Ankle Osteochondral Lesion Treatment

⚙️What This Procedure Involves

For small lesions (less than 15 mm): arthroscopic debridement and microfracture — the damaged cartilage is removed and small holes are drilled into the bone to stimulate healing. For larger or cystic lesions: retrograde drilling through the calcaneus to address subchondral cysts, OATS (osteochondral autograft from the knee), particulated juvenile cartilage allograft (DeNovo), or bone grafting with cartilage restoration. A malleolar osteotomy (cutting the ankle bone) may be needed for surgical access to posterior lesions. Operations take 45 minutes to two hours.

💡Why It May Be Recommended

Surgery is recommended for symptomatic osteochondral lesions causing persistent deep ankle pain, swelling, and catching that have not responded to physiotherapy, activity modification, and injection.

⚖️Non-Operative Alternatives

Physiotherapy, ankle bracing, activity modification, and corticosteroid or PRP injection. Many OCLs are asymptomatic and discovered incidentally on MRI.

📋Preparing for Surgery

MRI and CT to assess lesion size, location, and subchondral bone involvement. Standing X-rays. The surgical approach depends on lesion location.

✅Expected Benefits

Pain relief and improved function in approximately 75–85% of patients with microfracture. OATS and biological techniques may provide more durable cartilage restoration for larger lesions.

⚠️Common Risks

• Prolonged recoveryExpected

  Non-weight-bearing for six to eight weeks for microfracture and OATS.

• Ankle swellingExpected

  Prolonged swelling.

• Incomplete symptom reliefUncommon

  Not all patients achieve complete resolution.

🔴Less Common but Serious Risks

• Fibrocartilage durabilityLong-term

  Microfracture produces fibrocartilage that may degrade over five to ten years.

• Donor site morbidityUncommon

  If knee OATS is performed, knee donor site pain.

• Malleolar osteotomy non-unionUncommon

  If an osteotomy was needed for access.

• InfectionRare

  Joint infection.

• Progression to ankle arthritisLong-term

  Despite treatment.

💉Anaesthetic Considerations

General or spinal anaesthesia with ankle block.

🏃Recovery and Rehabilitation

Non-weight-bearing for six to eight weeks. Boot for two to four weeks. Physiotherapy for ankle range of motion and strengthening. Return to sport at four to six months. Full recovery six to twelve months.

📅Follow-Up

X-rays at six weeks. MRI at six months and one year to assess cartilage healing.

❓Frequently Asked Questions