Ankle Cartilage Injuries

Ankle Cartilage Injuries

Ankle cartilage injuries or osteochondral lesions/defects (OCDs) occur when the two ankle bones, the tibia (shin bone) and the talus bone collide. This can cause a cartilage injury from the impact. This typically occurs with a severe ankle sprain or the result of an ankle fracture. Cartilage is the smooth gliding surface on the joint surface of bones on either side of the joint. The bone below the cartilage is called the subchondral bone. The cartilage can detach from the underlying subchondral bone and sometimes break into small pieces. These small pieces can float in the joint and cause irritation. Additionally, the exposed unhealthy subchondral bone can also lead to inflammation, pain, catching in the joint, difficulty and pain with walking and sporting activities. These are common injuries in young, healthy patients, but can cause issues in patients of all ages.

Many times the body can heal these injuries, but sometimes they continue to cause patients pain. Dr. Kohring will order an MRI and oftentimes a CT scan to further evaluate your osteochondral lesion to determine treatment options.

Surgery

Surgery is done through a minimally invasive approach called an ankle arthroscopy. Two small incisions are made on either side of your ankle. A camera or arthroscope is inserted into your ankle through one incision and different tools are placed into the other incision to treat the cartilage injury. These instruments are used to visualize and treat the cartilage injury. The loose cartilage and pieces are removed from the joint. This leaves an area of exposed subchondral bone with solid surrounding cartilage borders, like an “empty pool.” A small pick is used to make holes in the subchondral bone to stimulate the body to heal the cartilage defect with a new type of cartilage called fibrocartilage. This procedure is called a microfracture. This fills in the cartilage defect or “pool” to restore the healthy, smooth gliding joint surface. 

After surgery, you are placed into a splint and are non-weight bearing for two weeks. You then begin gentle weight-bearing in a regular shoe and start physical therapy.

Revision Surgery for Recurrent Osteochondral Defects

Cartilage does not always heal after a microfracture, this can lead to ongoing pain and swelling after surgery. A repeat MRI and oftentimes a CT scan are ordered to re-evaluate the lesion. Treatment options depend on the size of the lesion and other factors seen on advanced imaging. Dr. Kohring will be happy to review your specific case in the office with you to determine your best treatment options.