Osteochondral lesion (OCL) or Osteochondritis dissecans (OCD)

What is Osteochondral lesion (OCL) or Osteochondritis Dissecans (OCD)?

Osteochondral lesion (OCL) or Osteochondritis dissecans (OCD) affects the talus bone. The talus bone is a bone in your ankle that connects the leg bones to the rest of the foot. It helps to support the weight of your leg and helps your ankle move.

One cause of OCL/OCD is a severe ankle sprain. They are also associated with obesity. Another cause is the ankle's inability to provide proper support or its improper alignment which causes repeated, excessive strain on the joint. In OCL/OCD, a fragment of cartilage and bone separates from the top or joint surface of the talus bone. This can lead to pain and potential instability in the ankle.

What are the signs and symptoms of OCL or OCD?

Symptoms of OCL/OCD may include:

• pain when running, walking or jumping
• swelling
• clicking or catching sensations in the ankle
• feeling unstable in the ankle

How is OCL or OCD diagnosed?

A health-care provider will perform a physical exam of your child's ankle. If OCL or OCD are suspected, then your child will also have standing X-rays of the affected ankle. An MRI may also be required.

How is OCL or OCD treated?

There is no urgent rush for an orthopaedic clinic consultation regarding OCD/OCLs. The only exception is a loose body in the joint that is causing symptoms. Stable lesions often heal on their own when growth plates are still open.

If your child is experiencing symptoms then the initial treatment strategies will include:

• medications such as ibuprofen (e.g., Advil) or naproxen (e.g., Aleve) 2 to 3 times per day for 4 to 6 weeks
• taking weight off the foot and ankle with a walking boot and crutches for 4 to 6 weeks

After 4 to 6 weeks, your child can begin to put some of their weight on their foot and ankle and gradually progress to bearing more weight. They will also start physiotherapy for range of motion, strengthening, balance and ankle stabilization for a period of 3 to 6 months. They are asked to avoid high-impact activities during this time (jumping, running, or pounding/high speed sports).

If symptoms continue for more than 6 months, then surgery may be indicated and a referral to an orthopaedic surgeon may be considered.

Surgical treatment

Surgery is only considered if there is a loose body in the joint that is causing symptoms, an unstable lesion, and the patient has not responded to a fully completed course of the initial treatment recommended.

Referrals to SickKids

• A referral is only appropriate if symptoms persist after completing a consistent 6-months of conservative management.
• All referrals require photos of the feet and ankles.
• All prior imaging should be uploaded onto the PACS system, Connecting Ontario or sent with the patient on a CD or sent to SickKids prior to their appointment to upload to our PACS. A set of 3-view weightbearing (standing) X-rays of the affected ankle are required before referral and should be attached to the referral.
• For patients 12 years of age and older, referrals will be redirected to a partner orthopaedic surgeon where wait-times are shorter.

References

Knipe, H. (2025, September 1). Osteochondritis dissecans of the ankle. Radiopaedia. https://radiopaedia.org/articles/osteochondritis-dissecans-of-the-ankle?lang=us

Knipe, H. (2025, November 21). Osteochondral lesion of the talus. Radiopaedia. https://radiopaedia.org/articles/osteochondral-lesion-of-the-talus?lang=us