Syndesmosis Injuries | Dr Christy Graff

Impact of a Talus Osteochondral Defect (OCD) on Anatomy and Health

Joint mechanics: The talus, like all bones of joints, has a smooth cartilage layer that allows the ankle to move without friction. Damage to this layer disrupts smooth motion.
Pain and stiffness: This condition can make walking, running, or even standing uncomfortable.
Long-term risk: Defects in the cartilage can lead to early arthritis, reduced mobility, and chronic ankle problems.
Swelling: The loss of cartilage can lead to inflammation of the joint, which causes swelling.

Athletes: Particularly those in high-impact sports like football, basketball, and soccer.
People with ankle injuries: Repeated ankle sprains or fractures increase the risk.
People with poor ankle alignment: Structural issues in the ankle may contribute to a higher risk.

Trauma: A significant ankle injury, such as a sprain or fracture.
Repetitive stress: Frequent micro-injuries from sports or physical activity.
Poor blood supply: In some cases, reduced blood flow to the bone weakens it, leading to collapse and damage.
Osteochondritis dissecans: This childhood condition can sometimes not heal and lead to an osteochondral defect.

Ankle pain: Especially after activity or standing for long periods.
Ankle swelling: Can increase or decrease depending on the amount of activity
Locking or catching: The ankle may get “stuck” due to loose cartilage fragments.
Instability: Feeling like the ankle may give way.
Reduced movement: Stiffness and difficulty flexing or pointing the foot.

Protect your ankle: Wear supportive shoes, especially during sports
Strength and balance training: Strong leg and ankle muscles help reduce the risk of injury; physiotherapy can often help after an ankle sprain
Proper rehabilitation: Fully recover from ankle sprains or fractures before returning to sport.
Avoid overuse: Allow rest days and avoid repetitive stress on the ankle.
Early treatment: Seek medical care after significant ankle injuries

Talus OCD can vary based on the location and nature of the injury:

Medial lesions: Found on the inside of the talus, usually deeper and cup-shaped. This condition is often caused by repetitive stress or long-standing ankle problems.
Lateral lesions: Found on the outside of the talus, usually more shallow and wafer-shaped. Often caused by a sudden ankle injury.
Stable vs. unstable lesions: Stable defects are cracks or damage where the cartilage remains attached. Unstable ones occur when pieces of cartilage and/or bone become loose inside the joint.

Doctors use staging systems to describe severity and guide treatment:

Stage 1: Small area of damage, but the overlying cartilage remains intact
Stage 2: Cartilage is partially detached but still in place.
Stage 3: Cartilage and bone are completely detached but not yet displaced.
Stage 4: Detached fragment has moved into the joint space, causing catching or locking.

Diagnosis combines patient history, physical examination, and imaging:

Clinical examination: Dr Graff will assess for swelling, instability, and range of motion.
X-rays: May show bone changes but can miss early cartilage damage.
MRI scan: Best test for detecting cartilage and bone damage, as well as loose fragments.
CT scan: Provides detailed images of bone defects and helps plan surgery.

Treatment depends on the stage, size, and symptoms:

Non-surgical options:
Rest, activity modification, and physiotherapy.
Anti-inflammatory medications for pain and swelling.
Bracing or immobilisation to protect the ankle.
Surgical options:
Arthroscopic assessment and retrograde drilling: If the cartilage is intact but the bone underneath is damaged, the bone can be drilled through adjacent bone (‘retrograde’) to keep the healthy cartilage intact
Arthroscopic debridement and microfracture: Damaged tissue is removed using keyhole surgery, and tiny holes are made in the bone to stimulate new cartilage growth; best for small lesions
Osteochondral grafting (OATS): Healthy bone and cartilage taken from a non-weight-bearing portion of the knee are transplanted to fill the defect.
Fixation: If the fragment is still intact, it can sometimes be pinned or screwed back in place.

Chronic pain: Persistent ankle pain during activity or even at rest.
Joint instability: Increased risk of sprains and further injury.
Loose fragments: Floating pieces of cartilage and bone may cause locking and catching in the ankle and further damage to the ankle joint
Arthritis: Progressive damage to the ankle joint leading to early osteoarthritis.
Reduced quality of life: Difficulty walking, running, or participating in sports and daily activities.

If you want more information or have any questions or problems, please contact Dr Graff at admin@christygraff.com or call the rooms at 0493 461 133.