J Korean Orthop Assoc.  2018 Apr;53(2):81-92. 10.4055/jkoa.2018.53.2.81.

Arthroscopic Treatment for an Osteochondral Lesion of the Talus

• Jeong BO
• Jung H

• KMID: 2410055
• DOI: http://doi.org/10.4055/jkoa.2018.53.2.81

Abstract

Ankle injury is one of the most common injuries, and osteochondral lesions of the talus occur in up to 70% of acute ankle sprains or fractures. The number of sports injuries have increased due to the increase in leisure activities, and the development of diagnostic techniques to evaluate the cartilage status leads to a higher prevalence of osteochondral lesions of the talus. Although osteochondral lesions of the talus with no symptoms can be treated conservatively, adult patients are usually treated by surgery because they are more likely to fail after non-surgical management. Recovery to normal cartilage is important, but there has been no surgical treatment established for effective cartilage regeneration. Bone marrow stimulation, such as arthroscopic microfracture, is a commonly used surgical procedure and an effective treatment for lesions that are small or failed after non-operative treatment. In addition, there are treatments, such as osteochondral autograft transplantation, osteochondral allograft transplantation and autologous chondrocyte implantation. The selection of the methods depends on the size and location of the lesion, the presence of subchondral cysts, and the results of previous surgery. Many surgical procedures have shown good results in short and mid-term follow-up studies but the results of long-term follow-up have been unclear. Various treatment methods, such as hyaluronan, platelet-rich plasma, mesenchymal stem cells, and bone marrow aspirate concentrate, have been available recently due to the development of various biological agents.

Keyword

talus; osteochondral lesion of the talus; microfracture; autologous osteochondral transplantation

MeSH Terms

Adult
Allografts
Ankle Injuries
Athletic Injuries
Autografts
Biological Factors
Bone Cysts
Bone Marrow
Cartilage
Chondrocytes
Follow-Up Studies
Humans
Hyaluronic Acid
Leisure Activities
Mesenchymal Stromal Cells
Platelet-Rich Plasma
Prevalence
Regeneration
Talus*
Biological Factors
Hyaluronic Acid

Figure

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  Figure 1 Simple radiograph and ar-throscopic view of the osteochondral lesion of the talus. (A) Simple radiograph shows radiolucent lesion at medial talus. (B) Arthroscopic view.

• 

  Figure 2 Arthroscopic microfracture. (A) Arthroscopic view of the osteochondral lesion of the talus. (B) Debridement and curettage was performed at the osteochondral lesion. (C) Microfracture was performed. (D) Bleeding after microfracture.

• 

  Figure 3 Osteochondral autologous transplantation. (A) Preoperative magnetic resonance imaging. (B) Preparation of the talus through medial malleolar osteotomy. (C) Autologous osteochondral harvest from lateral femomal condyle. (D) Osteochondral autologous transplantation was performed. (E) Secondary arthroscopic view after 2 years.

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