Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus

Abstract

BACKGROUND We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time. METHODS Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI). RESULTS At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in staging or lesion size. Pain at time of follow-up correlated with the depth of the lesion at initial MRI (P < .05) and with subchondral cyst formation and presence or change of bone marrow edema at follow-up MRI (P < .05). CONCLUSION Minimally symptomatic OLTs did not appear to progress or worsen over time when treated nonoperatively.

Post‐traumatic osteoarthritis of the ankle: A distinct clinical entity requiring new research approaches

“…This mechanism of injury is supported by the anatomic distribution of talar osteochondral lesions (OCLs), with the medial talus affected nearly twice as frequently as the lateral talus, and the mid‐one third of the talar dome affected four times more commonly than the anterior and posterior thirds combined . Evidence suggest that the majority (as high as 95%) of severe ankle sprains result in OCLs and over half of patients with OCLs develop OA . Ligament injury resulting in chronic ankle instability is a common sequelae to severe sprain, and approximately 15% of ankle sprains are recurrences .…”

Pain in Osteochondral Lesions of the Ankle – an Investigation Based on Data from the German Cartilage Registry (KnorpelRegister DGOU)

“…Only 6 lesions were associated with moderate (VAS 4-6) and one with severe (VAS 7-9) pain. Beyond that, Klammer et al detected no correlation between clinical parameters and the pain intensity according to the VAS [24].…”

“…In a retrospective study Klammer et al [24] examined 48 patients with 50 osteochondral lesions of the talus that received a conservative treatment. The visual analog scale (VAS) was used for the evaluation of the pain intensity at the time of follow-up.…”

Arthroscopically Assisted Anterior Treatment of Symptomatic Large Talar Bone Cyst

“…The pathogenesis of a talar cyst remains controversial, although some have supported the valve mechanism of the damaged cartilage (12). Klammer et al (13) reported conservative treatment and close observation were recommended to treat mild symptoms of a small cyst owing to its slow progression. When the talus is extensively destroyed, the absence of timely surgery will increase the risk of pathologic fracture and damage to the articular cartilage, leading to persistent swelling and pain of the subtalar joint and ankle joint.…”