An osteochondral defect, or osteochondral lesion, refers to an injury to the joint surface, with damage to the articular cartilage and subchondral bone. These injuries are graded based on size, degree of cartilaginous and bony destruction, and displacement of fragments. They usually occur in the young, active population, but they can occur at any age. These injuries probably occur in many ankle sprains (up to 70%) and are often missed as they may not be seen on x-ray and can only be seen on CT or MRI.

An osteochondral lesion of the tibia may occur after an isolated trauma, or it may occur after repetitive injuries. Symptoms include pain and swelling of the ankle with or without recent injury. Patients usually complain of a "deep" pain in the ankle joint. The pain may be isolated to the medial or lateral aspect of the talar dome or to the medial or lateral aspect of the distal tibia, or the pain may be more diffuse, involving the entire ankle. Mechanical locking / catching symptoms aren't as common as pain but can also be found in this injury. For example, if a patient states that their ankle gets "caught" or locked in a certain position and then they have to shake it loose, this represents a displaced osteochondral fragment getting caught in the tibiotalar joint.

Osteochondral lesions of talus are much more common than distal tibia, but they are managed similarly, and patients of all ages should be managed similarly.

Related topics: Ankle injury, Osteochondal defect