Osteochondral lesions of the talus

Abstract

Background and purpose - The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Patients and methods - This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3-10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results - No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle-hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Interpretation - Nonoperative treatment can be considered a good option for patients with OCL.

Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis?Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis?

“…The reason for this rapid progression, as explained by Reilingh et al 5 , is due to the formation of fibrocartilage which decreases in quality over time and shows inferior wear characteristics, and also due to irregularity and depression in subchondral bone plate after debridement of cartilage and microfracture. The rapid progression in our cases might be because of denuding normal hyaline cartilage during surgery Also, we believe that since all our cases were Scranton type V in contrast to the study by Seo et al 26 where majority of their patients are types 1 and 2 and they have not considered Scranton type V in their study, led to marked difference in outcome in terms of OA.…”

“…A recent study conducted by Seo et al 26 mentions that none of their cases out of total 142 patients developed osteoarthritis at long-term follow-up with conservative management. Our study in contrast reports 80% OA rate when the surgical technique reported by us is chosen.…”

Osteochondral lesion of talus with gout tophi deposition: A case report

“…OLT occur in the articular cartilage and subchondral bone of the talus and are commonly associated with ankle injuries, such as sprains and fractures[ 7 ]. The etiology of OLTs in patients without a history of trauma remains unknown.…”

Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles

“…23 Recent systematic reviews have reported that nonoperative treatment, such as rest and restriction of sporting activities with or without nonsteroidal anti-inflammatory drugs, is successful in only approximately 62% of patients with OLT. 6,32,38 Many surgical treatment options exist for OLT, such as arthroscopic debridement, bone marrow–stimulating techniques (particularly microfracture), osteochondral autograft or allograft, cell-based therapies, and tissue transplant. 10,12,23,26,27,29 Currently, arthroscopic microfracture has been widely accepted as the primary treatment strategy with good to excellent functional outcomes for small to mid-sized OLT because of quick recovery, cost-effectiveness, technical feasibility, high success rate, and low morbidity associated with this procedure.…”