or orthotics in cases with associated mechanical issues
Surgical treatment is indicated for symptomatic lesions that fail non-surgical care, displaced fragments with mechanical symptoms, and larger defects at risk of progression. Dr. Chudik performs arthroscopic procedures including debridement, microfracture, fragment fixation, and osteochondral autograft transfer (OATS) using plugs from the knee. Osteochondral allograft is reserved for very large defects.
Recovery and Outcomes
Recovery depends on the procedure. Debridement allows early return to weight-bearing within weeks. Microfracture typically requires six to eight weeks of protected weight-bearing followed by progressive loading and return to sport at four to six months. Osteochondral grafting has longer recovery, with return to sport typically six to nine months.
Outcomes are best when lesions are identified and treated early before extensive cartilage damage develops.
When to See Dr. Chudik
Schedule an evaluation if persistent ankle pain has continued after a sprain, if you have catching or locking, or if prior imaging has identified a talar dome lesion. Call 630-324-0402 or request an appointment online.