Arthroscopic Treatment for an Osteochondral Lesion of the Talus

Bi O Jeong; Hyuk Jung

doi:10.4055/jkoa.2018.53.2.81

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Jeong and Jung: Arthroscopic Treatment for an Osteochondral Lesion of the Talus

Original Article

J Korean Orthop Assoc 2018;53(2):81-92.

Published online: 1 December 2018

DOI: https://doi.org/10.4055/jkoa.2018.53.2.81

Arthroscopic Treatment for an Osteochondral Lesion of the Talus

Bi O Jeong, M.D., Ph.D., Hyuk Jung, M.D.

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea

Correspondence to: Hyuk Jung, M.D. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea TEL: +82-2-958-8346 FAX: +82-2-964-3865 E-mail: hyuk1845@hanmail.net

Received 2 January 2018 Accepted 7 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 followup 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.

Keywords: talus, osteochondral lesion of the talus, microfracture, autologous osteochondral transplantation

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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.

Table 1

Various Classification of the OLT

Radiography	CT	MRI	Arthroscopy
I. Subchondral compression	I. Cystic lesion in talar dome with intact roof	1. Articular cartilage damage only	A. Smooth and intact but soft
II. Partial detachment of osteochondral fragment	IIA. Cystic lesion with communication to talar dome surface	2a. Cartilage injury with underlying fracture and edema	B. Rough surface
	IIB. Open articular surface lesion with overlying nondisplaced fragment	2b. Stage 2a without bony edema	C. Fibrillation/fissures
III. Completely detached fragment without displacement	III. Nondisplaced lesion with radiolucency	3. Detached but undisplaced fragment	D. Flap present or bone exposed
IV. Detached and displaced fragment	IV. Displaced fragment	4. Detached and displaced fragment	E. Loose, nondisplaced fragment
IV. Detached and displaced fragment	V. OLT with subchondral cyst	5. Subchondral cyst formation	F. Displaced fragment

OLT, osteochondral lesion of the talus; CT, computed tomography; MRI, magnetic resonance imaging.

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