What is it?

The ankle joint has a cartilage lining which protects the bones and helps with joint motion. This cartilage can be damaged with sprains and fractures, as the joint surfaces impact on each other. There is initially a localised bruise, followed by cartilage softening and then

a small crack in the surface can develop. If this progresses a cyst

may form in the bone below the cartilage surface, forming an osteochondral lesion and sometimes a piece of cartilage may become loose.

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Symptoms

Pain is typically felt in the joint and becomes worse with activities. With careful examination the specific location can be isolated to either the medial, central or lateral aspects of the ankle. Patients may also have stiffness, locking or catching as a result of the injury and this may need addressing as well.

 

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Management

Initial management for all lesions should be protection of the

joint (ankle brace or walking boot), rest (crutches), compression (sometimes a compression bandage is of help) and elevation. Analgesics and non-steroidal anti-inflammatory medication may

also be used. Corticosteroid intra-articular injections may also

be considered.

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With persistent pain and symptoms despite non-operative measures, arthroscopic (‘keyhole’) surgery can be considered for small lesions. This involves removing the loose cartilage, clearing out the cyst and making little holes in the underlying bone to stimulate bone marrow. The cells found in the bone marrow form scar tissue within the defect, covering the underlying bone and thus provides pain relief. If this does not improve symptoms or the lesion is larger, than open surgery through a small incision at the front of the ankle (arthrotomy) may be required to fill the defect with graft.

Recovery

Your ankle will be in bandaging and a surgical boot will be provided but you should be non-weight-bearing for 2 weeks. You will be provided with crutches for support. Elevation, as much as possible, is important in the first few weeks, and ankle movements within limits of bandaging is recommended. The bandaging will come down at 2 weeks and dressings changed, and at this stage I would allow the foot to go into a normal comfortable shoe. Physiotherapy can be started at this stage and non-impact activities permitted.

 

With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 2 weeks is satisfactory. Otherwise, return to work should be expected after 6 weeks.

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Return to sports that are non-impact can be initiated at 6 weeks (training is allowed), however impact sporting activities are not permitted before 12 weeks.

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Return to driving will not be before 6 weeks and you must be able to perform an emergency stop. It is important to inform your insurance company of the type of procedure that has been undertaken to ensure the cover is valid.

 

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Risks of surgery

As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, failure for symptoms to settle and irritation from the wound.