Ankle Cartilage Injury

Ankle cartilage injuries most frequently affect the cartilage surface of the talus, one of the main bones forming the ankle joint. This condition is medically referred to as an osteochondral lesion of the talus (OLT).

These injuries involve damage to both the articular cartilage and the underlying subchondral bone, with varying degrees of severity. Osteochondral lesions of the talus are commonly caused by trauma, such as ankle fractures, or by repetitive microtraumas, particularly in individuals engaged in sports and high-impact activities.

How Is It Diagnosed?

Ankle cartilage injuries are often diagnosed through a physical examination and standard X-rays of the ankle. However, MRI and CT imaging may be required for a more detailed evaluation, especially when initial findings are inconclusive or when planning treatment.

What Affects Treatment Choices?

Treatment plans are tailored based on factors such as the patient’s age, activity level, size and location of the lesion, and whether a loose fragment is present in the joint.

What Is an Ankle Cartilage Injury (Osteochondral Lesion of the Talus)?

The ankle joint is formed by the tibia (shin bone) and the talus. This joint is known as the tibiotalar joint. In ankle cartilage injuries—typically after a sprain or repetitive stress in athletes—the damaged area is almost always the talar dome, the upper cartilage-covered surface of the talus bone.

In most cases, this injury involves both the articular cartilage and the subchondral bone, and sometimes even small cysts can form beneath the cartilage surface.

Symptoms of Ankle Cartilage Injury

• Pain in the front of the ankle

• Swelling around the ankle

• A catching or locking sensation while walking

• Reduced range of motion in the ankle joint

These symptoms tend to worsen with weight-bearing activities like walking or standing, but are usually mild during rest. As the condition progresses—especially if cartilage or bone fragments break off and move freely within the joint—symptoms can become more severe.

What Causes Ankle Cartilage Damage?

• Ankle sprains: Around 85% of ankle cartilage injuries are linked to trauma such as ankle sprains.

• Repetitive microtrauma: Especially common in athletes who perform sudden stops and changes in direction, such as in football or basketball.

• High-arched feet (Pes Cavus): Individuals with this foot type are at greater risk due to altered pressure distribution across the ankle joint.

Grading of Ankle Cartilage Lesions

• Stage I: Intact cartilage with a small area of bone compression beneath it.

• Stage II: Partial cartilage damage with incomplete separation from the main cartilage surface.

• Stage III: Full separation of the damaged cartilage, but it remains in place.

• Stage IV: The cartilage fragment has completely detached and may become loose within the joint.

How Are Ankle Cartilage Injuries Treated?

If left untreated, osteochondral lesions can lead to chronic pain, swelling, and progressive loss of joint motion. Proper treatment is essential—especially for athletes—to allow full healing before returning to sports.

Non-Surgical Treatment Options

• Immobilization with cast or walking boot: In the acute phase, the ankle may be immobilized for 6 weeks using a cast or a boot, combined with non-weight bearing using crutches. The goal is to reduce pressure on the damaged cartilage and allow healing. During this period, range-of-motion and strengthening exercises—guided by a physical therapist—are important to maintain joint function.

• PRP Injections (Platelet-Rich Plasma): Ultrasound-guided PRP injections into the ankle joint may help promote healing by delivering growth factors directly to the injured tissue.

Surgical Treatment Options

If non-surgical methods fail, surgery may be considered. The choice of technique depends on the size and location of the lesion.

• Arthroscopic Debridement & Microfracture: Ideal for lesions smaller than 1 cm². Damaged cartilage is cleaned, and tiny holes are drilled into the bone to stimulate new cartilage growth.

• Retrograde Drilling: Used when the cartilage surface is intact but there is damage or cyst formation in the bone beneath. In cases with bone cysts, the defect may be filled with bone grafts, often taken from the pelvis.

• Osteochondral Grafting (Mosaicplasty): Recommended for lesions larger than 1 cm². Healthy cartilage and bone are transplanted from a non-weight-bearing area of the body to the damaged site.

Physical Therapy for Ankle Cartilage Injuries

Physical therapy plays a crucial role in the treatment of ankle cartilage injuries. The primary goals are to reduce pain, control swelling, and restore joint mobility.

The treatment plan is tailored to each patient’s specific condition. In general, modalities such as ice application, ultrasound therapy, and electrical stimulation are used to relieve pain and inflammation. Manual therapy techniques help improve joint mobility, while customized exercise programs are designed to strengthen the muscles and support ankle stability.

Common Physiotherapy Modalities:

• Ice therapy

• Therapeutic ultrasound

• Electrical stimulation

• Manual joint mobilization

• Strengthening and stability exercises

Exercises for Ankle Cartilage Injury

Exercise is an essential component of the rehabilitation process. The goal is to increase ankle mobility and improve the strength of surrounding muscles. These exercises should ideally be performed under the supervision of a licensed physical therapist.

Recommended Exercises:

• Dorsiflexion and plantar flexion movements

• Circular ankle mobility exercises

• Heel raises to improve calf strength and ankle control

How Long Does It Take to Recover?

Recovery time varies depending on the severity of the cartilage damage and the patient's response to treatment.

• Mild injuries may heal within 1–2 weeks

• Moderate to severe cases can take several months

Adequate rest, proper treatment, and a consistent rehabilitation program can significantly shorten the healing process.

Conclusion

Ankle cartilage injuries most commonly affect the talar dome, the cartilage-covered top surface of the talus bone. This condition—medically known as an osteochondral lesion of the talus (OLT)—is often caused by major trauma or repetitive microtraumas, particularly in active individuals and athletes.

Diagnosis is typically made through physical examination and X-rays, although MRI or CT scans may be required for detailed assessment. Treatment options vary depending on the patient's age, activity level, and lesion characteristics, and may include immobilization, PRP injections, or surgical intervention if necessary.

If non-surgical treatments are not effective, surgery may be considered. Physical therapy is an essential part of recovery—helping reduce pain and swelling and restore joint function.

Therapeutic exercise accelerates recovery and helps prevent long-term complications.

With proper care and adherence to the treatment plan:

• Mild injuries can recover in 1–2 weeks

• Severe injuries may require several months

Thank you for reading this article.Feel free to explore utkuerdemozer.com for more expert insights on joint and sports-related injuries.