Arthritis, cartilage & bone
Ankle cartilage injuries and cartilage repair
Injuries to the cartilage of the ankle, often after a sprain, and the options from rest to arthroscopic repair.
Medically reviewed by Efe Ozturk, DPM · Last reviewed
What happens
A twisting ankle injury can bruise, crack or shear a piece of cartilage and bone from the surface of the talus, the bone at the top of the foot that forms the ankle joint. Because cartilage has no blood supply, it heals poorly. Some lesions settle; others leave a painful defect or a loose fragment.[1,2]
Signs to look for
- Pain deep in the ankle, often with activity, weeks or months after a sprain.
- Swelling that comes and goes.
- Catching, clicking or locking.
- A feeling that the ankle is unstable.[1]
These overlap with ongoing ligament problems, so an ankle that isn’t recovering from a sprain deserves a careful look. See ankle sprains.
How we evaluate it
X-rays at the practice may show a larger lesion, but many cartilage injuries only appear on MRI or CT, which we arrange when the history and examination suggest one.[1,2]
Non-surgical treatment
For small lesions, lesions without a loose fragment, and children, treatment often starts with a period of rest or protected weight-bearing in a boot, activity changes and physical therapy. A systematic review found a pooled clinical success rate of about 45% with non-operative treatment, from studies that varied widely, so it is a reasonable first step for the right lesion rather than a sure one.[3]
Surgical cartilage repair
- Arthroscopic debridement and marrow stimulation (microfracture): through a small camera, damaged cartilage is removed and small holes are made in the bone to let healing tissue fill the defect. It works best for smaller lesions; lesion size is a predictor of outcome.[4,5]
- Fixation of a larger, healthy fragment back in place.
- Cartilage and bone grafts for larger lesions or when earlier treatment failed.[2]
- Biologic adjuncts such as bone marrow aspirate concentrate (BMAC), prepared in the operating room from your own bone marrow, are sometimes added. Laboratory results are promising but clinical evidence in the foot and ankle is still limited.[6] See regenerative medicine.
Results and recovery
Arthroscopic marrow stimulation has lasting results for many people: in 262 ankles followed for at least ten years, 82% had not needed another operation, and that held at 15 years. Obesity was linked to a higher chance of needing further surgery.[7] Recovery involves a period of protected weight-bearing and then physical therapy, with a return to sport measured in months; the timeline depends on the procedure and the lesion.
Common questions
Will the cartilage grow back?
Not as the original cartilage. Marrow stimulation lets repair tissue fill the defect, and grafts replace damaged cartilage and bone with healthy tissue. Both aim to give a smooth, pain-free joint surface rather than to regrow what was lost.[2]
My sprain was months ago. Could this still be the cause?
Yes. Cartilage injuries often come to light when an ankle sprain or fracture doesn’t recover as expected, with deep pain, swelling or catching that lingers.[1] If that sounds familiar, an examination and, where needed, an MRI can tell.
When to seek care
In depth at our specialty practices
Same physician, same offices, same phone number. These guides go further into the specialist side of this topic.
References
- 1.American College of Foot and Ankle Surgeons. Talar Dome Lesion. FootHealthFacts. foothealthfacts.org (external site)
- 2.Rikken QGH, Kerkhoffs GMMJ. Osteochondral Lesions of the Talus: An Individualized Treatment Paradigm from the Amsterdam Perspective. Foot Ankle Clin. 2021;26(1):121-136. PubMed 33487235 (external site)
- 3.Buck TMF, Lauf K, Dahmen J, Altink JN, Stufkens SAS, Kerkhoffs GMMJ. Non-operative management for osteochondral lesions of the talus: a systematic review of treatment modalities, clinical- and radiological outcomes. Knee Surg Sports Traumatol Arthrosc. 2023;31(8):3517-3527. PubMed 37062042 (external site)
- 4.Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, et al. Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. Am J Sports Med. 2017;45(7):1698-1705. PubMed 27852595 (external site)
- 5.Zengerink M, Struijs PA, Tol JL, van Dijk CN. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):238-46. PubMed 19859695 (external site)
- 6.Glenn R, Johns W, Walley K, Jackson JB 3rd, Gonzalez T. Topical Review: Bone Marrow Aspirate Concentrate and Its Clinical Use in Foot and Ankle Surgery. Foot Ankle Int. 2021;42(9):1205-1211. PubMed 34219485 (external site)
- 7.Rikken QGH, Aalders MB, Dahmen J, Sierevelt IN, Stufkens SAS, Kerkhoffs GMMJ. Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus. J Bone Joint Surg Am. 2024;106(14):1268-1276. PubMed 38728384 (external site)
This is general health information and isn’t a substitute for advice from a clinician who knows your history. Read our medical disclaimer and how we write and review content.
Keep reading
Service
Ankle sprains
From a first sprain to an ankle that keeps giving way: diagnosis, rehabilitation and return to sport.
Service
Regenerative medicine (PRP)
PRP injections in the office and biologics in surgery, with an honest look at the evidence.
Service
Arthritis
Worn, stiff, painful joints: shoes, bracing and injections first, and fusion or replacement when needed.
Blog · Sports & running
Sprained ankle recovery: the first 72 hours and getting back to sport
A week-by-week plan for a sprained ankle, from the first days to getting back to your sport.