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I am a dedicated long-distance runner with a slight problem. I sprained my ankle in the last marathon really badly and ended up with an OLT lesion. If I have microfracture treatment and it works, will it hold up so that I can run long distances again?

Many people who sprain (or even break) their ankle end up with an additional injury known as an osteochondral lesion of the talus (OLT). Osteochondral refers to the layer of cartilage over the bone. The talus is one of the ankle bones between the heel and the lower leg bone. This type of defect in the bone can result in deep ankle pain, a clicking or locking sensation of the joint, and loss of motion and function. It certainly can put a damper on your ability to run long distances. Treatment is often with the technique you mentioned known as microfracture. Tiny holes are drilled around the lesion through the bone to the bone marrow. Breaching the bone in this way releases stem cells from inside the bone to improve blood circulation to the area. The stem cells form fibrocartilage and fill in the hole. Defects (holes) that measure less than one-half inch (15 millimeters) can be treated this way. The hope for this treatment is that the new fibrous cartilage will act as a shock absorber and protect the bone underneath. But no one really knows if the fibrocartilage that forms can hold up under constant load through the ankle -- especially in athletes or active adults. In fact, there have been a few studies that suggest the fibrocartilage starts to break down over time. Patients who once experienced pain relief and improved function suddenly find themselves back where they started from. A recent study done to help compile long-term data and see if studies on this topic are consistent enough to pool the information together. This could give you a better idea of the long-term results for many different people. Such a review is referred to as a systematic review and helps give a better picture of what happens down the road. The authors searched all the studies on osteochondral talus lesions (OTL) where microfracture was used as the main treatment. Over a period of 45 years (from 1966 to 2011), they found a total of 24 studies that could be included. But the data collected in these studies was NOT consistent enough to combine together for a big picture analysis. It was clear from this study that a set of guidelines is needed to aid researchers in collecting and then reporting information from their studies on the treatment of OLT. In this way, data collected is standardized and can be organized and used to assess short- medium- and long-term results. Patients benefit by receiving the best treatment based on evidence that it works and has long-lasting effects.

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