Osteochondral Lesions of the Talar Dome

Abstract

Osteochondral lesions of the talar dome are a common cause of ankle disability. Management options are as numerous as the terms used to describe these lesions. The recognition of a traumatic etiology has increased our understanding and management of these disorders. Modern imaging technology has enhanced the ability to fully evaluate and accurately classify this lesion, which is fundamental for proper treatment.

Fixation of osteochondral lesions of the talus using cortical bone pegs

“…Osteochondral lesions of the talus are often initially misdiagnosed as ligamentous injuries and the time interval between injury and the correct diagnosis may be long. 3,12 In chronic lesions there are often osteosclerotic changes in the bed, and osteochondral attachment cannot be achieved by conservative treatment or by drilling through the fragment alone. Excision of the lesion and curettage and drilling of the talar bed have been recommended.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13]16 It is important to achieve morphological repair of the dome of the talus and the osteochondral fragment should be reattached whenever possible. The pathological condition, the size and stability of the lesion, the continuity of the articular cartilage, the degree of displacement, the condition of the bed, the duration of symptoms, and the level of activity of the patient will all differ.…”

“…16 Since diagnosis in the initial stages is often difficult many chronic unstable lesions are found. 3,11 We have treated these by open reduction and fixation with bone pegs and now present our results.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The lesions are classified into four stages: stage I, a small area of compression of subchondral bone; stage II, a partially detached osteochondral fragment; stage III, a completely detached fragment which remains in the talar crater; and stage IV, displacement of the fragment. We have shown that arthroscopic drilling is appropriate for young patients with an early stable lesion.…”

Pott's Fracture

“…Ossification is usually seen at the level of the fibular fracture and often in association with the use of a syndesmotic screw. Osteochondral (transchondral) fractures of the talus can occur after any type of injury to the ankle, including simple sprains [25].…”