Talus Cartilage Injuries: Treatment Options

Talus Cartilage Injuries: Treatment Options

Without treatment, talus cartilage injuries are at risk for getting worse and can progress to ankle osteoarthritis. Treatment will depend on the extent of cartilage damage that is present. Different classification systems are used to diagnose talus cartilage injuries based on imaging results, where mild injuries show irritation to the cartilage and underlying bone, and more severe injuries show detachment of cartilage and bone from the talus.

Nonsurgical treatment is recommended for talus cartilage injuries where the cartilage and bone have not detached from the talus. This includes: rest; activity modification to limit high-impact activities like running, jumping, and sports; limiting or avoiding weight-bearing with the use of assistive devices like crutches or walkers; casts, braces, or walking boots to stabilize the ankle; physical therapy to improve ankle strength, range of motion, and balance; ice to reduce pain and swelling; pain medication; therapeutic injections into the ankle; and weight loss to reduce pressure at the ankle for those who are overweight or obese.

While these treatments can help manage symptoms, they do not fix the underlying cause. Conservative treatment methods have a limited success rate, with only about half of patients achieving pain relief and improved function. When symptoms do not improve after 3 to 6 months, surgery may be considered. Surgery is also recommended for injuries where there is cartilage and bone detached from the talus that causes significant pain and limited ankle range of motion.

Articular cartilage has a limited blood supply, so it has a limited ability to heal on its own. Surgical treatment will vary depending on the cartilage defect location, size, and physical demands of the patient. Different procedures are available to try to preserve or restore the cartilage. These include: chondroplasty, where the damaged cartilage is smoothed out; marrow stimulation, where small holes are drilled into the underlying bone to stimulate healing; osteochondral autologous transplantation, referred to as an OATS procedure, where a piece of cartilage and bone, called a plug, is transferred from a healthy non-weight-bearing area of the patient's knee into the cartilage defect; and cartilage transplantation, where cartilage is removed from the knee or ankle, or taken from a cadaver donor, and transferred into the cartilage defect.

Additional surgical procedures may be needed if certain factors, such as ankle instability or deformity of the foot, are contributing to the development of the cartilage injury. Many surgical procedures can be performed through arthroscopy, with small incisions made around the ankle joint. The decision to undergo surgery should be made through a discussion between the patient and health care provider to go over potential risks and benefits of an operation.

Things to take into consideration following surgery include weight-bearing restrictions, need for extended rehabilitation, and the risk of surgery having to be redone due to unsuccessful outcomes. Rehabilitation after surgery will depend on the procedure performed and the surgeon's preference. Typically, there is an initial period of non-weight-bearing where a patient will need to use crutches or another assistive device to stay off of the operated ankle, followed by a gradual increase in weight-bearing and physical activity over several weeks.