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Osteochondral Defect (OCD) of the Ankle

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An osteochondral defect (OCD) is a focal area of damage to the cartilage and underlying bone within the ankle joint. They most commonly occur on the talar dome (the top of the talus). The damage may involve only cartilage or extend into the bone, causing persistent pain, swelling, or instability.

Symptoms

• Deep, aching pain in the ankle joint
• Swelling, especially after activity
• Stiffness or reduced ankle movement
• Locking, catching, or a sensation of giving way
• Pain that persists beyond normal ankle sprain recovery

Diagnosis

Clinical examination combined with imaging. X-rays may show bone damage or loose fragments. MRI is especially useful for assessing cartilage damage and defect stability. CT scan may be requested for surgical planning.

Causes

• Ankle sprains or twisting injuries
• Direct trauma or impact to the joint
• Repetitive overloading in athletes
• Osteochondritis dissecans — spontaneous cartilage failure or vascular disruption

Non-Surgical Treatment

May be considered for small, stable lesions: activity modification, physiotherapy, supportive footwear, anti-inflammatory medications, and ankle bracing.

Surgery

Surgical options depend on the size and depth of the defect:

• Arthroscopic debridement and microfracture: Small holes made in the bone to stimulate fibrocartilage formation — most suitable for small, contained lesions.
• Curettage and drilling: Damaged cartilage and loose fragments removed; underlying bone drilled to improve blood flow.
• Cancellous bone grafting: For larger or deeper defects, autologous bone graft from the heel bone fills the void.
• Chondrocyte matrix application: A cartilage scaffold (e.g. Chondroguide) applied over the graft to regenerate cartilage tissue.

Recovery

Timeframe	What to Expect
0–2 weeks	Non-weight-bearing. Cast or boot. Foot elevated.
2 weeks	Wound review. Sutures removed. Transition to lighter boot.
2–6 weeks	Continued non-weight-bearing. Healing of graft site.
6–12 weeks	Gradual weight-bearing in boot. Physiotherapy begins.
3–6 months	Return to daily activities and low-impact exercise.
6–12 months	Return to full sport if healing is complete.