Osteochondral defect (OCD) refers to a condition that results in a focal area of cartilage loss in a joint. It is almost always caused by an injury, most often in the ankle by a sprain. Although OCD is also common in the knee and elbow joints it is especially prevalent in the ankle. Typically in the ankle, it affects the talus bone and is also referred to as an osteochondral lesion of the talus (OLT.)
Three bones come together to form the ankle joint; the tibia, the fibula, and the talus. The tibia and fibula are the bones of the lower leg that run parallel to each other. When they reach the ankle, the tibia inserts the inside of the ankle joint and the fibula as the outside of the joint. Serving as the connecting point between the leg and the ankle, the talus is a compact and very dense bone.
The talus is cradled by the tibia, which means that it supports the weight of the entire body, as well as the additional force created from movements, such as walking, running, climbing stairs, and sudden or violent twisting and changes of direction. As the connection between the leg and the foot, specifically the heel bone or calcaneus, the talus is covered in articular cartilage. The cartilage facilitates smooth movement of the joint.
What Is OCD Talus?
Osteochondral defect of the talus refers to a focal area of injured or damaged bone and cartilage on the upper part of the talus. Trauma, often from an injury to the ankle resulting in a severe sprain, is typically the cause of this condition. That said, OCD talus can also develop and worsen over time. This may be due to excessive and persistent pressure created by an ankle joint that is unstable, resulting in frequent ankle sprains.
The cartilage becomes injured during trauma, and creates a fracture through the cartilage down to or into the underlying bone. The cartilage becomes separated, or delaminated from the bone underneath, and cannot heal back because the cartilage has no blood supply of its own. Fluid from the ankle joint then can enter the exposed bone and create a cyst under the injured cartilage.
Symptoms of OCD Talus
Depending upon the extent of the damage, a patient’s pain can be variable. Typically the pain occurs when the ankle is rotated and loaded in such a way that places stress directly on the injured cartilage. This pain can be quite sharp at times. Others will feel just a chronic dull ache to the ankle that feels deep inside. Occasionally the fragment of cartilage will break off, and create a locking of the joint.
- Ankle pain is the most common symptom, often referred to as a deep, dull ache, and brought on by physical activity, like walking or running, particularly uphill, climbing stairs, and participating in sports
- Swelling, stiffness, and tenderness
- Weakness, to the point of feeling like the ankle may “give way” and not support your body weight
- Loss of range of motion
- Popping or clicking sound or sensation in the joint, possibly getting caught in one position caused by loose bone or cartilage fragments lodging between bones during movement
Treatment recommendations for OCD talus will vary based on the condition and lifestyle of the patient. Some of the most common considerations are:
- Age and activity level of the patient
- How severe the symptoms are and to what extent they are affecting the quality of life
- Size and location of the lesion, as well as the extent of damage
- Goals and expectations of the patient
For children and adolescents and adults with minor damage, particularly the absence of dislodged bone and cartilage fragments, nonsurgical options may often be sufficient. These will typically include some combination of:
- Immobilization – this may include a cast or ankle brace
- Medication – usually over-the-counter nonsteroidal anti-inflammatory drugs for pain and to reduce inflammation
- Physical therapy – to restore strength and range of motion once healing has taken place
Conservative measures are often unsuccessful in adults, especially when there is significant damage due to a lesion being especially large or there are fragments of bone or cartilage loose in the joint. At this point, surgery will likely be recommended. Various procedures are used to repair damage to the bone and cartilage of the talus and the decision will be made on an individual basis. Basically, these repairs will consist of:
- Drilling into the bone and creating new pathways for blood flow, or microfracture. This can be augmented with stem cells from bone marrow.
- Using pins or screws to stabilize the lesion if injury is of recent onset and fragment is detached
- In cases of large areas of cartilage loss, a graft of bone and cartilage may be used, which will reconstruct the damaged area
Contact Dr. Christopher E. Hubbard Today
If you have been diagnosed with OCD Talus and need treatment, do not hesitate in contacting Dr. Christopher Hubbard today. Dr. Hubbard has the necessary skills and knowledge to provide you with the treatment you need. Contact our New Jersey office today for your first appointment.