Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans

Abstract

This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.

Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus

“…Autologous and allogeneic osteochondral grafting are reasonable options for repairing OLT with cysts. When the area of osteochondral injury is large and many autologous bone fragments are required to fill the osteochondral lesion, allogeneic bone grafting is preferred; however, allogeneic bone grafting has many limitations, including the risks of rejection and disease transmission, and the high cost due to the limited number of donors [ 8 , 9 ]. And Migliorini found talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up by 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved [ 20 ].…”

“…Thus, the indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully. In addition, there are significant anatomical and biomechanical differences between the knee and ankle, and the healing rate after grafting knee cartilage to talar cartilage is unclear [ 8 , 9 ]. Moreover, there may be differences in the composition of cartilage matrix in the non-weight-bearing area of knee joint and talus cartilage, which may also lead to the recurrence of ankle pain and ankle dysfunction.…”

“…Autologous osteochondral grafts are usually taken from the osteochondral column of the ipsilateral knee, producing hyaline cartilage with excellent biomechanical properties, but potentially leading to irreversible knee damage. However, iliac bone grafts have fewer complications in the treatment of talar cartilage injuries, and the iliac periosteum has multifunctional stem cells with the ability to differentiate into chondrocytes and fibrocartilage [ 8 , 9 , 18 ].…”

Editorial Commentary: Drill and Fill: Bone Marrow Stimulation Plus Allograft Matrix May Optimize the Treatment of Osteochondral Lesions of the Talus

“…O steochondral lesions of the talus (OLTs) have long confounded orthopaedic surgeons. 1 The tenuous blood supply of the talus in conjunction with the avascularity of articular cartilage results in impaired healing potential and presents a significant challenge in OLT treatment. 2,3 Various treatment options have resulted from this conundrum, leading to both reparative and replacement surgical techniques with the decision-making process influenced by lesion size, location, chronicity, and previous management.…”

“…2,3 Various treatment options have resulted from this conundrum, leading to both reparative and replacement surgical techniques with the decision-making process influenced by lesion size, location, chronicity, and previous management. 1,4,5 Unfortunately, there is a paucity of high-quality evidence providing limited guidance to orthopaedic surgeons.…”