An osteochondral lesion is an area of damaged cartilage and softened bone on the top of the talus.

This can be caused by trauma to the ankle such as an ankle sprain.

They may arise spontaneously with no trauma. The reason for this is unknown.

The damage to the cartilage and underlying bone can result in the development of a cyst or fragmentation.

What are the symptoms?

Patients can present with pain, swelling or stiffness and may also experience a sharp catching sensation.
There may be no symptoms at all if the lesion is an incidental finding.

What is the non-surgical treatment?

This includes pain relief, rest, activity modification, and in some cases a Cam boot or ankle brace.

If there has been an associated ankle sprain physiotherapy is very important.

What is the surgical treatment?

Surgical treatment is required if the symptoms persist.

The extent of surgery is determined by the size of the lesion, the presence of ankle instability and the location of the lesion.

Surgery most commonly involves an ankle arthroscopy. This is performed through two small incisions on the front of the ankle. The loose cartilage is removed along with any damaged bone or cyst. The bone is then drilled to stimulate bleeding. This bleeding forms a clot and over time the development of a cartilage layer.

This new cartilage is not as robust as normal cartilage and may deteriorate over time resulting in return of symptoms.

The likelihood of success is determined by the size of the lesion.

In lesions less than 150mm 2 , surgery is successful in 75% of cases in relieving symptoms and allowing return to normal function.

In some cases where there is a larger bone cyst arthroscopy and drilling is less likely to be successful and alternative surgery may be recommended.

If there is associated ankle instability, surgery to reconstruct the ligaments is recommended.

What does the rehabilitation involve?

• Ankle arthroscopy and osteochondral lesion debridement is day surgery.
• You will have a bulky bandage which can be removed after 48 hours to allow regular application of ice and ankle motion.
• 2 weeks foot elevated the majority of time.
• In most cases you can be fully weightbear with crutches.
• You will be provided with a boot to be worn full time until the dressings are debulked.
• The boot is to be worn when walking until comfortable then at night only.
• You will be seen in Mr Curry’s rooms at 2 weeks where you will see Mr Curry and our Nurse Practitioner.
• Physiotherapy will begin at 2 weeks
• By 6 weeks you will be back to most daily activities.
• You must avoid impact or twisting activity for 8 weeks.
• Swelling resolution may take 3 months.
• Aim to return to sport at 3-4 months.

How long will I be off work?

This is dependent upon your occupation

• Seated job 2-3 weeks
• Standing job 6-8 weeks
• Heavy lifting job 10-12 weeks

When can I drive?

It is recommended you do not drive for 2 weeks.

What are the risks of the procedure?

General risks of surgery

• Infection
• Wound healing problems
• Nerve injury and scar sensitivity
• Blood clots to the leg
• Anaesthetic problems

Specific risks for ankle arthroscopy

• Ankle stiffness
• Incomplete symptom resolution
• Recurrence of symptoms