Ankle Conditions: Talar Dome Cartilage Damage (Osteochondral Lesion)

What causes a talar dome lesion? 

Osteochondral lesions of the talus (OLTs) most commonly happen due to a traumatic injury like an ankle sprain, in which the foot and ankle joint are twisted or compressed. In some cases, the bones in the ankle joint hit each other, damaging the surface of the overlying cartilage and causing an osteochondral fracture. 

If the cartilage heals improperly, blood flow to the underlying bone can be interrupted, resulting in osteochondritis dissecans (OCD), where the bone and cartilage begin to break off and remain floating in the ankle. This can cause chronic pain and ankle weakness.

However, other causes of osteochondral lesions of the talar dome include:

• Avascular necrosis (poor blood supply to the bone results in bone death)
• Repetitive motion and stress on the joint

What are talar dome lesion symptoms? 

In most cases, talar dome injury symptoms will set in after the symptoms of the initial ankle injury have subsided. Symptoms will vary depending on where the injury occurs (medial, posterior, or anterior side of the dome). 

Patients with talar dome lesions may experience: 

• Pain that resolves after the initial trauma but then returns
• Pain that worsens with activity
• Swelling, ankle instability, and locking of the ankle joint
• The feeling that the ankle joint clicks or catches

Diagnosing osteochondral lesion of the talus

At University Foot & Ankle Institute, our orthopedic surgeons will begin by asking you about your medical history, such as if you have had any recent ankle fractures or sprains. They’ll also perform a physical exam, feeling and moving your ankle to test your range of motion and pinpoint the injured area.

UFAI clinics also contain X-ray, CT scan, and MRI machines. X-rays allow us to view the bones of the ankle joint, while MRIs and CT scans show us the soft tissue, including the ligaments, tendons, and cartilage.

Many times, talar dome lesions can be identified visually.

What are the treatment options for talar dome lesions?

The University Foot & Ankle Institute is one of the world's top foot and ankle centers. Our doctors and surgeons are recognized for providing treatment of large osteochondral lesions of the talus with removal or cartilage transplant. 

However, when possible, we will try to use a non-surgical approach first.

Non-surgical treatments for talar dome lesions 

For mild cases of talar dome lesions, in which there are no floating pieces of bone or cartilage, our doctors may recommend the following:

• Immobilization of the ankle joint with a non-weight-bearing boot or cast.
• Physical therapy to restore range of motion once the lesion has healed.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to help with inflammation and pain.

Surgical talar dome lesion treatment 

Talar dome lesions are classified into stages using the Berndt and Harty classification system, ranking injuries from stage I to stage IV. Depending on the extent of the cartilage damage, treatment options can include arthroscopic removal of the damaged cartilage and drilling of the damaged region.

After arthroscopic debridement, in which our doctors clean up the joint by removing debris and freeing up any impingement, they will perform arthroscopic bone marrow stimulation. During this minimally invasive surgical technique, our doctors surgically cause microfractures to the anterolateral and mid-lateral areas of the talus. These openings allow blood and bone marrow into the damaged tissues, prompting new cartilage (fibrocartilage) to develop.

However, if the lesion is large or involves the deep bone below the cartilage-damaged area, another type of surgical treatment might be necessary. Our ankle surgeons may perform a transplant of fresh bone and cartilage. The bone can be taken from the patient's own body, usually in the form of a tibial autograft. Or, it may come from a lab, referred to as an allograft. 

Autologous grafts using tissue from your own body typically have lower risks of complications as there’s next-to-no risk of your body rejecting its own tissue. 

We implant the bone graft into the injured region, replacing the problematic areas and encouraging healing. The incidence of bone grafting is considerably lower than arthroscopy clean-out and bone marrow stimulation, as it is reserved for only the most severe cases.

BioCartilage transplant for osteochondral lesion treatment 

BioCartilage is a revolutionary product that results in a stronger ankle joint, faster recovery, and reduced chance of re-injury than with traditional methods. Read more about BioCartilage.

What to expect after talar dome osteochondral lesion surgery

Because the talus bone lacks a strong blood supply, healing a broken talus can take longer than most bones, with talar dome lesion surgery recovery often taking months.

Patients recovering from talar dome osteochondral lesion treatment may not be able to walk without crutches for several weeks, after which they will likely wear a walking cast or ankle brace for several more months. 

During gradual rehabilitation, we’ll recommend pain management medications and gentle exercises, usually through physical therapy, to help you regain your ankle strength, stability, and range of motion. Following our podiatrists' advice during the entire healing process is imperative, as doing too much too soon can reinjure the area or delay healing.

UFAI doctors have experience with talar dome lesions

The University Foot and Ankle Institute podiatry experts have decades of combined experience treating all forms of ankle injuries and concerns. Our orthopaedic surgeons use the latest technologies available to successfully diagnose and treat talar dome lesions in the most minimally invasive way possible. New patients or individuals concerned about foot or toe pain in the greater Los Angeles area are encouraged to call or schedule a consultation.

For a consultation, please call (877) 736-6001 or make an appointment online now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.