The management of defects in the gristle lining of the articular surface of the ankle is very similar to that in the knee; however, the ankle is much more forgiving as a result of its increased congruity. This means that simply smoothing over the edges with or without a microfracture procedure is often adequate to give an entirely normal functioning ankle and it is much less common to require the more major chondral resurfacing techniques. Defects in the articular surface of the talus are very common indeed and often incidental. The difficulty is often as a surgeon to balance the extent of the treatment and the necessary recovery from it against the gains achieved by the surgery. This is often the sort of surgery that is done in the off season to allow full recovery from a problem that has been niggling on for sometime. A much more common cause of pain in sportsmen and particularly footballers is the tibial spur known as “footballer’s ankle”. This tends to give discomfort across the front of the ankle which is to a large extent exercise related. It is not associated with any damage at all to the lining of the joint, nor to osteoarthritis. It is just an area of heaping up of bone, probably as a result of repeated impact which can be taken away very easily with a day case key hole procedure.
The more major techniques described in the “knee articular” page are also available for the ankle, but less frequently needed, and more complicated to do. They often require the ankle to be broken to allow access to the articular surface and are reserved for the severest cases.