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What is Osteochondritis Dissecans (OCD) of the Talus?

Osteochondritis Dissecans (OCD) is a condition that most commonly affects adolescents, ages 12-19, where the bone that supports the cartilage inside a joint begins to soften. Unfortunately, at this point no one knows exactly what causes OCD. It has been associated with traumatic injuries as well as long-term, chronic impact stresses. It may also be caused by a disruption in the blood flow to that portion of bone. If left untreated, this can lead to damage of the overlying cartilage of the joint. In the long term, this could lead to other conditions, most namely, arthritis.

Physical examination, detailed history, X-rays and MRIs can all be very helpful in the accurate diagnosis of OCD.

Causes

  • Acute traumatic injury to the ankle through loading or twisting weight-bearing activities
  • Chronic overuse or impact stresses
  • Chronic or recurrent ankle sprains

Signs & Symptoms

Acute

  • Sharp pain with swelling
  • Aching pain after injury
  • Pain with weight bearing
  • Clicking or locking of the ankle joint

Chronic

  • On and off swelling with activity
  • Aching pain after activity
  • Clicking or popping of the knee joint
  • Sensation of small injuries that seem to get better on their own over time

Treatment

Children with open growth plates (boys under 16 and girls under 14) can be treated non-operatively. Initially, impact activities or activities that may indirectly increase the stress at the injury site are to be completely avoided for about 3 months. Surgery may be recommended if the OCD does not appear to be healing or if the OCD is initially or becomes “unstable.”

If the OCD is stable, then the goal of surgery is to assist the healing of the OCD.  This can be done arthroscopically where small drill holes are used to create blood flow to assist with bone and cartilage healing.

If the OCD is unstable, the object of the surgery is to make it stable. This can be done using a screw(s) to help hold the cartilage in place. If this unstable piece has broken off and is not viable enough to fix, this piece is removed and new cartilage is placed in the “pot hole” created by the missing piece. This may require a separate surgery at a later time.

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