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Osteochondral Lesions of the Ankle

The Condition

Persistent ankle joint pain can limit activity and disrupt the ability to comfortably carry out the most simple activities of daily living. The severity of symptoms can vary from individual to individual. Causes for generalized ankle pain and impingement can include damage to the joint (osteochondral defect), capsule (synovitis) and ligaments (sprain).

The Treatment

Ankle pathology such as torn ligaments, joint cartilage damage, ankle joint capsule synovitis, and loose floating pieces of cartilage/bone may be be improved with conservative care. However, these conditions can all be treated via traditional open or arthroscopic surgery if the patient does not improve.

Frequently Asked Questions

An osteochondral defect of the ankle is a focal area of damage that has occurred at the joint surface. Typically both bone and cartilage become compromised due to a traumatic or pathologic process. The cartilage may catch in the joint with ankle motion resulting in pain with walking and other physical activities. If the damaged area becomes detached, the piece of cartilage is free to move throughout the joint and may lead to additional pain, damage and joint impingement.

These conditions are typically identified and diagnosed through physical examination, plain film radiographs (X-rays) and magnetic resonance imaging (MRI).

The need for surgical intervention will depend upon multiple factors that include symptom severity, type of injury sustained, and overall patient health. In many cases, conservative care can be offered to relieve the symptoms associated with these injuries. This may include oral medication, steroid injections, platelet rich plasma prolotherapy, immobilization and physical therapy.

Prolotherapy, also referred to as regenerative injection therapy, is a non-operative method of treatment that can be used to heal injured tendons, ligaments and joints. Platelet rich plasma is one form of prolotherapy that allows physicians to harvest the natural healing ability of the human body to repair the injured tissues. Platelet cells contain growth factors that promote and direct tissue healing. These cells are obtained from the patient via a simple blood draw and are concentrated using a centrifuge. The platelets and their growth factors are then injected into the injured tissue to promote healing. This method of treatment is commonly used to improve painful conditions of the ankle joint.

Ankle arthroscopy is a surgical procedure that is minimally invasive and provides the surgeon access to the interior of the joint in order to repair physical damage to the affected structures. The technique is traditionally performed via two very small incisions at the anterior aspect of the joint space, which allows for the introduction of a small camera, or ‘scope’, and specialized instruments. The live arthroscopic images are viewed during surgery on a television monitor in real time. Regions of cartilage damage can be removed and micro fractured to encourage new tissue growth. Torn ligaments can be repaired, synovitis can be addressed, and bone spurs and loose bodies can be removed using this technique.

Post operative recovery can range from 7 – 28 days depending upon the underlying pathology addressed. In many cases physical therapy and active range of motion exercises are prescribed. In some instances patients are encouraged to begin waking within 24 hours of surgery. The limited incision size reduces recovery and provides the added benefit of limited scar tissue formation in comparison to more traditional surgical approaches. The majority of patients report an improvement in joint function and mobility following the procedure.

Articles

A Patient’s Guide to Natural Healing: Autologous Conditioned Plasma (ACP)This brochure further explains the platelet rich plasma prolotherapy treatment currently offered at JCMG Podiatry.