The Foot and Ankle Clinic

Osteochondral defects and treatments

Osteochondral defects and treatments   |  What sort of injury may result in this condition?   |   How is this condition different from arthritis?   |   What symptoms might i expect?   |   Do I need to have it treated?   |   What are the treatments?   |  The operation - operative stills   |  Operative footage   |  After the operation   |  How likely is this to work?   | How soon will it work ?   |   Cartilage transplantation   |  What is involved?   |   Operative stills   |   After the operation the first 24 hours

 

After the operation

The first 24 hours

Pain relief
When you awake from surgery your ankle should feel comfortable. You will have had ankle and intra-articular injections of local anaesthetic whilst asleep.
You will be given a combination of three painkillers to be used regularly for the first 48 hours and then only if needed .

Mobility
Once back on the ward the physio will get you up .The amount of weight you are advised to put through the ankle will depend upon the size of the defect.  If it is a large defect which has required extensive debridement you will be advised not to put weight through for six weeks.  The physio will advise you on excercises to keep the ankle supple during this period.  With smaller defects you may put as much weight through as is comfortable. You may need crutches for a day or so.
Keep the leg elevated when not walking for the first 48 hours.

Length of stay
Once fully awake and mobile you will be able to go. A responsible adult to pick up and be with overnight .

Dressings
Leave intact and keep dry.

At two weeks
You will be seen in the outpatients for removal of sutures and review.
All dressings will be removed and you may now get the healed wounds wet.

At six weeks
If you have been non weight bearing this may now cease.

Further follow up may be required depending upon the size of defect and improvement in your symptoms.

How likely is this to work?
In the region of 80-95% chance of improvement in symptom, considering all cases of size and depth.

How soon will it work ?
Generally improvement will be seen early, but on occasion can take up to 12 months.

Cartilage transplantation (ostechondral grafting)

When/In whom?
If simple debridement and drilling is ineffective in reducing symptoms this is the next stage. The cases which are less likely to respond in the adult to simple debridement are probably the larger defects. The size of the defect is usually best estimated using MRI scans.

TalarDomeOATS (6.8MB) Download movie (5.8MB)

a large (wide and deep) talar anterolateral talar ocd(arrows)

a large (wide and deep) talar anterolateral talar ocd(arrows)

A large (wide and deep) talar anterolateral talar OCD(arrows).

What is involved?
This involves replacing the lost area of the joint with new bone and cartilage, to 'resurface' the defect. Generally we harvest a 'plug' of bone and cartilage from a non weight bearing area of the knee, occasionally from another part of the talus. This is known as OATS grafting (Osteochondral Autologous Transplantation). The standardised kit for performing this procedure has been developed and is supplied by Arthrex. However if the defect is very large, rather than disrupting a large area of joint surface elsewhere, a new cartilage lining can be regrown in a laboratory from your own cells and used to cover the defect.

To gain enough access to perform the grafting usually an osteotomy needs to be performed to get into the joint.  This means dividing one of the main bones of the ankle, either tibia or fibula, which is fixed back at the end of the operation.

fibula osteotomy fixed with a 'plate' to allow access for the graft

A fibula osteotomy fixed with a 'plate' to allow access for the graft. Note the previously visible defect in the talus is now filled



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