Osteochondral defect of talus (OCD/OLT)

What is an OCD of the talus?

An ostechondral defect (OCD) is damage to to the cartilage and underlying bone of the talus causing ankle pain. The talus is a bone in the ankle joint that articulates with the tibia and fibula.

What  causes an OCD of the talus?

Typically OCDs are caused by acute traumatic event such as an ankle sprain or fracture that do not heal. When the biological cartilage type 2 – hyaline cartilage is damaged, it is difficult for the body to regenerate. Often the cartilage that is regenerated  is type 1-fibrocartilage. Fibrocartilage does not have the durability of hyaline cartilage. Van dijk et al. suggest that the underlying pain of OCD of the talus, may be related to damage to the subchondral plate and underlying bony edema/cyst.

How to diagnose an OCD of the talus?

Clinically the patient will a deep achy pain within the ankle joint with range of motion, sometimes the patient will have a feeling of the ankle locking, catching or giving away. A diagnostic injection into the ankle joint is often done. X-rays may be able to diagnose an OCD, but often an MRI is needed.

How to treat OCDs of the talus?

Conservative treatment is often initiated first with immobilization, PT, NSAIDs, ankle bracing. Unless there is a large, displaced osteochondral fragment. If the patient requires surgical treatment, there is a wide variety of treatment options pending size of the lesion from arthroscopic/open micro fracture (<100/150mm^2), OATS, various cartilage allografts, talar en bloc replacement, ankle arthroplasty/arthrodesis. Recent literature has suggested that micro fracture may not have great long term clinical outcomes, due to incomplete healing of the underlying subchondral bone and importance in addressing the underlying subchondral bone edema/cysts.

Video of arthroscopic repair of talar OCD: https://www.youtube.com/watch?v=Dn_ZO1OFGtA

If you have been diagnosed with an OCD or may have an OCD you can make an appointment at https://ocfootandankleclinic.com/appointments/ or call (949) 651-1202

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