• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.190-194
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• 2002

Purpose: We present our experience about the clinical aspect and treatment modalities of ostechondritis dissecans of the talus. Material and Method: This study included 35 patients, 38 cases diagnosed as ostechondritis dissecans of the talus that were proved by clinical and radiologic finding. The methods of treatment were conservative (2 cases), multiple drilling (1 case), excision (1 case), excision, curettage & multiple drilling (23 cases), curettage & bone peg fixation (2 cases), curettage & bone graft (2 cases), and autogenous osteochondral transfer(Mosaicplasty) (7 cases). Results: Of the 38 cases, 30 cases were associated with a history of trauma (17 cases of medial lesion, 13 cases of lateral lesion), and 9 cases of which had major trauma history and 21 cases, minor repetitive trauma history. According to O'Farrel grading system, 21 cases (55%) had good results, 11 cases (29%) had fair results, and 6 cases (16%) had poor results. Of the medial lesion 16 cases had good results, 6 cases, fair results, and 2 cases, poor results. Of the lateral lesion 5 cases had good results, 5 cases, fair results, and 4 cases, poor results. Conclusion: There were fair or good results in 84% of patients with surgical treatment. Curettage and multiple drilling reveals a good result in medial lesion in grade I, II, III and lateral lesion in grade I, II. Autogenous osteochondral transfer(Mosaicplasty) is considered for the cases in grade III, IV(medial and lateral), lesion exceeds 1Cm of size and poor result with another treatment modality.

• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.195-200
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• 2002

Purpose: To investigate the MRI and arthroscopic findings of osteochondral lesion of the talus which looked normal on plane radiography. Materials and methods: We investigated the MRI and arthroscopic findings of seven osteochondral lesions in which there were no abnormal finding on plane radiography and no cystic changes on MRI. Average age was 31 years(range, 19-43 years). Arthroscopic findings were classified according to the Ferkel's criteria. Results: History of injury was reported in all cases and the average duration from injury to presentation was 4 years and 4 months. Low signal change in T1WI was found in 6 of 7 lesions, no signal change in 1 case. Low signal change in T2WI was found in 4, no signal change in 3. 6 STIR images were obtained. High signal change was found in 3, no signal change in 2 and intermediate signal change was in 1. Arthroscopic grading was A in 1, C in 1, D in 2 , E in 1 and F in 2. We could not find any correlation between the findings on MRI and arthroscopic examination. Conclusion: We suggest arthroscopic examination is needed for accurate diagnosis of the osteochondral lesions of the talus which looked normal on plane radiography, because they have various MRl findings and high likelihood of existence of unstable cartilage lesions.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.28-34
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• 2001

Study design: Clinical results were retrospectively analyzed in 11 patients with fractures of talar neck who were treated in our department from Jan. 1994 to Dec. 1999. Objective: The purpose of this study is to evaluate the short-term results and to assess the prognostic factors of talar neck fractures. Material and Method: 11 cases with fractures of talar neck were reviewed retrospectively with minimum 1 year follow-up. There were 8 men & 3 women, and the average age was 25. The most common cause was traffic accident. According to the modified Hawkins classification, type I was in 4 cases, type II in 5, type III in 2, and type IV was none. All type I fractures were treated conservatively, and others were treated operatively. Results: According to Hawkins criteria, there was excellent result in 7 cases(64%), good in 2(18%), and fair in 2(18%). Post-traumatic arthritis occurred in 2 cases, but there was no avascular necrosis. Conclusion: Careful selection of method of treatment and urgent management are important prognostic factors in talar neck fractures. The longer follow-up in more cases is necessary to evaluate the long-term clinical results and complications more accurately.

• Journal of Korean Foot and Ankle Society
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• v.25 no.4
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• pp.185-189
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• 2021

An aneurysmal bone cyst (ABC) can occur in many parts of the human body, but a primary ABC of the talus is extremely rare. ABCs are benign, but aggressively growing tumors that usually occur in the first two decades of life. Patients mainly complain of pain, limited movement of the involved joint or a palpable mass. Pain may worsen suddenly because of pathological fractures. If not treated properly, ABC has a risk of local recurrence, followed by the destruction of the joint and a significant functional deficit. While the complete removal of the bone tumor is essential, it is also important to treat the resultant bone defect after removal. The talus has an important part to play in weight-bearing. Therefore, an appropriate bone graft is required for large bone defects that occur after an ABC removal from the talus. We report a primary ABC of the talus in a 28-year-old male that was treated by curettage and a bone pillar pattern graft of autologous tricortical iliac crest bone. The patient had an excellent functional outcome with early weight-bearing, and there was no recurrence at 16 months of follow-up.

• Journal of Korean Foot and Ankle Society
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• v.27 no.4
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• pp.137-143
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• 2023

Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evaluations comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.

• Journal of Korean Foot and Ankle Society
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• v.27 no.4
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• pp.148-153
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• 2023

Traditionally, arthroscopic microfracture and autologous osteochondral autograft transplantation have been the primary surgical treatments for osteochondral lesions of the talus. On the other hand, recent advancements have introduced alternative approaches, such as autologous chondrocyte transplantation, matrix-derived autologous chondrocyte transplantation, intra-articular injection of concentrated bone marrow aspirate concentrate, and the use of fibrin glue to address chondral defects. Furthermore, some studies have explored a combination of bone marrow aspirate and matrix-derived chondrogenesis. In light of these developments, this report presents a case study of a young male patient in his early twenties with a relatively large osteochondral lesion exceeding 1.5 cm² on the medial talar dome. Instead of removing the osteochondral lesion, a surgical approach was employed to retain the lesion while addressing the unstable cartilage in the affected area. This approach involved a combination of bone marrow aspirate concentrate and matrix-derived chondrogenesis. The treatment yielded favorable clinical outcomes and ultimately successfully induced the bony union of osteochondral lesions. This paper reports the author's experience with this innovative approach with a review of the relevant literature.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.2
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• pp.82-86
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• 2012

Purpose: The purpose of this study was retrospectively to evaluate the results of the modified Kidner procedure for symptomatic accessory navicular in athletes. Materials and Methods: Between July 1999 and December 2004, 26 feet in 22 patients with symptomatic accessory navicular who had underwent modified Kidner procedure were available for clinical follow-up, and 12 cases in 9 patients were available for clinical and radiological follow-up with a minimum follow-up of 5 years were included in this study. All those patients had symptomatic accessory navicular bone who underwent modified Kidner procedure. American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, Visual Analogue Scale (VAS), and satisfaction rate were investigated. Talo-first metatarsal (T-MT1) angle, talo-calcaneal (TC) angle, and calcaneal pitch (CP) angle were measured in standing lateral radiograms. Results: AOFAS score was improved from $40.8{\pm}7.5$ (32~57) preoperatively to $88.7{\pm}8.0$ (72~100) postoperatively, and the difference was significant (p<0.01). VAS was improved from $7.0{\pm}0.9$ (5~9) preoperatively to $1.8{\pm}0.8$ (1~4) postoperatively, and the difference was significant (p<0.01). At the lastest follow up, 11 feet were very satisfied, 11 feet satisfied, and 4 feet unsatisfied (a satisfaction rate 85.0%). No significant difference was observed for T-MT1 angle (p=0.67), TC angle (p=0.93), and CP angle (p=0.49). Conclusion: Modified Kidner procedure for the symptomatic accessory navicular showed satisfactory results and is appeared to be one of the useful treatments.

• The Journal of the Korean bone and joint tumor society
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• v.19 no.1
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• pp.1-8
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• 2013

Purpose: Primary bone tumors of hindfoot are uncommon compared with other locations, and there have been few large-group studies. This study was designed to analyze the characteristics and the clinical results of the primary bone tumors of hindfoot. Materials and Methods: Forty five cases in 44 patients who have been diagnosed from 1989 to 2011 were reviewed. The minimum follow-up period was 1 year. We retrospectively reviewed the medical records and images. Results: Twenty six cases were male and 18 cases were female. Mean follow-up period was 33.1 months and mean age was 25.1 years. Forty four cases were benign and 1 case was malignant. Thirty six cases occurred in calcaneus and 9 cases were in talus. The most common benign bone tumor was simple bone cyst (20 cases), followed by intraosseous lipoma (12 cases), and chondroblastoma (4 cases). In calcaneus, there were 18 cases of simple bone cyst, and 12 cases of intrasosseous lipoma. In talus, there were 3 cases of chondroblastoma, 2 cases of simple bone cyst, and 2 cases of intraossesous ganglion. Many patients with hindfoot bone tumors presented with pain, but some were found accidentally. Patients received surgical procedures, such as curettage and bone graft, open reduction and internal fixation, tumor resection, and below knee amputation. Conclusion: Primary bone tumors of hindfoot are rare and can be misdiagnosed as ankle sprain or contusion. Although most are benign, malignant tumors cannot be ruled out, so early diagnosis and appropriate treatment is important.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.71-74
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• 2002

Purpose : To evaluate the clinical and radiological characteristics of osteochondral ridges of talus and ankle. Materials and Methods : We have analyzed their clinical symptoms and signs, radiologic and CT findings and post-operative results in 17 ankle joints of 14 patients (bilateral in 3), followed them for average 13 months after surgical excision. Results : No definite trauma, but mostly in male after middle age. Their chief complaints are pain on ankle, especially in dorsiflexion or squatting position, and symptom durations are very long, more than average 15 months. Definite diagnosis was made by lateral radiograms of ankle joint. Osteochondral ridges are common in talar neck (10 cases), tibia (4 cases) and both side (3 cases). After excision of osteophytes, all patients gained normal ankle without pain and any limited motion. Conclusions : Anterior impingement syndromes are common in middle aged male, but no definite correlation with sports. Plantar and dorsiflexed lateral radiographs are helpful in definite diagnosis for impingement, and surgical excision is best for treatment.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.547-556
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• 2019

Purpose: This study evaluated the results of surgical treatment for residual or recurrent deformity after the conservative treatment of idiopathic clubfoot. Materials and Methods: Fifty-one cases (32 patients), who were followed up to skeletal maturity, were reviewed retrospectively. The mean age at the last follow-up was 18.7 years. The surgical options included selective or comprehensive soft tissue release, tendon lengthening and transfer, and various types of osteotomy. The radiology measurements included the talocalcaneal angle and talo-first metatarsal angle in the anteroposterior (AP) view, and the talocalcaneal angle and calcaneal pitch in the lateral view. The radiology measurements were compared with the normal values for adults. The clinical evaluations were made using the ankle-hindfoot score and the midfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS): excellent (>85), good (71-85), pair (56-70), and poor (<56). Results: At the last follow-up, the percentages of the 51 cases, whose parameter values fell within the normal ranges were as follows: in the AP view, 41.2% (talocalcaneal angle); and 90.2% (talo-first metatarsal angle). In the lateral view, the percentage was 84.3% (talocalcaneal angle). For the calcaneal pitch, the percentages were 61%. The mean AOFAS score was 88.1±10.7 on the ankle-hindfoot score and 86.7±11.5 on the midfoot score. Conclusion: The long-term outcome of patients with idiopathic clubfoot, who underwent surgical treatment after conservative treatment, was found to be 43%-90% of the normal range of radiographic indices. Clinically, the mean AOFAS scores were "excellent". Therefore, a satisfactory result can be obtained by analyzing the elements of deformity more accurately and then using the selective operation method, even if the non-surgical correction method fails.