Osteochondral Lesion of the Talus in Children and Adolescents

Mi Hyun Song

doi:10.4055/jkoa.2018.53.3.210

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Song: Osteochondral Lesion of the Talus in Children and Adolescents

Original Article

J Korean Orthop Assoc 2018;53(3):210-217.

Published online: 1 December 2018

DOI: https://doi.org/10.4055/jkoa.2018.53.3.210

Osteochondral Lesion of the Talus in Children and Adolescents

Mi Hyun Song, M.D.

Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea

Correspondence to: Mi Hyun Song, M.D. Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea TEL: +82-2-2626-3239 FAX: +82-2-2626-2486 E-mail: wwiiw@naver.com ORCID: https://orcid.org/0000-0003-4082-1455

Received 3 November 2017 Revised 11 January 2018 Accepted 22 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

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.

Keywords: osteochondral lesion, talus, ankle, children, adolescents

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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.

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.

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.

Table 1

Dipaola Staging System

Stage	Arthroscopic	Magnetic resonance imaging
I	Irregularity and softening of articular cartilage, no definable fragment	Thickening of articular cartilage and low signal changes
II	Articular cartilage breached, definable fragment, not displaceable	Articular cartilage breached, low signal rim behind fragment indicating fibrous attachment
III	Articular cartilage breached, definable fragment, displaceable, but attached by some overlying articular cartilage	Articular cartilage breached, high signal changes behind fragment indicating synovial fluid between fragment and underlying subchondral bone
IV	Loose body	Loose body

Cited from the article of Dipaola et al. (Arthroscopy. 1991;7:101-4).²⁶⁾

Table 2

Giannini's Classification

	Stage	Extension	Treatment
Acute injuries	I	<1 cm² in diameter of lesions	Debridement
	II	>1 cm² in diameter of lesions	Fixation
Chronic injuries	0	Injuries with preserve the joint surfaces	Retrograde drilling
	I	<1.5 cm² in diameter of lesions	Microfracture
	II	Lesions with >1.5 cm² in diameter and <5 mm in depth	Cartilage replacement
	IIA	Lesions with >1.5 cm² in diameter and >5 mm in depth	Cartilage replacement+bone graft
	III	Anatomy disruption	Massive graft

Cited from the article of Vannini et al. (Orthop Clin North Am. 2012;43:237-44).²⁷⁾

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