Arthritis of the Foot and Ankle

Big Toe Arthritis

Midfoot Arthritis

Heel / Hindfoot Arthritis

Ankle Arthritis

Ankle Replacement

Talar Dome Lesion

Osteochondritis Dessicans of the Talar Dome | Talar Dome Lesion | Talar Dome Fracture

Introduction

Cartilage damage of the ankle, also know as an osteochondral lesion of the talus or tibia, may occur from a traumatic fracture or sprain of the ankle. The bones in the ankle joint may bang against each other at the time of initial injury with damage to the cartilage surface. The initial pain may resolve with the original injury, but there may be internal pain of the ankle with activity and exercise. The pain is often a chronic aching pain with possible locking of the joint.

Picture showing an ankle joint that has suffered damage to the cartilage following a sprain. The arrow is pointing to the area of damage on the outside of ankle.

Diagnosing an Osteochondral Lesion

The diagnosis of cartilage damage also known as an osteochondral lesion is often done with x-rays and/or an MRI. Initial x-rays are done to check the alignment of the foot and ankle and also check for any sort of bone damage along with the cartilage damage. With an MRI, the ligament structures, tendons and cartilage of the ankle can be checked and analyzed.

Picture showing an MRi of the ankle in cross section from front to back. The arrow is pointing the light area on the joint cartilage where the cartilage is damaged.

Picture showing an MRi of the ankle in cross section from side to side. The arrow is pointing the dark area on the joint cartilage where the cartilage is damaged.

Surgical Options for Cartilage Damage

Based on the size of cartilage damage, the treatment options are either arthroscopic removal of the damaged cartilage and drilling of the damaged region in order to grow new cartilage called fibrocartilage. If the lesion is large or involves the deep bone below the cartilage damage area, a transplant of fresh bone and cartilage, either from the patient’s knee or from a lab, is placed as a plug into the damaged region.

Picture showing schematic of surgical repair of the damaged cartilage. The chip of cartilage is removed. Then the bone is drilled to encourage fibrocartilage to grow in place of the missing cartilage.

Visible Region of Cartilage and Bone Damage (yellow arrow) in the Ankle Joint
Fresh Replacement Talus for Harvest and Transplant of Cartilage and Bone	Transplanted Cartilage and Bone (yellow arrow) Just Prior to Final Positioning Press Fit

Cartilage Transplant Advancements

The newest option available that is very exciting and only performed at a few locations in the world is called Denovo cartilage transplantation. The Denovo product is small fragments of fresh cartilage from a child that has passed in the past two weeks. This cartilage is still alive and is transplanted to the damaged cartilage area of the ankle through a small incision. The cartilage is glued in place with a special glue called fibrin glue and then incorporates into the surrounding cartilage. The Denovo procedure is excellent for small to medium size cartilage damage regions with minimal depth and underlying bone damage or cyst formation.

Why University Foot and Ankle?

It is rare that a single group can perform all the above surgery options. Each patient is treated with the best option for their situation and University Foot and Ankle Institute is one of the top centers in the world in the treatment of large osteochondral lesions of the talus with fresh transplant and an expert in the Denovo cartilage transplant procedure.

Our Podiatrists, surgeons and physical therapists are the very best in California! Request an appointment with a doctor at our Los Angeles or other Southern California offices.