Osteochondral Defect Of The Ankle

Osteochondral Defect (OCD) of the Ankle

An osteochondral defect is damage to the cartilage and underlying bone of the ankle joint (usually the talus). It may occur after an injury or develop gradually due to abnormal joint mechanics.

Traumatic OCD

Usually follows a significant ankle sprain, most commonly an inversion injury.

Symptoms

• Persistent ankle pain after injury
• Swelling
• Occasionally catching or locking of the ankle

Investigations

• Plain X-rays may appear normal
• MRI scan is diagnostic and shows:
  • Location and size of the lesion
  • Cartilage integrity
  • Associated ligament injuries

Treatment

Initial Treatment

• Immobilisation in a splint or cast to settle acute symptoms

Definitive treatment — surgery
Most symptomatic lesions require surgery.

• Arthroscopic (keyhole) procedure to assess stability and cartilage cover
• Many lesions require open surgery to directly access the defect
• Fixation of fragment ± bone grafting where necessary

Non-traumatic OCD

Symptoms often develop gradually and may follow minor injury.
Commonly associated with:

• Chronic ligament instability
• Varus ankle alignment (tibial–heel malalignment)

Symptoms

• Persistent pain and swelling
• Activity-related discomfort

Investigations

• X-rays often inconclusive

MRI scan confirms location and cartilage status

Treatment

Non-operative management
Aims to address the underlying cause:

• Ankle brace and physiotherapy for ligament laxity
• Orthotics or corrective footwear to improve alignment

Surgical treatment
Indicated if symptoms persist.

Treatment focuses on correcting the mechanical problem:

• Ligament reconstruction alone, or
• Ligament reconstruction combined with calcaneal osteotomy to restore alignment

After correction of the underlying cause, the OCD lesion is treated arthroscopically (and open fixation if required as described above).

Correcting alignment and stability is important, as treating the defect alone without addressing the cause risks recurrence.