Foot Ankle iSAWE 13

Question

A 27 year old woman has deep ankle pain and swelling for six months after an inversion injury.

Foot Ankle iSAWE 13, CT and radiograph of the ankle
CT and radiograph of the ankle. Image by Mikael Häggström, Wikimedia Commons, CC0.
  1. Describe the imaging and the typical sites of these lesions.
  2. How are they classified?
  3. Outline management options.

Answer

Imaging

  • Osteochondral lesion of the medial talar dome with a cystic subchondral component
  • Medial lesions are posterior, deep and cup shaped, often atraumatic
  • Lateral lesions are anterior, shallow and wafer shaped, usually traumatic
  • MRI shows cartilage, oedema and fragment stability

Berndt and Harty

StageDescription
ISubchondral compression
IIPartially detached fragment
IIICompletely detached, not displaced
IVDisplaced fragment
  • Hepple MRI classification adds subchondral cysts (stage V)

Management

  • Non-operative for stable lesions, protected weight bearing for 6 weeks
  • Arthroscopic debridement and microfracture for lesions under 1.5 cm squared (about 107 mm squared) or under 15 mm diameter
  • Fixation of large acute fragments
  • Osteochondral autograft (OATS) for large or cystic lesions or failed microfracture
  • Medial malleolar osteotomy may be needed for access
  • Osteochondral allograft or matrix induced chondrocyte implantation for large defects

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.