A single traumatic injury and repeated trauma can cause osteochondral lesions. Ankle sprains can cause an osteochondral lesion, especially if you have sprained an ankle many times. Prolonged pain after an ankle sprain could indicate an osteochondral lesion. Antero-lateral lesions are usually caused by an ankle sprain. Other traumatic twisting incidents can also cause this type of lesion. Medial talar dome lesions are often the result of overuse and many minor injuries.