More than 500,000 high school football injuries occur each year in the U.S., with ankle injuries accounting for 15% of them. In particular, osteochondral lesions of the talus, or OLTs, are injuries that involve both the subchondral bone and the overlying cartilage of the talus. As we are well into the football season, it’s important to be well aware of the causes, diagnosis, and treatment of this injury.
The majority of OLTs occur after a traumatic ankle injury or ankle sprain. Approximately 27,000 people experience ankle sprains each day in the U.S. and OLTs have an incidence of between 50% and 70% of all acute ankle sprains. If you have this form of injury, the main symptom is ankle pain, often when standing or weight bearing. As cartilage injuries have a poor spontaneous healing response, symptomatic OLTs often require surgical treatment.
Cause of Injury:
Football is a physically demanding contact sport associated with higher injury rates than most other sports. Generally, ankle sprains are the most common sports-related injury. In football, ankle injuries are believed to be associated with match speed and the impact forces during physical collision and tackles. Repetitive ankle sprains and chronic ankle instability can also result in OLT.
Foot and ankle surgeons may have a suspicion for OLT from a patient’s history and symptoms. Routine x-rays often miss up to 50% of these injuries as it is unable to detect overlying cartilage injuries. Therefore, an MRI is recommended for a definitive diagnosis with high sensitivity to cartilage and bone changes. MRI can also detect other related pathology, such as ligament or tendon injuries.
Lesion size and location determine the appropriate treatment strategy. Reparative procedures such as bone marrow stimulation is indicated for lesions of less than 10 mm in diameter and performed by minimally invasive arthroscopic techniques. Injured cartilage and bone are removed to promote healing stimulation. Larger lesions are best treated with replacement procedures including autologous osteochondral transplantation.
Biological agents such as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) have been more recently studied as an adjunct to surgical treatment and good evidence of effectiveness is established. These biologics release a number of cytokines and growth factors that stimulate the healing of cartilage and bone. OLTs are common. Any player who has an ankle sprain that is not resolving should consider an MRI to out rule these cartilage injuries. Treatment, when started soon, shows excellent outcomes with the addition of biologic adjuvants. These outcomes have been improving.
Dr. John G Kennedy specializes in osteochondral injuries, Achilles tendon injuries, ankle instability, and ligament reconstruction and has a primary interest in lower limb surgery, particularly sports-related injuries.
Dr. Yoshiharu Shimozono is an attending orthopaedic surgeon from Teikyo University, Tokyo, Japan.