Frequently Asked Questions

I'm searching the web for any information I can find about severe ankle sprains with bone damage. The surgeon says I have an osteochondral lesion -- that's a hole in the bone where the injury was the worst. I guess it was a bad enough sprain to actually pull away some cartilage and a piece of bone with it. I see there is a lot of information about this type of injury in the knee but not much on the ankle. Can the ankle be treated with the OAT bone grafting they use in the knee?

Ankle sprains are a common occurrence, especially among athletes and sports participants. More and more orthopedic surgeons are recognizing and reporting the fact that ankle sprains often come with other injuries as well. In fact, in about half of all cases, there is this type of osteochondral lesion you are describing where the sprain is severe enough to cause a piece of cartilage and bone to detach. Treatment for this problem does follow techniques used for similar defects in the knee. Bone marrow stimulation, chondrocyte (cartilage) implantation, and osteochondral autologous transplantation (OAT) are three of the most commonly used treatments. The type of treatment used depends on many different factors. For example, your age and activity level as well as your personal goals for activity and sports participation are vitally important variables. But the location of the lesion and the size/depth of the defect are important considerations, too. There are some known risk factors that can contribute to treatment failure that should be kept in mind. Previous studies have shown that people who are morbidly obese experience significant knee pain from the harvest site. Significant ankle deformity or poor alignment of the ankle axis for rotation or other movements is another risk factor that can result in poor outcomes following the OAT procedure. Patients with ankle osteoarthritis or ligamentous instability of the ankle are not good candidates for this procedure either. And anyone young enough to have open growth plates should also not be treated with osteochondral autologous transplantation (OAT). Surgeons generally advise young, active patients who are thinking about having osteochondral transplantation just what to expect after surgery. There may be a risk that the outcomes won't be as expected. The patient may have to reduce activity level and possibly change type of sports participation. Surgeons should select patients carefully for this procedure keeping risk factors (especially obesity) in mind.

Jochen Paul, MD, et al. Sports Activity After Osteochondral Transplantation of the Talus. In The American Journal of Sports Medicine. April 2012. Vol. 40. No. 4. Pp. 870-874.

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