The bottom bone of the ankle joint is called the talus, and when this and its overlying cartilage are injured, an osteochondral lesion occurs. These could be fractures, blistering of the cartilage or cyst-like lesions under the cartilage.
Profound locking or freezing of the ankle joint, when it will not bend, indicates an osteochondral lesion. Prolonged or persistent pain despite treatment for other conditions such as a sprain also raises concern. Pain is felt primarily at the inner and outer joints of the ankle.
Non-operative treatment requires immobilisation. Surgical treatments depend on the characterization and location of the lesion. Arthroscopy is a possibility if the lesion is accessible by that method. Debridement removes the damaged cartilage and bone. The fragment may also be fixed, the lesion can be drilled and transfer and grafting of bone and cartilage are also options. Mr. Samarji’s goal with all surgery is to restore the gliding movement to the talus and the re-establishment of the normal mechanics. Bone grafts or cartilage transfers take longer to recover from.
Not all patients with an osteochondral lesion will need surgery. If the osteochondral lesion is not painful it does not necessarily need to be treated surgically. If an osteochondral lesion is present and painful the alternative to surgery would be to undergo a period of immobilisation in a walker boot or a cast. With regard to an operation if the lesion is painful and does not respond to non-operative measures then surgery to deal with a painful osteochondral lesion is highly effective. Approximately 80% of patients will get a good result from surgery, but it is important in making the decision to weigh up not just the chance of getting a good result, which is very high, but also what is involved and also the risks of any procedure. This is fully discussed at the consultation alongside the other treatment options in order that you are able to make a sensible decision regarding any treatment that may be needed for the osteochondral lesion.
If surgery is needed for an osteochondral lesion, this generally takes the form of keyhole surgery. An arthroscopy of the ankle is carried out. The area of damage (osteochondral lesion) is prepared and small perforations are made in the bone to allow for bleeding and the development of new cartilage to take the place of the old damaged cartilage. The operation takes between thirty to ninety minutes. The operation is generally carried out as a day-case but may require an overnight stay. Following surgery, the ankle is immobilised in a walker boot or a plaster cast for approximately six weeks.
Surgery for an osteochondral lesion is generally done as a day case. Sometimes an overnight stay is required following which you would be allowed home the following morning.
Following keyhole surgery for an osteochondral lesion, return to work may be possible around two weeks following the procedure. Consideration to transport and driving to and from work needs to be taken into account particularly if the right leg has been the one that has been treated. The requirement for immobilisation in a walker boot or cast is for six weeks. Return to sports is at approximately three to six months for heavier sports, but for more gentle sports / low impact sports generally it is about two to three months following surgery.
After surgery for an osteochondral lesion, you will require physiotherapy to strengthen the ankle and leg. Generally, between six and ten sessions of physiotherapy will be needed following this type of keyhole surgery for an osteochondral lesion.
All surgery carries elements of risk and surgery for an osteochondral lesion is no different. Risks include infection, clots, nerve or vessel injury and complex pain. It is important to weigh up the risks of surgery set against what is involved and also the benefits and chance of success. Considering risks is part of the decision-making process for any surgical treatment.