Treatment of Osteochondral Lesions of the Talus

Abstract

➢ Osteochondral lesions of the talus remain difficult pathological entities to treat and require the utilization of a combination of conventional radiographs, computed tomographic scans, and magnetic resonance images to determine osseous involvement. Along with the size of the lesion, these characteristics will dictate the treatment required to obtain a satisfactory clinical result.➢ Operative treatment should be reserved for patients who have mechanical symptoms following an acute osteochondral lesion of the talus or who are not satisfied with the result after 3 to 6 months of nonoperative treatment.➢ The gold standard of operative treatment for lesions measuring <1.5 cm2 remains microfracture. Repair, replacement, or regenerative procedures should be considered for patients with refractory lesions or larger lesions.

Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation

“…Osteochondral lesions of the talus (OLTs) are common and may cause pain and dysfunction of the ankle. 5 , 7 , 8 , 27 OLTs can be a consequence of ankle sprain or trauma. Symptomatic OLTs that do not respond to nonoperative management, consisting of immobilization, protected weightbearing, nonsteroidal anti-inflammatory drugs, and/or physical therapy, need to be surgically treated.…”

“… 6 , 18 However, in patients with full-thickness cartilage lesions and large subchondral cysts, the optimal treatment remains to be determined. 7 , 16 , 24 The large cavity of the debrided cyst may compromise the structural support of the articulation, and the subchondral bone defect may hinder cartilage regeneration. Recent studies 7 , 18 , 24 , 28 have shown that in patients with OLTs associated with large subchondral cysts, structural bone grafting, such as osteochondral autografts/allografts and autologous chondrocyte implantation, may provide good results.…”

“… 7 , 16 , 24 The large cavity of the debrided cyst may compromise the structural support of the articulation, and the subchondral bone defect may hinder cartilage regeneration. Recent studies 7 , 18 , 24 , 28 have shown that in patients with OLTs associated with large subchondral cysts, structural bone grafting, such as osteochondral autografts/allografts and autologous chondrocyte implantation, may provide good results. However, the potential donor site morbidity and long-term outcomes, including arthroscopic and radiological outcomes, remain to be investigated.…”

Characteristics of Osteochondral Lesions of the Talus in Different Age Groups

“…Some recent studies have shown that scaffold-based therapies such as autologous matrix-induced chondrogenesis can be considered as an effective treatment strategy [5,6]. There are disputes between operation and non-operation [7], as well as among different surgical procedures [8][9][10]. Meanwhile, the same surgical procedure also has different effects among age groups.…”

Tratamiento Artroscópico en Lesión Osteocondral Subtalar

“…8 De persistir el estímulo nocivo, se altera la capacidad de reparación tisular y la perfusión ósea, lo que genera el desarrollo de quistes subcondrales, dando inicio a una cascada eventos degenerativos hasta la artrosis. 9,10 El domo talar es la zona más afectada del retropie de ese tipo de lesiones. Elías y col., 11 establece que las lesiones en la región central del domo son las más frecuentes, seguidas de la región anterolateral y luego la posteromedial.…”