Osteochondritis dissecans (OCD) is a pathological condition characterized by the presence of pain and joint stiffness in the ankle. It can affect individuals across all age groups and is often associated with a history of ankle sprain and consequent cartilage damage.
• While the location may vary due to ankle injuries, OCD predominantly manifests in the upper portion of the talus bone, which comprises cartilaginous tissue.
Symptoms
Initially, the symptoms of OCD resemble those of other ankle sprains. Swelling and pain in the ankle region are commonly experienced, along with difficulty in bearing weight on the affected joint. Diagnostic imaging, such as radiography, may be employed to visualize any evident fracture lines in the joint cartilage. Additionally, patients may exhibit ankle swelling and generalized discomfort.
Diagnosis
The diagnosis of OCD primarily relies on the patient’s medical history and a thorough physical examination. Radiographic assessment is typically conducted, with a particular focus on evaluating the ankle, including the upper region referred to as the talar dome. However, more advanced imaging techniques like computerized tomography (CT) or magnetic resonance imaging (MRI) scans are considered more effective in evaluating the extent of the lesion.
Treatment
Non-Surgical Intervention
The treatment of osteochondritis dissecans (OCD) involves a period of immobilization of the ankle for approximately six weeks, accompanied by the use of crutches to restrict weight-bearing on the affected joint. This conservative approach is continued if favorable progress is observed.
Surgical Intervention
In cases where the condition is not promptly identified, incomplete healing of the bone fragment and the persistence of issues may arise. Surgical intervention may be necessary at this stage to alleviate symptoms.
The surgical procedure typically involves accessing the ankle joint, preferably utilizing arthroscopic techniques, to remove the fractured fragment. Debridement and drilling procedures are performed to facilitate the ingrowth of blood vessels and the filling of the defect with fibrous cartilage. Ultimately, the newly formed scar tissue occupies the defect, leading to improved ankle mobility. In instances where the defect is extensive, an open surgical method known as mosaicplasty, involving the transfer of cartilage, may be considered.
Rehabilitation
During the recovery phase, the use of crutches is recommended for a minimum of six weeks, while regular radiographic evaluations are conducted to monitor progress.
Patients are provided with ankle splints and integrated into a comprehensive rehabilitation program. Under the guidance of a physiotherapist, targeted ankle exercises are implemented to enhance joint mobility and functional recovery.
