From the Research
Osteochondritis dissecans (OCD) lesions in the ankle typically present with deep, aching ankle pain, localized tenderness, mild swelling, and limited range of motion, and should be further investigated with imaging studies to guide treatment decisions between conservative management and surgical intervention based on lesion stability, size, and location. The clinical findings of OCD lesions in the ankle include:
- Deep, aching ankle pain that worsens with activity and improves with rest
- Localized tenderness over the affected area of the talus (most commonly the medial or lateral talar dome)
- Mild swelling
- Limited range of motion, particularly with dorsiflexion
- Antalgic gait and pain with weight-bearing activities
- Provocative tests like the anterior drawer test may elicit pain if the lesion is anteriorly located
- Crepitus might be felt during ankle movement in cases where the fragment is unstable
- Signs of instability if there is associated ligamentous injury
According to the most recent study 1, the management of symptomatic OCD of the knee can be applied to the ankle, and surgical intervention is often necessary for unstable OCD lesions, with techniques such as osteochondral fixation, subchondral bone preparation, and arthroscopic-assisted or open fixation showing excellent outcomes. The study also highlights the importance of early identification and treatment to prevent progression to early degenerative changes.
The treatment options for OCD lesions in the ankle include:
- Conservative management with rest, cast immobilization, and use of nonsteroidal anti-inflammatory drugs (NSAIDs) 2
- Surgical options such as lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation, and techniques such as osteochondral transplantation and autologous chondrocyte implantation 2, 3
- Arthroscopic microdrilling, micropicking, and open procedures such as osteochondral autograft transfer system and matrix-induced autologous chondrocyte implantation 4
It is essential to note that the treatment approach should be individualized based on the patient's specific condition, lesion stability, size, and location, as well as the presence of any associated injuries or comorbidities.