Understanding Osteochondral Lesions

The medical field is full of jargon and insider terms that can sometimes seem confusing or overwhelming to outsiders. Here in New York, we do our best to break down definitions and help patients understand more about their bodies and the challenges they are dealing with — especially before undergoing a surgeries like arthroscopies or cartilage cell transplants. In this blog, I’ll be breaking down the concept of osteochondral lesions. If you have any additional questions or concerns about this condition, I want to be there to help. Don’t hesitate to reach out and learn more.

What are osteochondral lesions?

Simply put, they are injuries or small fractures that occur on or around the cartilage surface of the talus. The talus is a large bone in your ankle that works in conjunction with the tibia of the leg and other bones in your feet. There are three specific types of osteochondral lesions: the first is injury to the cartilage surface with an actual loss of part of the chondral surface and underlying subchondral bone. This is the most common type of injury that will require care. The second most common type is an injury to the superficial cartilage surface with a crush cartilage injury or shear tear of the cartilage surface. Finally, there is a subchondral cyst type injury with a cyst formation deep to the cartilage surface but an intact overlying cartilage and bone surface. This latter type of injury is fairly rare.

Why do they happen?

Osteochondral lesions usually develop when your ankle is pushed or twisted in an unnatural way. This can cause things to shift in directions they shouldn’t. Identifying and diagnosing this injury can be challenging. Often, the lesions are at least part of the cause of an overall ache that pops up during activities like athletic competition or running. In fact, symptoms will likely come and go and may only be identified after occurring multiple flare-ups. Since symptoms of an osteochondral lesion are similar to those of other ailments, a diagnostic imaging test is typically the best way to identify the problem at hand.

What can be done?

Fortunately, patients don’t have to live with the discomfort of a lesion forever. In fact, there are multiple ways we can attempt to treat the issue. As with most medical situations, I prefer to use the least extensive strategy first and accelerate treatments if a body does not respond to the initial care. At first, we might try eliminating the issue with a cast or a brace. If this does not prove effective, surgery is recommended.

The surgical approach that I suggest will be based on several factors, including the extent of your injury and the level of activity you hope to maintain after recovery. Most commonly, an arthroscopy can deliver great results. With this minimally invasive surgery, we will use a tiny camera to have a precise view of the area, make a small incision and keep as much of your natural joint intact as possible. This approach makes the healing process faster and cleaner.