Ankle OCD
What is Ankle OCD?
The ankle joint is an articulation of the end of the tibia and fibula (shinbones) with the talus (heel bone). Osteochondral injuries, also called osteochondritis dissecans (OCD), are injuries to the talus bone, characterized by damage to the bone as well as the cartilage covering it. Sometimes, the lower end of the tibia or shinbone may also be affected.
Causes of Ankle OCD
Osteochondral injuries are most often caused by trauma to the ankle joint, such as with ankle sprains. Some cases may not have any previous history of ankle injury, and may be caused by local osteonecrosis or a metabolic defect.
Symptoms of Ankle OCD
The predominant symptom of osteochondral injury is pain, which may be localized to the ankle joint. Other symptoms may include tenderness and swelling of the ankle joint with difficulty in weight- bearing, locking of the ankle or instability.
Diagnosis of Ankle OCD
Osteochondral injuries are diagnosed by a physical examination, X-ray and CT and MRI scans. Plain X-ray images can reveal other fractures, bone spurs and narrowing of the joint. A CT scan helps identify any bony fragments and cysts, but is not very helpful to visualize bone edema or cartilage defects. MRI is the best imaging modality, which helps to visualize the cartilage and bone lesions as well as bone edema.
Treatment of Ankle OCD
Non-surgical or surgical treatment may be recommended for the management of osteochondral injuries of the ankle joint. Non-surgical treatment with immobilization, restricted weight-bearing and physical therapy may be ordered to help the bone and cartilage to heal, and improve muscle strength, mobility and coordination. Surgical treatment is recommended for more severe injuries and comprises of debridement (removing) of the damaged cartilage and removal of any loose bodies. Some of the most commonly used surgical techniques include microfracture or drilling of the lesion, grafting of cartilage and bone, or fixation of the fragments with the help of screws.
OATS Procedure
Position Statement:
The American Orthopaedic Foot & Ankle Society (AOFAS) endorses the use of osteochondral autograft and allograft transplantation for the treatment of osteochondral lesion of the talus, especially large diameter lesions, cystic lesions, and those that have failed previous surgical treatment. AOFAS does not consider these procedures to be experimental in a patient population that has failed nonoperative management. The American Orthopaedic Foot & Ankle Society is a medical specialty society whose 2,200 members are orthopaedic surgeons specializing the operative and nonoperative treatment of injuries, disease, and other conditions of the foot and ankle. The AOFAS promotes quality patient care through education, research, and training of orthopaedic surgeons and other healthcare providers, and serves as a resource for government, industry, and the healthcare community on issues concerning the medical and surgical care of the foot and ankle.
