Treatment principles for osteochondral lesions in foot and ankle

Abstract

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the condition is often symptomatic enough to warrant treatment. In more than one third of cases, conservative treatment is unsuccessful, and surgery is indicated. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Surgical options are lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation and techniques such as osteochondral transplantation [osteochondral autograft transfer system (OATS)] and autologous chondrocyte implantation (ACI). Furthermore, smaller lesions are symptomatic and when left untreated, OCDs can progress; current treatment strategies have not solved this problem. The target of these treatment strategies is to relieve symptoms and improve function. Publications on the efficacy of these treatment strategies vary. In most cases, several treatment options are viable, and the choice of treatment is based on defect type and size and preferences of the treating clinician.

Juvenile Particulate Osteochondral Allograft for Treatment of Osteochondral Lesions of the Talus: Detection of Altered Repair Tissue Biochemical Composition Using 7 Tesla MRI and T2 Mapping

“…Osteochondral lesions of the talus occur in the setting of ankle trauma or instability (1) and are characterized by a defect of the articular cartilage and the adjacent subchondral bone (2). The challenge of treating lesions of the avascular cartilage was first appreciated in 1743 by Dr. Hunter, who stated that an articular cartilage lesion is a "troublesome thing and once destroyed, it is not repaired" (3).…”

Osteochondritis Dissecans of the Talus

“…• Fizioterapinės procedūros: gydomoji mankšta, raumenų masažas, mikrobangų terapija, magnetoterapija, ultraaukšto dažnio terapija, elektroforezė su kortikosteroidais, proteoliziniais fermentais, kalio jodidu [15,26,27].…”

Osteochondral autograft transplantation with biplanar distal tibial osteotomy for patients with concomitant large osteochondral lesion of the talus and varus ankle malalignment

“…The choice of the management strategy for OLTs depends on factors such as clinical manifestations, lesion size and location and surgeons’ preference [12]. For symptomatic lesions smaller than 10 mm, conservative or debridement and microfracture under arthroscopy is indicated while for symptomatic lesions greater than 10 mm or secondary lesions, osteochondral autograft transplantation, autologous chondrocyte implantation (ACI) or allograft transplantation might be preferred [2, 13, 14].…”