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Osteochondral Defect of the Talus

What is OCD of the Talus?

Osteochondral defect of the talus is defined as a separation of articular cartilage, with varying amounts of damage to the talar dome. The talus is a unique bone heavily covered in articular cartilage that is necessary to provide pain-free range of motion within the ankle joint. Studies show the cartilage thickness is relatively thin compared to other weight-bearing joints and is commonly damaged with injury. Conservative or surgical treatment is required to help with pain and function and reduce further disability.

When should I consider surgery?

Conservative therapies are less invasive treatments that may offer temporary or permanent pain relief for patients and include
  • Activity modification
  • Custom orthotics
  • Anti-inflammatory medications
  • Ultrasound-guided corticosteroid injections (PRP/Amnio Flowable)
 
If these measures have failed with multiple attempts or when the injury is severe, you may be a candidate for surgical repair.
 

Surgical Goals and Treatment  

After thorough physical examination and review of your advanced imaging studies, Dr. Cottom and Dr. McAlister will formulate a surgical plan that is tailored to the severity of your injury. The goals for surgical repair are to restore function, reduce pain, and ultimately curb any further progression of ankle arthritis that commonly occur with these injuries.
 
Our team uses minimally invasive arthroscopic techniques to surgically repair osteochondral defects. We first create small incisions to the ankle and inserts an arthroscope, which is a viewing instrument made up of a tiny lens, light source, and camera to enable the surgeon to visually examine the ankle. Arthroscopy allows direct visualization of the ankle joint and avoids any trauma to surrounding structures that would be at risk in a traditional, open approach.
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MRI imaging of the foot and ankle demonstrating an osteochondral lesion of the talar dome

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Arthroscopy technique in the operating room under intraoperative fluoroscopy 

Series of intra-op photos taken with the arthroscope demonstrating cartilage injury in the ankle joint

Specific Techniques

Current treatment algorithms are based on the size and location of the lesion, integrity of the cartilage within the ankle joint, and the presence of any subchondral cysts or swelling around the joint. Dr. Cottom and Dr. McAlister have operated on numerous patients and trained in all the treatment options necessary to treat all severity levels of OCD in the talus. These advanced surgical techniques include bone marrow stimulation, autologous chondrocyte implantation, OATS procedure, and Subchondroplasty®.
Series of intra-op photos showing different arthroscopic techniques performed

Bone Marrow Stimulation (BMS)

For smaller and less severe lesions, BMS techniques can initiate your body’s healing process to self-repair while avoiding any damage to healthy cartilage. These include a combination of chondral abrasion, subchondral drilling, and microfracture. After the damaged cartilage is trimmed, we drill small holes into the bone to allow blood and bone marrow cells to create a scar tissue to fill in the defect.

Osteochondral Autograft or Allograft (OATS)

Following BMS techniques, lesions may be too large for scar tissue to properly fill in the defect and bone grafting is required. The OATS procedure is a one-step procedure that harvests a plug of healthy bone and cartilage taken usually from your knee (autograft) or from a cadaver donor (allograft) that is transferred into the prepared defect in the talar dome. Over time, the bone and cartilage will grow into the damaged area.

Autologous Chondrocyte Implantation (ACI)

Another alternative to OATS is ACI, which is a two-stage procedure involving first harvesting a small amount of healthy cartilage from a non-weight bearing surface. The cells are then grown in a lab for 3-5 weeks then re-implanted into the defect in the second procedure.

MACI Procedure

MACI (autologous cultured chondrocyte on porcine collagen membrane) is a newer generation of ACI that differs by implanting the healthy cartilage onto a collagen matrix and serves as a foundation for new cartilage cells to grow.

Subchondroplasty ® (SCP)

SCP is a newer procedure that injects a calcium phosphate synthetic bone graft into the damaged portion of bone.  This synthetic bone graft creates a reaction in the body without damaging the existing bone scaffold.  Over time, the synthetic bone graft will be resorbed and replaced by your native bone. 

What is the recovery process? 

Average recovery time after undergoing surgery to repair the lesion ranges from 4-6 weeks and is dependent on a number of patient factors, including your age and medical conditions. It is recommended that you avoid bearing weight to your ankle for at least 6-8 weeks until your ankle has healed. Once your surgeon has assessed your healing, you may be prescribed crutches to begin partially weight-bearing. During the initial healing process, your ankle may swell or become painful. It is important to elevate the ankle elevated above your heart level and to ice around your knee to reduce swelling. Pain medication will be provided following surgery and should be taken as directed. Following rehabilitation exercises and limiting any high impact athletic activities is paramount to ensure good outcome.
 
 

Risks/Complications

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
 
Specific risks associated with surgical repair of osteochondral defects using minimally invasive techniques may include
  • Post-operative bleeding
  • Infection
  • Stiffness
  • Numbness to part of the skin near the incisions
  • Injury to vessels, nerves, and a chronic pain syndrome

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