Talar Osteonecrosis After Subchondroplasty for Acute Lateral Ligament Injuries: Case Series

Abstract

Talar osteonecrosis is a well-described phenomenon following talar neck fracture, but is a rarely described complication after procedures about the foot and ankle. Here we describe the clinical course of 5 cases of talar osteonecrosis following injection of calcium phosphate into the talus (subchondroplasty) with or without acute lateral ligament repair after acute lateral ankle ligament injuries performed at an outside institution. Practitioners should be aware of this potentially devastating complication. Future research is indicated to determine the safety and efficacy of subchondroplasty for the talus.Level of Evidence: Level V, case series.

Letter Regarding: Talar Osteonecrosis After Subchondroplasty for Acute Lateral Ligament Injuries: Case Series

“…We have read with much interest the comments regarding our manuscript written in the discussion section of "Talar Osteonecrosis After Subchondroplasty for Acute Lateral Ligament Injuries: Case Series" and we find that some clarification will be effective at elucidating some concerns. 1,2 The authors state that we reported no complications; however, we did have a complication, which was described in the Results section. This was a 46-year-old obese woman that approximately 5 weeks after her procedure was discovered to have a stress fracture of the talar neck at the calcium-bone interface.…”

Response to “Letter Regarding: Talar Osteonecrosis After Subchondroplasty for Acute Lateral Ligament Injuries: Case Series”

“…Calcium phosphate injected at a certain volume and for the proper indications may be a therapeutic tool in the foot and ankle surgeon’s armamentarium. However, in addition to our own study 2 and the talar neck fracture described above, 1 another case series was reported at a third institution with findings of talar osteonecrosis in 4 patients. 3 We therefore believe that randomized clinical trials are warranted in the talus by those using this product prior to generalized use by the foot and ankle community.…”