J Korean Orthop Assoc.  2017 Apr;52(2):153-160. 10.4055/jkoa.2017.52.2.153.

Non-Operative Treatment for Symptomatic Osteochondral Lesion of the Talus

• Kim JS
• Lee HS
• Seo SG
• Song JW
• Seo DK

• KMID: 2438980
• DOI: http://doi.org/10.4055/jkoa.2017.52.2.153

Abstract

PURPOSE
Although reports on operative treatment of osteochondral lesion of the talus (OLT) are increasing, to the best of our knowledge, there have been only a few reports on non-operative treatment of OLT. The purpose of this study is to report the prognosis of non-operative treatment for OLT patients.
MATERIALS AND METHODS
This retrospective study included 104 patients (57 male, 47 female) with OLTs having a follow-up period of more than two years, between 2003 and 2013. The location, size, and stage of the OLT were confirmed by magnetic resonance imaging or computed tomography. At the final follow-up, simple radiographs confirmed the progression of osteoarthritis. We surveyed the limitations of sports activity, visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scale, and SF-36.
RESULTS
There were no patients with progression of osteoarthritis at the final follow-up. Only two patients (2.4%) complained the limitation of desired sports activity. The mean VAS significantly decreased from 4.3 (range, 0-8) to 1.1 (range, 0-4) (p<0.001). The mean AOFAS scale significantly improved from 83.3 (range, 41-100) to 92.5 (range, 65-100). Moreover, the mean SF-36 also improved from 52.6 (range, 30.0-91.0) to 72.9 (range, 40.6-97.0) (p<0.001).
CONCLUSION
Sufficient non-operative treatment is initially recommended to OLT patients because pain, in general, improves in most cases despite the presence of symptoms. Moreover, it's worth noting that the progression to osteoarthritis is rare.

Keyword

talus; osteochondral lesion; conservative treatments

MeSH Terms

Ankle
Follow-Up Studies
Foot
Humans
Magnetic Resonance Imaging
Male
Orthopedics
Osteoarthritis
Prognosis
Retrospective Studies
Sports
Talus*

Figure

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  Figure 1 Articular surface of talar dome is divided into nine areas.

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  Figure 2 Magnetic resonance imaging shows bone marrow edema and bone cyst of the talus.

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  Figure 3 An 18-year-old male. (A) Initial magnetic resonance imaging (MRI), (B) 10.4 years follow-up MRI. The size of the lesion decreased and American Orthopedic Foot and Ankle Society scale improved from 65 to 91.

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  Figure 4 A 71-year-old male. (A) Initial magnetic resonance imaging (MRI), (B) 2.5 years follow-up MRI. The size of the lesion increased. However, American Orthopedic Foot and Ankle Society scale improved from 65 to 88.

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