Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Osteochondral lesions of the talus (OLT) — defects involving the articular cartilage and underlying subchondral bone of the talar dome from acute trauma (ankle fracture, osteochondral impaction injury) or repetitive microtrauma — are present in up to 70% of ankle sprains that fail to resolve with standard rehabilitation, and represent a spectrum from small stable lesions that respond to conservative care to large unstable cystic lesions requiring surgical cartilage restoration. Selecting among the available cartilage repair strategies — bone marrow stimulation (BMS/microfracture), osteochondral autograft transfer system (OATS), and autologous chondrocyte implantation (ACI) — is based primarily on lesion size, lesion containment, and prior treatment history.

Lesion Assessment and Conservative Management

OLT classification (Berndt and Harty, modified): Stage I — compression of articular surface; Stage II — partial detachment; Stage III — complete detachment, undisplaced; Stage IV — displaced fragment; Stage V — subchondral cystic lesion (the most surgically challenging). Lesion size thresholds: <1.5cm² — bone marrow stimulation appropriate as first-line surgical treatment; 1.5–4cm² — OATS preferred for primary surgery in appropriate anatomy; >4cm² — ACI or scaffold-based techniques; cystic lesions — cyst decompression, grafting, and surface cartilage restoration required. MRI: T2 sequences define articular cartilage loss; T1 identifies subchondral edema and cystic change; 3D volumetric sequences measure lesion area precisely. Conservative management: appropriate for Stages I–II in skeletally immature patients; non-weight-bearing with immobilization × 6–8 weeks; 45–50% healing rate on follow-up MRI; failed conservative management at 3 months prompts surgical referral.

Surgical Cartilage Repair Options

Bone marrow stimulation (arthroscopic microfracture/BMS): arthroscopic debridement of the OLT; perforation of the subchondral plate with a microfracture awl at 3–4mm intervals (allows marrow stem cells to access the defect and form fibrocartilage repair tissue); appropriate for lesions <1.5cm²; 85% good-excellent outcomes at 2 years; results deteriorate over time (fibrocartilage is biomechanically inferior to hyaline cartilage); 5-year failure rate 20–30%. OATS (osteochondral autograft): one or more cylindrical osteochondral plugs harvested from the lateral femoral condyle or knee; press-fit into matching holes in the talar OLT; transfers hyaline cartilage; best for 1.5–4cm² contained lesions; 85–90% good-excellent outcomes at 5 years; donor site morbidity (10–15%) is the primary disadvantage. ACI (autologous chondrocyte implantation): Stage 1 — knee arthroscopy for chondrocyte harvest; laboratory culture ×4–6 weeks; Stage 2 — reimplantation of chondrocytes beneath a collagen scaffold into the OLT; best for large lesions >4cm² or failed prior BMS; MACI (matrix-induced ACI) simplifies implantation with pre-seeded scaffold; 80% good-excellent at 5 years for large lesions; highest cost and two-stage procedure. Dr. Biernacki at Balance Foot & Ankle evaluates and treats osteochondral talar lesions with arthroscopic repair at our Bloomfield Hills and Howell offices. Call (810) 206-1402.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

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Ankle Cartilage Repair in Michigan

Balance Foot & Ankle treats osteochondral lesions of the talus with advanced cartilage repair techniques. Our surgeons select the optimal procedure based on lesion size, location, and patient factors.

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Clinical References

1. Zengerink M, et al. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):238-246.
2. Savage-Elliott I, et al. Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot Ankle Spec. 2014;7(5):414-422.
3. Giannini S, et al. One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res. 2009;467(12):3307-3320.