J Korean Orthop Assoc.  2018 Jun;53(3):210-217. 10.4055/jkoa.2018.53.3.210.

Osteochondral Lesion of the Talus in Children and Adolescents

• Song MH

• KMID: 2429168
• DOI: http://doi.org/10.4055/jkoa.2018.53.3.210

Abstract

Osteochondral lesion of the talus (OLT) is a disease affecting the subchondral bone and articular cartilage of the talus, which may cause fragmentation and displacement of the osteochondral lesion. The stability of the joint and the size of the lesion are important prognostic factors. Conservative treatment is preferred in the initial treatment of OLT in skeletal immature patients because it has a more favorable prognosis than adult OLT in terms of the healing potential and improvement of symptoms. Surgery is recommended when the conservative outcome is unsatisfactory and the fragment is large or displaced. Surgical procedures, including marrow stimulation technique, autologous osteochondral transplantation, and autologous chondrocyte implantation, were performed depending on the condition of the osteochondral lesion.

Keyword

osteochondral lesion; talus; ankle; children; adolescents

MeSH Terms

Adolescent*
Adult
Ankle
Bone Marrow
Cartilage, Articular
Child*
Chondrocytes
Humans
Joints
Prognosis
Talus*

Figure

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  Figure 1 Case of a 6-year-old boy treated conservatively. (A) Initial anteroposterior (AP) radiograph of the ankle joint showing a large osteolytic lesion with a sclerotic rim in the lateral aspect of the talar dome. (B) Coronal T2-weighted fat suppression magnetic resonance imaging showing an osteochondral fragment with high signal intensity in the medial aspect of the talar dome with intact articular cartilage. The lesion was classified as stage II according to Dipaola et al.26) (C) After a 2-year follow-up, the size of the lesion decreased on the AP radiograph. (D) Final AP radiograph at the 4-year follow-up showing complete healing of the lesion.

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  Figure 2 Case of an 11-year-old boy who underwent arthroscopic retrograde drilling and bone graft. (A) Preoperative anteroposterior (AP) radiograph of the ankle joint showing complete detachment of the osteochondral fragment in the medial aspect of the talar dome. This concurred with the Berndt and Harty stage III osteochondral lesion of the talus. (B) Coronal T1-weighted magnetic resonance imaging showing an iso-intense osteochondral fragment in the medial aspect of the talar dome with a low signal intensity lesion behind the fragment. The lesion was classified as stage II according to Dipaola et al.26) (C) Intraoperative arthroscopic image demonstrating an intact articular surface of the talar dome. (D) Intraoperative C-arm image performing retrograde drilling. (E) Postoperative 2-year AP radiograph showing complete healing of the lesion.

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  Figure 3 Case of a 17-year-old boy who underwent autologous osteochondral transplantation. (A) Preoperative anteroposterior (AP) radiograph of the ankle joint showing displacement of the osteochondral lesion in the medial aspect of the talar dome. The lesion was classified as a Berndt and Harty stage IV osteochondral lesion of the talus. (B) Coronal T2-weighted fat suppression magnetic resonance imaging showing the detachment of articular cartilage of the medial talar dome, which indicated that the lesion was classified as stage IV according to Dipaola et al.26) (C) Intraoperative gross photograph demonstrating a large-sized osteochondral lesion of the talar dome. (D) Postoperative gross photograph of the autologous osteochondral transplantation. (E) Postoperative 7-year AP radiograph showing complete healing of the lesion.

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