Have you ever twisted your ankle, recovered from the initial sprain, but found that a deep, nagging pain just won’t go away? You might experience clicking, catching, or swelling after activity.
If this sounds familiar, you may not just be dealing with a sprain—you might have damage to the joint surface itself, known as an Osteochondral Defect (OCD) or Osteochondral Lesion of the Talus (OLT).
At Prisk Orthopaedics and Wellness, our goal is joint preservation. We want to keep you active, moving, and athletic for as long as possible. As a fellowship-trained foot and ankle surgeon, I specialize in advanced cartilage restoration techniques designed to repair these 'potholes' in your joint before they turn into widespread arthritis.
What is an OCD Lesion?
Your ankle joint consists of the tibia (shin bone) and the talus (ankle bone). These bones are coated in articular cartilage—a smooth, white surface that allows the joint to glide without friction.
A severe ankle sprain or impact can chip or bruise this cartilage, sometimes damaging the underlying bone. Think of it like a pothole in a paved road. If left untreated, the pothole gets bigger, eventually ruining the suspension of the car (or in this case, leading to ankle arthritis).
Sizing the Defect: One Size Does Not Fit All
The medical literature is clear: the size of the 'pothole' dictates the treatment. There is no magic wand, but there is a scientific hierarchy of repair:
- Small Lesions (< 1.5 cm²): These often respond well to stimulation techniques (cleaning up the defect and encouraging new growth).
- Large Lesions (> 1.5 cm²): These usually require structural support—borrowing bone and cartilage from elsewhere to fill the gap.
- Cystic Lesions: If there is a cyst (a hollow cavity) under the cartilage, we must fill that void with bone graft to support the surface.
My Approach: The 'POW' Toolkit for Cartilage Repair
At Prisk Orthopaedics and Wellness, I utilize the latest biologic and mechanical technologies to customize the repair to your specific injury.
1. Ankle Arthroscopy and The Arthrex PowerPick™
For smaller lesions, we start with Ankle Arthroscopy. This is a minimally invasive procedure using a camera to visualize the joint. I clean out the loose flaps of cartilage and stabilize the edges of the defect.
Traditionally, surgeons used 'microfracture' (poking holes with an awl) to release marrow cells and stimulate healing. However, I prefer using the Arthrex PowerPick. This is a specialized drill that creates precise, clean channels into the bone. This allows marrow elements (stem cells) to flow into the defect without damaging the surrounding bone structure, creating a 'super-clot' that turns into fibrocartilage repair tissue.
2. 'Spackling' the Pothole: BioCartilage and BMAC
For lesions that need more than just a drilled hole, we combine biology with scaffolding.
- BMAC (Bone Marrow Aspirate Concentrate): We harvest your own stem cells from your bone marrow.
- Arthrex BioCartilage: This is an extracellular matrix derived from allograft cartilage.
We mix your stem cells (BMAC) with the BioCartilage to create a paste. After preparing the defect, I apply this paste like spackle into the pothole and seal it with a fibrin glue. This provides a scaffold for your cells to grow into, resulting in a repair that is much more like your natural hyaline cartilage than standard microfracture alone.
3. Structural Repairs: OATS and Allografts
For large defects or those that have failed previous surgeries, we need to replace the missing tissue entirely.
- OATS (Osteochondral Autograft Transfer System): We take a plug of healthy bone and cartilage from a non-weight-bearing part of your knee and transplant it into the hole in your ankle. It’s like using a hole cutter to replace a patch of damaged sod on a golf green.
- Allograft Transplantation: For very large defects, we may use fresh cartilage and bone from a donor to reconstruct the joint surface.
Why Not Just Wait? The Risks of Delay
The most critical reason to address OCD lesions early is to prevent the progression of osteoarthritis. Once the cartilage is gone throughout the joint, our options change drastically.
If we miss the window for cartilage restoration, we are often left with two difficult choices:
- Ankle Fusion: Screwing the bones together so they don't move. This eliminates pain but puts stress on other joints and changes your gait.
- Ankle Arthroplasty (Replacement): Replacing the joint with metal and plastic. While technology is improving, this is a major surgery with activity restrictions.
Expertise Beyond the Ankle
While I specialize in foot and ankle surgery, the principles of biologic joint preservation apply elsewhere. I also perform cartilage restoration for the knee, utilizing similar techniques as well as MACI (Matrix-induced Autologous Chondrocyte Implantation), a two-step procedure where your own cartilage cells are grown in a lab and re-implanted into the knee defect.
Get Back on Your Feet
You do not have to live with chronic ankle pain. Whether you are a high-level athlete or just want to walk your dog without pain, cartilage restoration can provide a second lease on life for your joints.
If you have been told you have an OCD lesion, a talar dome lesion, or 'loose bodies' in your ankle, come see us. Let’s discuss how we can use the latest technology to save your joint.
Call Prisk Orthopaedics and Wellness today or schedule your consultation online.
