Talar Dome Fractures (Osteochondral lesion or defect)
What Is a Talar Dome Fracture?
The ankle joint is the articulation of 2 bones, the tibia and the talus. When an injury occurs to the cartilage and underlying bone of the talus within the ankle joint it is called a talar dome lesion. Other terms used include an osteochondral defect (OCD), osteochondral lesion of the talus (OLT) and osteochondritis dessecans, which are all used interchangeably. Talar dome lesions usually occur from an injury, such as an ankle sprain.
Signs & Symptoms
The signs and symptoms of a talar dome lesion may include:
- Lasting pain deep in the ankle that is worse with activity
- Clicking or catching feeling in the ankle
- Ankle locking or a feeling that the ankle is “giving out.”
- Ankle swelling
Usually X-rays are taken, but sometimes the lesion can be difficult to detect. An MRI or CT scan may be ordered as well, especially if the ankle pain does not resolve with conservative care.
Immobilization. Sometimes a period of immobilization with a cast or cast boot is used to allow the lesion to heal. An ankle brace may needed if the ankle is unstable to prevent recurrent ankle sprains and further injury to the ankle joint.
Oral medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be helpful to reduce pain and inflammation.
Steroid Injections: Steroid injections into the joint using a form of cortisone can be performed to also reduce pain and inflammation.
Physical therapy: Once the lesion has had a chance to heal, physical therapy can also be helpful to reduce pain and swelling.
If conservative treatment does not resolve pain, surgical treatment may be recommended. The procedure is dependent on the size of the lesion, but in most cases, ankle arthroscopy is recommended.
Arthroscopy of the ankle is a less invasive surgical technique performed through small incisions that give full access to a joint. This involves placing a telescopic camera (the diameter of a drinking straw) and small tools into the joint to clean up the lesion and stimulate healing while watching the surgery on a monitor. The obvious advantages to arthroscopy over traditional techniques are the smaller incisions that permit early range of motion (often in the same day), as well as a reduction in postoperative recovery time with less pain and swelling.
Typically, patients are non-weightbearing for 1-2 weeks to permit the small incisions to fully heal, slowly increasing activities as tolerated for the next 4-6weeks, until a return to full activities can be accomplished.
After surgery, in most instances, we recommend early range of motion activities, especially if scar tissue was found within the ankle. This early motion helps to prevent return of the adhesions and promote faster recovery.
If the ankle arthroscopy fails to relieve pain or the talar dome lesion is very large, a type of Cartilage Resurfacing Surgery may be recommended. If you have had an ankle sprain that is not getting better, we recommend make an appointment for an evaluation today.
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