Osteochondral Lesions

Video Transcriptions

I’m going to talk about osteochondral lesions of the talus. The talus is part of the ankle. The talus is a rather interesting bone in our body in the sense that it is 60% covered by articular cartilage. It is the most important part the articulation of the ankle in the sense it allows you to sort of move the ankle up and down in coordinates with the tibia and the fibula.

Because ankle sprains are one of the most common injuries, talus osteochondral lesions can often happen during this situation. However, we are not quite sure as to why talus osteochondral lesions happen. If you dive into the word osteochondral lesion, it means osteo, bone, and chondral, cartilage, and what that implies is that when you have the injury a piece of both bone and cartilage from the talus can break off, fragment, or even just fissure or crack.

We usually see this in traumatic instances, but it’s also common in adolescence and in I would say about 6% of ankle sprains, actually can have an osteochondral lesion. So while you may think you just have an ankle sprain and you can walk it off or rehabilitate it, if you continue to have symptoms that haven’t improved after physical therapy or just regular rest, ice and elevation, you may have what’s called this osteochondral lesion of the talus. It’s become a much broader term now. You may be familiar with what used to be called osteochondritis dissecans.

The ankle is the third most common area to have it following the knee and the elbow, but we’ve sort of broadened the term to include anything that includes the bone and the cartilage of the talus, and that’s why osteochondritis dissecans is still used, but now we’re more accepting of the word osteochondral lesion of the talus to incorporate and to encompass everything that could potentially happen to the cartilage and the bone.

Now these lesions are rather difficult to deal with sometimes. In adolescence, in children, they’re generally non-displaced and generally can be treated with cast immobilization and can heal very well. However, in older people, especially adults that have high activity or repetitive injury or have an acute trauma that may caused it, these lesions can be rather difficult to treat.

There are two types of lesions to generally think of these. One would be contained, and one would be uncontained. The contained lesions are exactly sort of how it sounds. They are nice, well-fit lesion that may be in the center of the talus, or more commonly, post-remedial or anterolaterally on the talus. They have a good surrounding bone around it and wall, so they’re nice and contained.

Uncontained is exactly how it sounds. It sort of spills out or may involve the shoulder of the talus where it curves around its edges. There is no supporting structure or wall so it’s a little bit more difficult to treat. The way we treat these is always non-operatively first. You try to get it to heal by cast immobilization, do some rehabilitation, but if that fails, usually we require more advanced imaging like MRI or CT scan to further delineate exactly the location, the type of bone that’s involved, and also the size of the lesion.

The size is a big predictor, and the location, of how we treat these lesions, and this is where you can get into the idea of arthroscopy or even potentially an open sort of treatment that may be required. Because the talus is entirely covered with cartilage, is encompassed in the ankle mortise of the tibia and the fibula, it’s difficult to get to, so some of the lesions are not very easily accessible through a scope. If that’s the case, you have to actually cut the malleoli to get to the area.

Generally speaking, if it’s under about 15 millimeters squared, the lesion can be treated with microfracture. It’s where we make small fractures in the bone to hopefully create new cartilage. This cartilage isn’t the same cartilage you were born with, but it is adding some sort of covering to the bones so there’s not this raw surface that’s present.

Now the bigger lesions are the ones that are uncontained or are a little bit more difficult to treat, and require sometimes cartilage transplants or what’s called an osteochondral allograft. This is a very technically demanding procedure and is also carries a smaller success rate than potentially the microfracture would. You are actually physically taking either allograft cartilage cells or taking someone else’s bone and cartilage, their talus, and transplanting it to replace your bad area or your lesion.

So, as you can imagine, this one requires much longer recovery and prolonged amount of time of being off of it, and it also, because it’s foreign tissue, can sometimes carry a risk of not healing. Generally speaking, though, osteochondritis dissecans or osteochondral lesions of the talus will present with some mechanical symptoms. Because that surface is irregular you get popping and locking and clicking and sort of this recurrent swelling that may happen with activity, and this happens mostly with people who have chronic ankle instability.

If this is something that you experience and you’re having these symptoms and you think you perhaps maybe just had an ankle sprain or just tweaked your ankle a little bit but you’re having these persistent symptoms, I would definitely think osteochondral lesions of the talus may be a problem that you may be suffering from.

Osteochondral Lesions

Video Transcriptions

I’m going to talk about osteochondral lesions of the talus. The talus is part of the ankle. The talus is a rather interesting bone in our body in the sense that it is 60% covered by articular cartilage. It is the most important part the articulation of the ankle in the sense it allows you to sort of move the ankle up and down in coordinates with the tibia and the fibula.

Because ankle sprains are one of the most common injuries, talus osteochondral lesions can often happen during this situation. However, we are not quite sure as to why talus osteochondral lesions happen. If you dive into the word osteochondral lesion, it means osteo, bone, and chondral, cartilage, and what that implies is that when you have the injury a piece of both bone and cartilage from the talus can break off, fragment, or even just fissure or crack.

We usually see this in traumatic instances, but it’s also common in adolescence and in I would say about 6% of ankle sprains, actually can have an osteochondral lesion. So while you may think you just have an ankle sprain and you can walk it off or rehabilitate it, if you continue to have symptoms that haven’t improved after physical therapy or just regular rest, ice and elevation, you may have what’s called this osteochondral lesion of the talus. It’s become a much broader term now. You may be familiar with what used to be called osteochondritis dissecans.

The ankle is the third most common area to have it following the knee and the elbow, but we’ve sort of broadened the term to include anything that includes the bone and the cartilage of the talus, and that’s why osteochondritis dissecans is still used, but now we’re more accepting of the word osteochondral lesion of the talus to incorporate and to encompass everything that could potentially happen to the cartilage and the bone.

Now these lesions are rather difficult to deal with sometimes. In adolescence, in children, they’re generally non-displaced and generally can be treated with cast immobilization and can heal very well. However, in older people, especially adults that have high activity or repetitive injury or have an acute trauma that may caused it, these lesions can be rather difficult to treat.

There are two types of lesions to generally think of these. One would be contained, and one would be uncontained. The contained lesions are exactly sort of how it sounds. They are nice, well-fit lesion that may be in the center of the talus, or more commonly, post-remedial or anterolaterally on the talus. They have a good surrounding bone around it and wall, so they’re nice and contained.

Uncontained is exactly how it sounds. It sort of spills out or may involve the shoulder of the talus where it curves around its edges. There is no supporting structure or wall so it’s a little bit more difficult to treat. The way we treat these is always non-operatively first. You try to get it to heal by cast immobilization, do some rehabilitation, but if that fails, usually we require more advanced imaging like MRI or CT scan to further delineate exactly the location, the type of bone that’s involved, and also the size of the lesion.

The size is a big predictor, and the location, of how we treat these lesions, and this is where you can get into the idea of arthroscopy or even potentially an open sort of treatment that may be required. Because the talus is entirely covered with cartilage, is encompassed in the ankle mortise of the tibia and the fibula, it’s difficult to get to, so some of the lesions are not very easily accessible through a scope. If that’s the case, you have to actually cut the malleoli to get to the area.

Generally speaking, if it’s under about 15 millimeters squared, the lesion can be treated with microfracture. It’s where we make small fractures in the bone to hopefully create new cartilage. This cartilage isn’t the same cartilage you were born with, but it is adding some sort of covering to the bones so there’s not this raw surface that’s present.

Now the bigger lesions are the ones that are uncontained or are a little bit more difficult to treat, and require sometimes cartilage transplants or what’s called an osteochondral allograft. This is a very technically demanding procedure and is also carries a smaller success rate than potentially the microfracture would. You are actually physically taking either allograft cartilage cells or taking someone else’s bone and cartilage, their talus, and transplanting it to replace your bad area or your lesion.

So, as you can imagine, this one requires much longer recovery and prolonged amount of time of being off of it, and it also, because it’s foreign tissue, can sometimes carry a risk of not healing. Generally speaking, though, osteochondritis dissecans or osteochondral lesions of the talus will present with some mechanical symptoms. Because that surface is irregular you get popping and locking and clicking and sort of this recurrent swelling that may happen with activity, and this happens mostly with people who have chronic ankle instability.

If this is something that you experience and you’re having these symptoms and you think you perhaps maybe just had an ankle sprain or just tweaked your ankle a little bit but you’re having these persistent symptoms, I would definitely think osteochondral lesions of the talus may be a problem that you may be suffering from.