Document Detail

Approach alternatives for treatment of osteochondral lesions of the talus.
MedLine Citation:
PMID:  12512414     Owner:  NLM     Status:  MEDLINE    
Osteochondral lesions of the talus are common injuries, especially in the athletic population. Although multiple etiologies exist, lateral lesions have a higher incidence of association with a specific traumatic event. It has been postulated that lateral lesions are produced when the anterolateral aspect of the talar dome impacts the fibula on application of an inversion or dorsiflexion stress to the ankle [2]. There is general agreement that surgery should be performed only in symptomatic cases, as osteochondral lesions of the talar dome show little tendency to progression and do not seem to lead to osteoarthritis [10,42]. Appropriate preoperative imaging is extremely important. Standard radiographs of the ankle supplemented with lateral plantar flexion and dorsiflexion views and CT or Mr imaging can be helpful in evaluating the size, depth, and exact location of the lesion. This information is essential in planning the appropriate surgical procedure. Although many stage I and II lesions respond well to conservative therapy and a period of immobilization, some higher-grade lesions (stage III and IV) eventually require surgical intervention. Most lesions can be approached arthroscopically. Many arthroscopic procedures have been shown to be successful, including debridement with abrasion chondroplasty, subchondral drilling, and microfracture [18-20]. But certain larger or refractory lesions may require an open approach to the ankle joint to restore the articular cartilage. Most lateral lesions have an anterior location and are easily accessible through a standard anterolateral approach. Most medial lesions are located on the posterior talar dome, and a medial malleolar osteotomy is usually required. Osteotomies, in particular of the medial malleolus, should be approached carefully. The possible complications of nonunion and malunion can lead to progressive arthritis of the ankle joint.
David O Navid; Mark S Myerson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Foot and ankle clinics     Volume:  7     ISSN:  1083-7515     ISO Abbreviation:  Foot Ankle Clin     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2003-01-06     Completed Date:  2003-03-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9615073     Medline TA:  Foot Ankle Clin     Country:  United States    
Other Details:
Languages:  eng     Pagination:  635-49     Citation Subset:  IM    
Department of Orthopaedic Surgery, Union Memorial Hospital, Johnston Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218, USA.
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MeSH Terms
Ankle Joint / radiography,  surgery*
Ligaments, Articular / injuries
Osteochondritis Dissecans / surgery*
Osteotomy / methods
Talus / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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