Korean J Sports Med.  2017 Sep;35(2):77-85. 10.5763/kjsm.2017.35.2.77.

Treatment of Osteochondral Lesions of the Talus in Athletes

• Yoo J
• Yeo ED
• Lee YK

• KMID: 2389646
• DOI: http://doi.org/10.5763/kjsm.2017.35.2.77

Abstract

The definition of osteochondral lesion of the talus (OLT) is any defect involving both the articular surface and the subchondral bone of the talus. Many of these lesions are associated with acute ankle injury. Although many classification schemes for OLT have been proposed, Berndt and Harty's 4-staging classification is most commonly used. Stage 4 lesions and symptomatic lesions under grade 3 are usually recommended to surgical treatment. The treatment approach for athletes should be more elaborate due to the need for an early return to play. Several different types of treatment are described for OLTs in athletes, including bone marrow stimulation, osteochondral autograft transfer system, and autogenous chondrocyte implantation. Osteochondral autograft transfer system shows good clinical outcome and has the advantages that could be applied to large defect and recurred lesions, however, it has some disadvantages in terms of the complications related with the donor site and the difficult approach to the medial lesions. Although autogenous chondrocyte implantation has been extensively applied for treating OLTs with successful clinical outcomes, it has some limitations that apply to athletes in terms of the 2-stage and complicated procedure and the insurance issues. Bone marrow stimulation being a simple and cost-effective procedure associated with a low complication rate and low postoperative pain has faster return to play and is recommended the first-line treatment for the OLTs of athletes.

Keyword

Athletes; Microfracture; Autografts; Talus

MeSH Terms

Ankle Injuries
Athletes*
Autografts
Bone Marrow
Chondrocytes
Classification
Humans
Insurance
Pain, Postoperative
Return to Sport
Talus*
Tissue Donors

Figure

• 

  Fig. 1 The treatment algorithm for osteochondral lesion of the talus. NSAIDs: non-steroidal anti-inflammatory drugs, OATS: osteochondral autograft transfer system, ACI: autogenous chondrocyte implantation. Reproduced from Dragoni et al. Foot Ankle Int 2011;32:910-6, with permission of SAGE Publications 26).

• 

  Fig. 2 Arthroscopic microfracture technique. (A) Arthroscopic view of the medial talar dome lesion. (B) The same lesion after curettage and (C) microfracture. (D) The healed lesion filling with fibrous cartilage after 2 years.

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  Fig. 3 The fluoroscopic images of osteochondral autograft transfer system. (A) The resection of the lateral malleolus was done during the approach to the lateral talar dome lesion. (B) The image shows plating of the lateral malleolus after the procedure.

• 

  Fig. 4 These pictures show second look arthroscopy after autologous chondrocyte implantation of osteochondral lesion of the talus. (A, B) Complete degree of defect repair and filling of the defect, (C, D) <50% incomplete degree of defect repair and filling of the defect. Reproduced from Lee et al. Scand J Med Sci Sports 2012;22:510-550).

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