Osteochondral Defect (OCD) of the Ankle

Osteochondral Defect Overview

An osteochondral defect (OCD) is a focal area of damage to the cartilage and underlying bone within a joint. In the ankle, OCDs most commonly occur on the talar dome (the top of the talus bone that forms part of the ankle joint). The damage may involve only the cartilage or extend into the bone, and can lead to persistent pain, swelling, locking, or instability of the ankle.

OCDs can develop following trauma (such as an ankle sprain or fracture), or they may arise without a specific injury in some individuals due to cartilage wear or vascular issues.

Osteochondral Defect Symptoms and Diagnosis

Common symptoms of an osteochondral defect include:

• Deep, aching pain in the ankle joint

• Swelling, especially after activity

• Stiffness or reduced ankle movement

• Locking, catching, or a sensation of giving way

• Pain that persists beyond normal ankle sprain recovery

Diagnosis is made through a combination of clinical examination and imaging. X-rays may show areas of bone damage or loose fragments. MRI scans are especially useful in assessing the extent of cartilage damage and the stability of the defect. In some cases, a CT scan may be requested for surgical planning.

Osteochondral Defect Causes

Osteochondral defects of the talus often occur after:

• Ankle sprains or twisting injuries

• Direct trauma or impact to the joint

• Repetitive overloading in athletes

• Underlying bone or cartilage conditions

• In rare cases, spontaneous cartilage failure or vascular disruption (osteochondritis dissecans)

These injuries may go unnoticed at first, particularly if associated with a sprain, and only become apparent when symptoms persist beyond the expected recovery time.

Osteochondral Defect Treatment and Prevention

Treatment depends on the size, location, and stability of the defect, as well as your activity level and symptom severity.

Non-surgical management may be considered for small, stable lesions:

• Activity modification and rest

• Physiotherapy to maintain ankle strength and flexibility

• Use of supportive footwear or orthotics

• Anti-inflammatory medications

• Temporary use of an ankle brace

However, if the defect is unstable, symptoms persist, or the defect is large, surgical treatment may be necessary.

Osteochondral Defect Surgery

Surgery is aimed at restoring a smooth joint surface and promoting healing of the bone and cartilage. The approach depends on the size and depth of the defect.

Surgical options may include:

• Arthroscopic debridement and microfracture: Small holes are made in the underlying bone to stimulate healing and the formation of fibrocartilage. This is most suitable for small, contained lesions.

• Curettage and drilling: Damaged cartilage and loose fragments are removed, and the underlying bone is drilled to improve blood flow and promote healing.

• Cancellous bone grafting: For larger or deeper defects, Mr Hester may use autologous bone graft taken from the calcaneum (heel bone) to fill the void left by damaged bone.

• Chondrocyte matrix application: A chondrocyte matrix, such as Chondroguide, may be applied over the graft to help regenerate cartilage tissue and improve surface smoothness.

Some of these procedures are usually carried out through arthroscopic (keyhole) surgery, though open surgery may be required in some cases.

Mr Hester will discuss the specific surgical plan with you, including whether bone grafting or chondrocyte matrix application is appropriate, based on the size and location of your osteochondral defect.

Osteochondral Defect Surgery Recovery

Post-operative care is designed to protect the repair while allowing gradual return to activity:

• You will typically be placed in a cast or boot and instructed to be non-weight-bearing for up to 6 weeks.

• At 2 weeks, the wound is reviewed and sutures trimmed or removed.

• After 6 weeks, gradual weight-bearing begins, usually in a walking boot.

• Physiotherapy starts to regain strength, mobility, and proprioception.

• Impact activities are generally avoided until at least 12 weeks post-surgery, with full return to sport expected at 6–12 months, depending on recovery.

Expected Recovery Timeline

0–2 weeks

Rest, non-weight-bearing. Cast or boot. Keep foot elevated.

2 weeks

Wound review. Sutures removed or trimmed. Transition to lighter cast or boot.

2–6 weeks

Continued non-weight-bearing. Healing of graft site.

6–12 weeks

Begin gradual weight-bearing in a boot. Start physiotherapy.

3–6 months

Return to daily activities and low-impact exercise.

6–12 months

Return to full activity and sports if healing is complete and pain is manageable.