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Journal articles on the topic 'Osteochondral lesions of the talus'

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Published: 30 June 2021

Last updated: 2 February 2022

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1

Savage-Elliott, Ian, Keir A. Ross, Niall A. Smyth, Christopher D. Murawski, and John G. Kennedy. "Osteochondral Lesions of the Talus." Foot & Ankle Specialist 7, no. 5 (August 5, 2014): 414–22. http://dx.doi.org/10.1177/1938640014543362.

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Osteochondral lesions of the talar dome are increasingly diagnosed and are a difficult pathology to treat. Conservative treatment yields best results in pediatric patients, often leaving surgical options for adult populations. There is a paucity of long-term data and comparisons of treatment options. Arthroscopic bone marrow stimulation is a common first-line treatment for smaller lesions. Despite promising short to medium term clinical results, bone marrow stimulation results in fibrocartilagenous tissue that incurs differing mechanical and biological properties compared with normal cartilage. Autologous osteochondral transplantation has demonstrated promising clinical results in the short to medium term for larger, cystic lesions and can restore the contact pressure of the joint. However, concerns remain over postoperative cyst formation and donor site morbidity. Recent developments have emphasized the usefulness of biological adjuncts such as platelet-rich plasma and concentrated bone marrow aspirate, as well as particulate juvenile cartilage, in augmenting reparative and replacement strategies in osteochondral lesion treatment. The purpose of this article is to review diagnosis and treatment of talar osteochondral lesions so that current practice guidelines can be more efficiently used given the available treatment strategies. A treatment paradigm based on current evidence is described.Levels of Evidence: Therapeutic, Level V, Expert Opinion

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2

Hao, Da-Peng, Jian-Zhong Zhang, Zhen-Chang Wang, Wen-Jian Xu, Ji-Hua Liu, and Ben-Tao Yang. "Osteochondral Lesions of the Talus." Journal of the American Podiatric Medical Association 100, no. 3 (May 1, 2010): 189–94. http://dx.doi.org/10.7547/1000189.

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Background: Conventional magnetic resonance imaging (MRI) has been demonstrated to be a valuable tool in diagnosing osteochondral lesions of the talus. No previous study, to our knowledge, has evaluated the diagnostic ability of fat-suppressed fast spoiled gradient-echo (FSPGR) MRI in osteochondral lesions of the talus. We sought to compare three-dimensional fat-suppressed FSPGR MRI with conventional MRI in diagnosing osteochondral lesions of the talus. Methods: Thirty-two consecutive patients with clinically suspected cartilage lesions undergoing three-dimensional fat-suppressed FSPGR MRI and conventional MRI were assessed. Sensitivity, specificity, and accuracy of diagnosis were determined using arthroscopic findings as the standard of reference for the different imaging techniques. The location of the lesion on the talar dome was recorded on a nine-zone anatomical grid on MRIs. Results: Arthroscopy revealed 21 patients with hyaline cartilage defects and 11 with normal ankle joints. The sensitivity, specificity, and accuracy of the two methods for detecting articular cartilage defect were 62%, 100%, and 75%, respectively, for conventional MRI and 91%, 100%, and 94% for three-dimensional fat-suppressed FSPGR MRI. Sensitivity and accuracy were significantly higher for FSPGR imaging than for conventional MRI (P < .05), but there was no difference in specificity between these two methods. According to the nine-zone anatomical grid, the area most frequently involved was the middle of the medial talar dome (16 lesions, 76%). Conclusions: T1-weighted three-dimensional fat-suppressed FSPGR MRI is more sensitive than is conventional MRI in detecting defects of articular cartilage covering osteochondral lesions of the talus. (J Am Podiatr Med Assoc 100(3): 189–194, 2010)

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3

Steele, John R., Travis J. Dekker, Andrew E. Federer, Jordan L. Liles, Samuel B. Adams, and Mark E. Easley. "Osteochondral Lesions of the Talus." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 247301141877955. http://dx.doi.org/10.1177/2473011418779559.

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Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. They require a strong plan. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment required to achieve a satisfactory result. In general, operative treatment is reserved for patients with displaced OLTs or for patients who have failed nonoperative treatment for 3 to 6 months. Operative treatments can be broken down into cartilage repair, replacement, and regenerative strategies. There are many promising treatment options, and research is needed to elucidate which are superior to minimize the morbidity from OLTs.

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4

Schachter, Aaron K., Andrew L. Chen, Ponnavolu D. Reddy, and Nirmal C. Tejwani. "Osteochondral Lesions of the Talus." Journal of the American Academy of Orthopaedic Surgeons 13, no. 3 (May 2005): 152–58. http://dx.doi.org/10.5435/00124635-200505000-00002.

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5

Easley, Mark E., Daniel L. Latt, James R. Santangelo, Marc Merian-Genast, and James A. Nunley. "Osteochondral Lesions of the Talus." American Academy of Orthopaedic Surgeon 18, no. 10 (October 2010): 616–30. http://dx.doi.org/10.5435/00124635-201010000-00005.

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6

Roach, Richard. "Osteochondral Lesions of the Talus." Journal of the American Podiatric Medical Association 93, no. 4 (July 1, 2003): 307–11. http://dx.doi.org/10.7547/87507315-93-4-307.

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Knowledge of osteochondral lesions of the talus parallels that of similar lesions affecting the knee in many respects. Morbidity can be significant, and a variety of diagnostic and surgical techniques have been described. Although these lesions are significant for all patients, in athletic individuals they may bring about the end of their sporting careers. Fragment stability remains critical in the management of these injuries. With advances in diagnostic methods and further specialization in arthroscopy, outcomes will continue to improve. (J Am Podiatr Med Assoc 93(4): 307-311, 2003)

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7

Santrock, Robert D., Matthew M. Buchanan, Thomas H. Lee, and Gregory C. Berlet. "Osteochondral lesions of the talus." Foot and Ankle Clinics 8, no. 1 (March 2003): 73–90. http://dx.doi.org/10.1016/s1083-7515(03)00007-x.

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8

Carney, Dwayne, Monique C. Chambers, Lorraine Boakye, Ned Amendola, Alan S. Yan, and MaCalus V. Hogan. "Osteochondral Lesions of the Talus." Operative Techniques in Orthopaedics 28, no. 2 (June 2018): 91–95. http://dx.doi.org/10.1053/j.oto.2018.02.004.

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9

White, Kevin S., and Andrew K. Sands. "Osteochondral lesions of the talus." Current Orthopaedic Practice 20, no. 2 (April 2009): 123–29. http://dx.doi.org/10.1097/bco.0b013e31819bccd8.

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10

McCullough, Kirk A. "Osteochondral Lesions of the Talus." Journal of Bone and Joint Surgery 102, no. 1 (January 2020): e3. http://dx.doi.org/10.2106/jbjs.19.01203.

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11

Loomer, Richard, Carol Fisher, Robert Lloyd-Smith, John Sisler, and Tom Cooney. "Osteochondral lesions of the talus." American Journal of Sports Medicine 21, no. 1 (January 1993): 13–19. http://dx.doi.org/10.1177/036354659302100103.

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12

Hunt, Kenneth J., Arthur T. Lee, Derek P. Lindsey, William Slikker, and Loretta B. Chou. "Osteochondral Lesions of the Talus." American Journal of Sports Medicine 40, no. 4 (February 23, 2012): 895–901. http://dx.doi.org/10.1177/0363546511434404.

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13

Choi, Gi Won, Woo Jin Choi, Hyun Kook Youn, Yoo Jung Park, and Jin Woo Lee. "Osteochondral Lesions of the Talus." American Journal of Sports Medicine 41, no. 3 (January 25, 2013): 504–10. http://dx.doi.org/10.1177/0363546512472976.

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14

Hannon, C. P., N. A. Smyth, C. D. Murawski, B. A. Savage-Elliott, T. W. Deyer, J. D. F. Calder, and J. G. Kennedy. "Osteochondral lesions of the talus." Bone & Joint Journal 96-B, no. 2 (February 2014): 164–71. http://dx.doi.org/10.1302/0301-620x.96b2.31637.

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15

Seo, Sang Gyo, Jin Soo Kim, Dong-Kyo Seo, You Keun Kim, Sang-Hoon Lee, and Ho Seong Lee. "Osteochondral lesions of the talus." Acta Orthopaedica 89, no. 4 (April 11, 2018): 462–67. http://dx.doi.org/10.1080/17453674.2018.1460777.

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16

Kerkhoffs, G. M. M. J., and J. Karlsson. "Osteochondral lesions of the talus." Knee Surgery, Sports Traumatology, Arthroscopy 27, no. 9 (August 10, 2019): 2719–20. http://dx.doi.org/10.1007/s00167-019-05647-4.

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17

Verghese, Navin, Amy Morgan, and Anthony Perera. "Osteochondral Lesions of the Talus." Foot and Ankle Clinics 18, no. 1 (March 2013): 49–65. http://dx.doi.org/10.1016/j.fcl.2012.12.003.

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18

Deol, Premjit Pete S., Daniel J. Cuttica, William Bret Smith, and Gregory C. Berlet. "Osteochondral Lesions of the Talus." Foot and Ankle Clinics 18, no. 1 (March 2013): 13–34. http://dx.doi.org/10.1016/j.fcl.2012.12.010.

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19

Myerson, Mark S. "Osteochondral Lesions of the Talus." Foot and Ankle Clinics 18, no. 1 (March 2013): xi. http://dx.doi.org/10.1016/j.fcl.2012.12.011.

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20

Sochacki, Kyle R., Robert A. Jack, and Pedro E. Cosculluela. "Osteochondral Lesions of the Talus: Osteochondral Allograft Transplantation." Operative Techniques in Sports Medicine 25, no. 2 (June 2017): 120–28. http://dx.doi.org/10.1053/j.otsm.2017.03.008.

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21

Bae, Su-Young. "Osteochondral Lesions of the Talus: Autologous Osteochondral Transplantation." Journal of Korean Foot and Ankle Society 24, no. 2 (June 15, 2020): 55–60. http://dx.doi.org/10.14193/jkfas.2020.24.2.55.

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22

Sundararajan, S. R., Terence Derryl Dsouza, Ramakanth Rajagopalakrishnan, and Shanmuganathan Rajasekaran. "Osteochondral lesions of the talus-current concepts." Journal of Arthroscopic Surgery and Sports Medicine 1 (October 14, 2020): 218–25. http://dx.doi.org/10.25259/jassm_38_2020.

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Osteochondral lesions of the talus encompass important clinical conditions encountered in day-to-day practice. Varied etiology and non-specific clinical signs make the diagnosis of these lesions challenging. Surgical treatment is indicated after a failed conservative trial, larger lesion and can be broadly split into cartilage repair, replacement, and regenerative strategies. Outcomes following surgery are variable and thus treatment strategy has to be tailored to every patient based on specific factors.

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23

Hermanson, Evan, and Richard D. Ferkel. "Bilateral Osteochondral Lesions of the Talus." Foot & Ankle International 30, no. 8 (August 2009): 723–27. http://dx.doi.org/10.3113/fai.2009.0723.

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Background: Osteochondral lesions of the talus (OLT) are relatively uncommon but may be a cause of significant pain and disability. Although the majority of patients have an osteochondral lesion of the talus that is unilateral, bilateral involvement has been reported in 10% to 25% of cases. In addition, factors that cause one side to be symptomatic and the contralateral side to be asymptomatic have never been evaluated. Materials and Methods: A database containing all patients at our institution with an OLT has been maintained for the past 23 years. This was reviewed and patients with bilateral involvement identified. A chart review was performed to determine location and size of the OLT, which were symptomatic, associated with trauma, and required surgery. Results: Between 1984 and 2007, 526 patients with an OLT were seen. Fifty-two patients had bilateral OLT, for an overall bilateral incidence of 10%. Of these, 16 patients required no surgery (Group 1), 31 required only unilateral surgery (Group 2), and five required bilateral surgery (Group 3). 88% of the OLT were located medially. Symptomatic talar lesions were significantly larger compared to asymptomatic OLT ( p < 0.01). Of those that required only unilateral surgery, the size of the OLT eventually requiring surgery was significantly larger ( p < 0.01). Conclusion: The overall incidence of bilateral involvement was 10%. A majority of patients with bilateral involvement had the OLT located on the medial side. A larger surface area appeared to be related to the presence of symptoms and the need for surgery.

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24

Lee, Keun-Bae. "Retraction: Osteochondral Lesions of the Talus." Journal of Korean Foot and Ankle Society 24, no. 4 (December 15, 2020): 174. http://dx.doi.org/10.14193/jkfas.2020.24.4.174.

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25

Schumann, L., P. A. A. Struijs, and C. N. van Dijk. "Traumatic osteochondral lesions of the talus." Der Orthopäde 30, no. 1 (January 29, 2001): 66–72. http://dx.doi.org/10.1007/s001320050575.

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26

Josten, C., and T. Rose. "Acute and chronic osteochondral talus lesions." Der Orthopäde 28, no. 6 (June 1999): 500–508. http://dx.doi.org/10.1007/pl00003635.

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27

Dobbs, Bruce M., Shawn M. Cazzell, and Monara Dini. "Central Talar Dome Lesions." Journal of the American Podiatric Medical Association 101, no. 2 (March 1, 2011): 192–95. http://dx.doi.org/10.7547/1010192.

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Osteochondral lesions of the talus have been documented, reported, and studied since as early as the 19th century. The evolution of classification systems has allowed surgeons to better manage osseous lesions. Most osteochondral lesions of the talus have been categorized as anterolateral, posteromedial, or central with respect to the talar dome and its articulating surface. The complexity of the aforementioned lesions each present their own set of obstacles and, hence, management. Specifically, surgery on a central talar dome lesion is complicated by poor exposure and limited access, proving to be a challenging operation. Preoperative planning, including exhaustive imaging before any talar dome surgery, is imperative. We present a case study that involves the need for a distal tibial chevron (wedge) talus, with incorporation of a cadaveric allograft to fill the defect. (J Am Podiatr Med Assoc 101(2): 192–195, 2011)

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28

Looze, Christopher A., Jason Capo, Michael K. Ryan, John P. Begly, Cary Chapman, David Swanson, Brian C. Singh, and Eric J. Strauss. "Evaluation and Management of Osteochondral Lesions of the Talus." CARTILAGE 8, no. 1 (September 28, 2016): 19–30. http://dx.doi.org/10.1177/1947603516670708.

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Osteochondral lesions of the talus are common injuries that affect a wide variety of active patients. The majority of these lesions are associated with ankle sprains and fractures though several nontraumatic etiologies have also been recognized. Patients normally present with a history of prior ankle injury and/or instability. In addition to standard ankle radiographs, magnetic resonance imaging and computed tomography are used to characterize the extent of the lesion and involvement of the subchondral bone. Symptomatic nondisplaced lesions can often be treated conservatively within the pediatric population though this treatment is less successful in adults. Bone marrow stimulation techniques such as microfracture have yielded favorable results for the treatment of small (<15 mm) lesions. Osteochondral autograft can be harvested most commonly from the ipsilateral knee and carries the benefit of repairing defects with native hyaline cartilage. Osteochondral allograft transplant is reserved for large cystic lesions that lack subchondral bone integrity. Cell-based repair techniques such as autologous chondrocyte implantation and matrix-associated chondrocyte implantation have been increasingly used in an attempt to repair the lesion with hyaline cartilage though these techniques require adequate subchondral bone. Biological agents such as platelet-rich plasma and bone marrow aspirate have been more recently studied as an adjunct to operative treatment but their use remains theoretical. The present article reviews the current concepts in the evaluation and management of osteochondral lesions of the talus, with a focus on the available surgical treatment options.

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29

Ross, Keir A., Justin Robbins, Mark E. Easley, and John G. Kennedy. "Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus." Operative Techniques in Orthopaedics 24, no. 3 (September 2014): 171–80. http://dx.doi.org/10.1053/j.oto.2014.02.012.

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30

Görtz, Simon, Allison J. De Young, and William D. Bugbee. "Fresh Osteochondral Allografting for Osteochondral Lesions of the Talus." Foot & Ankle International 31, no. 4 (April 2010): 283–90. http://dx.doi.org/10.3113/fai.2010.0283.

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31

Flynn, Seán, Keir A. Ross, Charles P. Hannon, Youichi Yasui, Hunter Newman, Christopher D. Murawski, Timothy W. Deyer, Huong T. Do, and John G. Kennedy. "Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus." Foot & Ankle International 37, no. 4 (December 14, 2015): 363–72. http://dx.doi.org/10.1177/1071100715620423.

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32

Scotti, Celeste, Andre Leumann, Christian Candrian, Andrea Barbero, Davide Croci, Dirk J. Schaefer, Marcel Jakob, Victor Valderrabano, and Ivan Martin. "Autologous Tissue-engineered Osteochondral Graft for Talus Osteochondral Lesions." Techniques in Foot & Ankle Surgery 10, no. 4 (December 2011): 163–68. http://dx.doi.org/10.1097/btf.0b013e318237c196.

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33

Sammarco, G. James, and Nilesh K. Makwana. "Treatment of Talar Osteochondral Lesions Using Local Osteochondral Graft." Foot & Ankle International 23, no. 8 (August 2002): 693–98. http://dx.doi.org/10.1177/107110070202300803.

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Twelve patients with an osteochondral lesion of the talus were treated with excision of the lesions and local osteochondral autogenous grafting. The lesion was accessed through a replaceable bone block removed from the anterior tibial plafond. The graft was harvested from the medial or lateral talar articular facet on the same side of the lesion. The average age of the patients was 41 years and duration of symptoms was 90 months (ave.). There were six males and six females with the right talus involved in eight and the left in four patients. Graft sizes ranged from four to eight millimeters in diameter. There was a significant improvement in the AOFAS score from 64.4 (ave.) pre-operatively to 90.8 (ave.) postoperatively (p>0.0001), at a follow-up of 25.3 months (ave.). The AOFAS score was slightly higher in patients under 40 years of age and in those without pre-existing joint arthritis. All patients were very satisfied with the procedure. Arthroscopy performed in two patients at six and 12 months following surgery showed good graft incorporation. No complications occurred at the donor site or the site of bone block removal on the distal tibia. The results show that stage III and IV talar osteochondral lesions can be accessed successfully excising a tibial bone block and using local autogenous osteochondral graft harvested from the ipsilateral talar articular facet.

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34

Chiang, Chieh, and Man-Kuan Au. "Mosaicplasty for Osteochondral Lesions of the Talus." Journal of the American Podiatric Medical Association 103, no. 1 (January 1, 2013): 81–86. http://dx.doi.org/10.7547/1030081.

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Two women (24 and 27 years old) noted pain in the affected ankle of several years’ duration. Radiography and magnetic resonance imaging revealed osteochondral lesions of the talus in both patients. The lesion sites measured 1.3 × 1.0 × 0.4 cm (0.52 cm3) and 2.0 × 1.9 × 0.5 cm (1.9 cm3). Each patient received a medial malleolar osteotomy with mosaicplasty. Donor plugs were obtained from the ipsilateral knee in both patients. Surgery was performed successfully in both patients without complications. At 2-year follow-up, both patients had recovered good ankle function, with no donor site morbidity. American Orthopedic Foot and Ankle Society ankle/hindfoot scores improved in the affected ankles from 16 to 84 in case 1 and from 43 to 87 in case 2. Mosaicplasty is effective in treating stage III or IV osteochondral lesions of the talus and results in good-to-excellent recovery of function. (J Am Podiatr Med Assoc 103(1): 81–86, 2013)

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35

Souza, Glenda Brauer Bonjardim de, Caio Augusto de Souza Nery, Marcelo Pires Prado, José Felipe Marion Alloza, and Alexandre Leme Godoy-Santos. "En bloc osteochondral autograft in the treatment of osteochondral lesions of the talus." Scientific Journal of the Foot & Ankle 13, no. 3 (September 30, 2019): 217–22. http://dx.doi.org/10.30795/scijfootankle.2019.v13.953.

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Osteochondral lesions of the talus are common, and the choice of treatment is based on the extent, depth and symptoms. Osteochondral autografts are indicated for large, deep and recurrent lesions. The authors describe the treatment of these lesions using an en bloc osteochondral autograft obtained from the lateral trochlea of the ipsilateral knee performed in 4 ankles and evaluate the outcomes in the medium term with regard to complaints in the recipient site, donor site and aspect of the reconstructed site. The described procedure proved to be effective in the treatment of complex osteochondral lesions of the talus, restoring the normal functional pattern in the final evaluation. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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36

Savva, Nicholas, Majid Jabur, Mark Davies, and Terry Saxby. "Osteochondral Lesions of the Talus: Results of Repeat Arthroscopic Debridement." Foot & Ankle International 28, no. 6 (June 2007): 669–73. http://dx.doi.org/10.3113/fai.2007.0669.

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Background: Repeat arthroscopic debridement of osteochondral lesions of the talus has a poor reputation despite a paucity of evidence in the literature. Methods: We reviewed all patients who had repeat arthroscopic debridement of an osteochondral lesion performed by the senior author. They were scored using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and lesions were graded using the system described by Berndt and Harty. Results: Between 1993 and 2002, 808 consecutive ankle arthroscopies were performed by the senior author, of which 215 were to treat osteochondral lesions of the talus. Of these, 12 had repeat arthroscopies because of unresolved symptoms. AOFAS scores improved from a mean of 34.8 prior to arthroscopy to 80.5 after repeat arthroscopy at a mean followup of 5.9 years (18 months to 11 years). Two patients returned to professional sports after the second procedure. Six patients returned to their preinjury levels of sporting activity and three returned to the same sports but played to a lesser standard or less frequently. One patient had already had a cartilage transplantation procedure. Conclusions: This is the first series specifically assessing patients who have had repeat arthroscopic debridement of osteochondral lesions of the talus, using the same debridement technique by a single surgeon. Our results question the assumption that repeat arthroscopic debridement yields poor results. They also provide a baseline for the newer chondral and osteochondral transplantation techniques to compare to at the medium term.

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37

Roychan, Maghrizal, and Andre Triadi Desnantyo. "Patofisiologi dan Tatalaksana Osteochondral Lesion of the Talus." Medica Arteriana (Med-Art) 1, no. 2 (December 30, 2019): 45. http://dx.doi.org/10.26714/medart.1.2.2019.45-56.

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ABSTRAKPenyakit Osteochondral Lesion of the Talus (OLT) adalah kelainan pada tulang talus di lapisan subchondral yang berupa lesi osteochondral pada talar dome dengan konsekuensi abnormalitas pada tulang rawan sendi talar. Pasien biasanya datang berobat ke tenaga kesehatan dengan keluhan yang tidak spesifik dan dengan gejala seperti nyeri pada pergelangan kaki, bengkak serta berkurangnya berkurangnya ruang gerak. Penegakan diagnosis bisa dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang sederhana seperti foto X-ray maupun pemeriksaan penunjang canggih seperti CT-Scan dan MRI. Tatalaksana OLT bervariasi. Tatalaksana pada OLT tergantung dari tahapan lesi, kronisitasnya, dan keluhan simtomatis yang menyertainya. Pasien dengan keluhan simtomatis yang akut dan non-displaced sering diberikan terapi nonoperatif biasanya berupa terapi konservatif dengan imobilisasi. Lesi yang tidak berhasil atau tidak menunjukkan perbaikan dalam keluhan simtomatisnya setelah 3 sampai 6 bulan, serta lesi dengan displacement dapat direncanakan untuk terapi operatif. Ada beberapa macam tehnik operatif yang dapat dilakukan untuk menyembuhkan OLT. Tehnik operatif ini dapat dikategorikan menjadi cartilage repair, cartilage regeneration dan cartilage replacement techniques.Kata kunci: osteochondral lesion of the talus, patofisiologi, tatalaksanaABSTRACTOsteochondral Lesion of the Talus (OLT) is an abnormality in the talus bone in the subchondral layer in the form of osteochondral lesions in the talar dome with consequent abnormalities in the talar joint cartilage. Patients usually come to a health care provider with nonspecific complaints and with symptoms such as pain in the ankles, swelling and reduced space for movement. The diagnosis can be made with a history, physical examination and simple investigations such as X-rays and sophisticated investigations such as CT-Scan and MRI. The management of OLT varies. The management of OLT depends on the stage of the lesion, its chronicity, and the accompanying symptomatic complaints. Patients with acute and non-displaced symptomatic complaints are often given nonoperative therapy usually in the form of conservative therapy with immobilization. Lesions that are unsuccessful or show no improvement in symptomatic complaints after 3 to 6 months, and lesions with displacement can be planned for operative therapy. There are several types of operative techniques that can be done to cure OLT. These operative techniques can be categorized into cartilage repair, cartilage regeneration and cartilage replacement techniques. Keywords: osteochondral lesion of the talus, patophysiology, treatment

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38

Laffenêtre, O. "Osteochondral lesions of the talus: Current concept." Orthopaedics & Traumatology: Surgery & Research 96, no. 5 (September 2010): 554–66. http://dx.doi.org/10.1016/j.otsr.2010.06.001.

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39

De Burca, Neasa. "Osteochondral Lesions of the Talus: a review." Physiotherapy Practice and Research 30, no. 1 (2009): 29–31. http://dx.doi.org/10.3233/ppr-2009-30107.

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40

Hannon, Charles P., Christopher D. Murawski, Ashraf M. Fansa, Niall A. Smyth, Huong Do, and John G. Kennedy. "Microfracture for Osteochondral Lesions of the Talus." American Journal of Sports Medicine 41, no. 3 (September 11, 2012): 689–95. http://dx.doi.org/10.1177/0363546512458218.

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41

Yulish, Barry S., George P. Mulopulos, Donald B. Goodfellow, Patrick J. Bryan, Michael T. Modic, and Beth M. Dollinger. "MR Imaging of Osteochondral Lesions of Talus." Journal of Computer Assisted Tomography 11, no. 2 (March 1987): 296–301. http://dx.doi.org/10.1097/00004728-198703000-00021.

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Cuttica, Daniel J., W. Bret Smith, Christopher F. Hyer, Terrence M. Philbin, and Gregory C. Berlet. "Osteochondral Lesions of the Talus: Predictors of Clinical Outcome." Foot & Ankle International 32, no. 11 (November 2011): 1045–51. http://dx.doi.org/10.3113/fai.2011.1045.

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Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm2. There were 20 lesions larger than 1.5 cm2 and 110 lesions smaller than 1.5 cm2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm2 and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions are often associated with inferior functional outcomes and may require a more extensive initial procedure. Level of Evidence: IV, Retrospective Case Series

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Parekh, Selene G., Mark E. Easley, Samuel B. Adams, and Christopher E. Gross. "Surgical Management of Osteochondral Lesions of the Talus." Duke Orthopaedic Journal 5, no. 1 (2015): 35–47. http://dx.doi.org/10.5005/jp-journals-10017-1054.

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ABSTRACT Osteochondral lesions of the talus (OLT) present a formidable treatment challenge to the orthopaedic surgeon. Historical cartilage repair strategies often result in the formation of fibro cartilage leading to suboptimal clinical results. With advances in regenerative medicine, modern surgical techniques are diverse and employ autograft, allograft and tissueengineered constructs for cartilage repair. Fresh and particulated juvenile allograft transplantation have become popular options in the United States. Worldwide, both cellular and acellular tissueengineered constructs are utilized. In all cases, there is still debate as to the optimal cell source and scaffold material and only short term clinical results are available. This article will review these current as well as experimental techniques for cartilage repair of osteochondral lesions of the talus. Adams Jr SB, Gross CE, Tainter DM, Easley ME, Parekh SG. Surgical Management of Osteochondral Lesions of the Talus. The Duke Orthop J 2015;5(1):3547.

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Mologne, Timothy S., and Richard D. Ferkel. "Arthroscopic Treatment of Osteochondral Lesions of the Distal Tibia." Foot & Ankle International 28, no. 8 (August 2007): 865–72. http://dx.doi.org/10.3113/fai.2007.0865.

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Background: Osteochondral lesions of the tibia are much less frequent than those of the talus, and treatment guidelines have not been established. We hypothesized that arthroscopic treatment methods used for osteochondral lesion of the talus would also be effective for those of the distal tibia. Methods: A review of 880 consecutive ankle arthroscopies identified 23 patients (2.6%) with osteochondral lesions of the distal tibia. Four patients were excluded because of concomitant acute ankle fractures requiring open reduction and internal fixation and two were lost to followup, leaving 17 in the study. The mean age was 38 (19 to 71) years. Six (35%) had osteochondral lesions of the tibia and talus; 11 had isolated lesions of the distal tibia. Treatment included excision, curettage, and abrasion arthroplasty in all patients. Five patients had transmalleolar drilling of the lesion, two had microfracture, and two had iliac bone grafting. At last followup, patients were evaluated with a questionnaire, physical examination, and ankle radiographs. Results: Mean followup was 44 (24 to 99) months. Preoperatively, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 52; postoperatively, it was 87. Using the Wilcoxon signed-rank test to compare preoperative and postoperative scores, there was significant improvement in the ankle-hindfoot score postoperatively ( p < 0.001). Seven patients had excellent results, seven had good results, one had a fair result, and two had poor results. Conclusions: Osteochondral lesions of the distal tibia present a challenge to the orthopedic surgeon. Arthroscopic treatment by means of debridement, curettage, abrasion arthroplasty, and, in some patients, transmalleolar drilling, microfracture, or iliac crest bone grafting, resulted in excellent and good results in 14 of 17 patients at medium-term followup.

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Atay, Evren Fehmi, Melih Güven, Murat Çakar, Cumhur Ibrahim Başsorgun, Budak Akman, and Cemal Bes. "An Unusual Cause of a Cystic Lesion with an Osteochondral Defect in the Talus." Journal of the American Podiatric Medical Association 101, no. 3 (May 1, 2011): 269–74. http://dx.doi.org/10.7547/1010269.

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An intraosseous lipoma is a rare benign bone lesion that proliferates from mature lipocytes. It occurs most frequently in the lower limb, particularly in the calcaneus. The talus is an unusual location for this rare lesion. A review of the literature produced only two reports with talar intraosseous lipomas under the name of intraosseous lipomatosis, which described multiple lipomas in different areas. We describe a 38-year-old male patient who had an isolated intraosseous lipoma with an osteochondral defect in the talus and was treated with autologous osteochondral graft transplantation by medial malleolar osteotomy. He could walk with full weightbearing without any assistance at the end of 12 months. Intraosseous lipoma localized in the talus may be confused radiologically with other bone lesions, especially with unicameral bone cyst, if it is associated with an osteochondral defect. Autologous osteochondral graft transplantation is a successful treatment method for talar intraosseous lipoma. (J Am Podiatr Med Assoc 101(3): 269–274, 2011)

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Hurley, Eoghan T., Sarah K. Stewart, John G. Kennedy, Eric J. Strauss, James Calder, and Arul Ramasamy. "Current management strategies for osteochondral lesions of the talus." Bone & Joint Journal 103-B, no. 2 (February 1, 2021): 207–12. http://dx.doi.org/10.1302/0301-620x.103b2.bjj-2020-1167.r1.

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The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article: Bone Joint J 2021;103-B(2):207–212.

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Lee, Keun-Bae, Hyun-Kee Yang, Eun-Sun Moon, and Eun-Kyoo Song. "Modified Step-Cut Medial Malleolar Osteotomy for Osteochondral Grafting of the Talus." Foot & Ankle International 29, no. 11 (November 2008): 1107–10. http://dx.doi.org/10.3113/fai.2008.1107.

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Background: Osteochondral grafting for the treatment of osteochondral lesions of the talus (OLT) usually requires a medial malleolar osteotomy (MMO) to achieve adequate intraarticular exposure. This study describes the technique used and the results obtained using a modified step-cut MMO for osteochondral grafting of talar dome lesions. Materials and Method: Eleven feet in ten patients underwent modified step-cut MMO prior to osteochondral grafting for OLT. The patients included three women and seven men with a mean age of 40 (range, 20 to 51) years. Modified step-cut MMO consisted of an oblique osteotomy, which was made at approximately 45 degrees to the transverse plane of the proposed traditional step-cut osteotomy, and a vertical osteotomy to the axilla on the medial tibial plafond. Results: In all patients, modified step-cut MMO provided better perpendicular access to lesions than traditional step-cut osteotomy. In all cases, the osteochondral graft plug was accurately set perpendicular to the defect area, and all ten patients experienced uncomplicated osteotomy healing at a mean 8 weeks postoperatively without loss of reduction or malreduction. Conclusion: Modified step-cut MMO is an excellent, reproducible method for perpendicular access to a talar dome lesion. Level of Evidence: IV, Retrospective Case Study

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Bleazey, Scott, and Stephen A. Brigido. "Reconstruction of Complex Osteochondral Lesions of the Talus With Cylindrical Sponge Allograft and Particulate Juvenile Cartilage Graft." Foot & Ankle Specialist 5, no. 5 (August 30, 2012): 300–305. http://dx.doi.org/10.1177/1938640012457937.

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Osteochondral lesions of the talus can be a challenging injury to treat for even the most experienced foot and ankle surgeon. Although the advances in imaging have made the diagnosis of chondral lesions more accurate, surgeons are still struggling to find ways to reliably treat advanced lesions with subchondral bone damage. This article looks at the use of allograft bone and particulate juvenile cartilage in patients with advanced subchondral bone damage and osteochondral lesions of the talus. Levels of Evidence: Therapeutic, Level IV, Case series

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Pereira, Gregory F., John Steele, Amanda N. Fletcher, Samuel B. Adams, and Ryan B. Clement. "A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0038. http://dx.doi.org/10.1177/2473011420s00382.

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Category: Ankle Introduction/Purpose: The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs. Methods: PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures. Conclusion: The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up. [Table: see text]

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Elghawy, Ahmed Aly, Carlos Sesin, and Michael Rosselli. "Osteochondral defects of the talus with a focus on platelet-rich plasma as a potential treatment option: a review." BMJ Open Sport & Exercise Medicine 4, no. 1 (February 2018): e000318. http://dx.doi.org/10.1136/bmjsem-2017-000318.

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ObjectiveTo provide a review of osteochondral lesions of the talus, to discuss the evidence of the risks and benefits of platelet-rich plasma (PRP) as a viable treatment option, and to measure the efficacy of PRP using MRI evidence of cartilage regeneration, as well as scales that measure improvement in ‘pain’ and ‘functionality’.Eligibility criteriaStudies that use PRP in either conservative or intraoperative settings to treat osteochondral defects of the talus.ResultsThere are seven studies that compare hyaluronic acid or standard surgical options against PRP in treating osteochondral lesions of the talus. Five studies use PRP as supplemental treatment in intraoperative settings, while two studies use PRP conservatively as intra-articular injections. There were minimal adverse effects. Pain and functionality scores consistently improved in those who underwent PRP treatments over the course of 4 years. MRI showed significant but inconsistent results in chondral regeneration.ConclusionPRP may show clinical benefit in those with osteochondral lesions of the talus in terms of pain and functionality, although chondral regeneration via MRI is inconsistent. Limitations include the small sample sizes in these seven studies, as well as no standardised formula for PRP preparation.Clinical relevanceTo serve as an overview of the literature regarding PRP treatment for osteochondral lesions of the talus and how this modality may improve patient outcomes in pain, functionality and chondral regeneration. A case is reported to complement the subject review.

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