• 대한족부족관절학회지
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• 제19권2호
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• pp.47-50
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• 2015

Microfracture procedure has been widely recognized as the primary surgical treatment for an osteochondral lesion of the talus. However, if symptoms persist after initial surgery, selection of a secondary procedure can be difficult. The author desciribes the advantage and value of autologous osteochondral transplantation as a secondary procedure after failed microfracture for osteochondral lesion with a review of sevral previous published articles.

• 대한족부족관절학회지
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• 제19권1호
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• pp.7-10
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• 2015

Microfracture as a reparative strategy is the treatment of choice for an osteochondral lesion of talus. Although the results of microfracture are generally excellent, at least 30% of patients who received microfracture have acute or chronic ankle pain with several or unknown causes. The most important factor for unsatisfactory outcome after microfracture is the size of the lesion. For failed osteochondral lesion of talus, the second options are autologous osteochondral graft, autologous chondrocyte implantation, or re-microfracture. In this article, we present the autologous chondrocyte implantation as a second procedure for failed microfracture and compare its clinical outcome with other methods based on a literature review.

• 대한족부족관절학회지
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• 제19권2호
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• pp.43-46
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• 2015

Arthroscopic treatment has been reported to provide effective improvement of ankle function when used in treatment of small osteochondral lesion of talus; however, favorable long-term results have been less predictable for large osteochondral lesion of talus. In cases in which primary arthroscopic treatment fails, the decision regarding which subsequent technique to choose has become increasingly difficult, as good clinical outcomes may be unlikely for such patients irrespective of the surgical technique used. Redomicrofracture should be used judiciously for treatment of osteochondral lesion of talus in which arthroscopic treatment has failed.

• 대한족부족관절학회지
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• 제10권2호
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• pp.150-155
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• 2006

Purpose: The purpose of this study is to assess the results of the autologous osteochondral grafting harvested from medial side of talus for relatively large osteochondral lesion of the medial talar dome. Materials and Methods: From October 2004 to September 2005, 12 patients with osteochondral lesion measured more than 10 mm in axial MRI who were followed up more than 1 year after operation were analyzed. We evaluated postoperative symptoms by Mann and Reynolds scale, morbidity of donor site, and compared the range of both ankle motion. We also evaluated the union at the medial malleolar osteotomy site, trabecular connection between the grafted osteochondral mass and talus, irregularity of the articular surface in lesion. Results: Clinical results were rated as excellent in 4, good in 7, fair in 1. The mean angle of the total range of motion in affected ankle was decreased by 3 degrees compared to that in unaffected ankle. We did not observe abnormal findings at donor site. The osteotomized bone was united at mean 9 weeks (range, 8-12 weeks). We observed trabecular connection between grafted osteochondral mass and talus at mean 14 weeks (range, 12-16 weeks). We also observed irregular articular surface in osteochondral lesions in 6, smooth articular surface in 6. Conclusion: The local autologous osteochondral graft for relatively large osteochondral lesion of the medial talar dome is useful operative method with advantages of wide operative field, low morbidity of donor site, and high satisfaction rate.

• 대한족부족관절학회지
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• 제7권1호
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• pp.21-29
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• 2003

Purpose: The purpose of this study is to review clinical and radiologic changes after arthroscopic operation without bone graft for osteochondral lesion with subchondral cyst on the talus. And we compared the results with those without cyst. Radiologic changes were also observed. Materials and Methods: Arthroscopic microfrature or abrasion arthroplasty was performed on 10 caeses of osteochondral lesions with subchondral cyst and 20 cases without cysts. Preoperative and postoperative symptoms were evaluated by Ankle-Hind foot scale of AOFAS and the score of two groups were compared(t-Test : Paired Two Test for Means). Radiologic evaluation was performed after operation on patients with osteochondral lesion with cyst. Results: On patients of osteochondral lesion with subchondral cyst on talus, there was clinical improvement compared to the preoperative status and compared to patients without cysts(P=0.01) after arthroscopic operation. We could get increase of density and decrease of size of cystic lesion on plain film with time passage. Conclusion: We report 10 cases with osteochondral lesion with subchondral cyst on talus which resulted in clinical and radiological improvement after arthroscopic microfracture or abrasion arthroplasty without bone graft.

• 대한족부족관절학회지
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• 제16권1호
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• pp.9-18
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• 2012

Osteochondral lesions of the talus are isolated cartilage and/or bone lesions that are known cause of chronic ankle pain. They can occur as the result of a single acute ankle injury or from repetitive loading of the talus. Technical development in radiologic imaging and ankle arthroscopy have improved diagnostic capabilities for detecting osteochondral lesions. Characteristics which are important in assessing an osteochondral lesions include: the size, the type (chondral, subchondral, cystic), the stability, the displacement, the location, and the containment of lesion. Nonoperative treatment involving period of casting and non-weight-bearing is recommended for acute, non-displaced osteochondral lesions in select pediatric and adolescent patients. Operative treatment is recommended for unstable lesions or failed conservative management. Marrow stimulation techniques (abrasion chondroplasty, multiple drilling, microfracture), osteochondral autograft or allograft, autologous chondrocyte implantation, are frequently employed. The purpose of this article is to review the historical background, etiology, classification systems, diagnostic strategies, and to describe a systematic approach to management of osteochondral lesions of the talus.

• 대한족부족관절학회지
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• 제11권2호
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• pp.209-215
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• 2007

Purpose: To evaluate clinical results of autologous osteochondral graft in osteochondral lesions of the talus. Materials and Methods: Twenty feet in twenty patients underwent osteochondral autologous transfer in the osteochondral lesions of the talus. Sixteen were men and four were women. The mean age was 40.8 years old. The mean follow up was 2 years 9 months. Eighteen cases were medial, one case was lateral and one case was both, respectively. The average duration of symptom was 4 years 3 months. AOFAS ankle/hindfoot score (AOFAS score), visual analogue scale (VAS), Lysholm knee score were evaluated preoperatively and at the final follow up. Results: Postoperative AOFAS score was 87.3 (range, 69-100), which was significantly improved from preoperative AOFAS score of 62.0 (p=0.000). Postoperative VAS was 2.9 (range, 0-7), which was significantly improved from preoperative VAS of 7.5 (p=0.000). Postoperative Lysholm knee score was 92.4 (range, 80-100). All osteotomy of medial malleolus was united by the 4th month after surgery. Postoperative VAS was conversely correlated with the follow up period (p=0.024). There was no complications associated with surgery. Conclusion: Autologous osteochondral grafts in osteochondral lesion of the talus demonstrated excellent results with a short-term follow up.

• 대한족부족관절학회지
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• 제10권1호
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• pp.48-55
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• 2006

Purpose: The purpose of this study is to assess the results of the autologous osteochondral grafting for the osteochondral lesion of the talus. Materials and Methods: This study included 21 patient who had been treated with the open autologous osteochondral grafting between December, 1999 and December 2003. We treated the patients with autologous osteochondral grafting method who had the lesion of stage II or medial lesion of stage III without improvement for at least 6 months, the medial lesion of stage IV, the lateral lesion of stage III, IV by Berndt and Harty's classification or who had not improved with previous operation. The average duration of follow up was 26 (12-56) months. 6 patients had been treated with the previous operation that 3 patients with drilling, 3 patients excision, curettage and drilling. Results: The average AOFAS Ankle/Hindfoot score was 92.7 points and no patient had a limitation of the daily activities due to pain or abnormal function. Postoperative radiography showed good joint congruency and postoperative MRI good incorporation of the graft. The average Lysholm knee score was 96 points and only two patients had mild knee pain during severe exertion. Conclusion: The autologous osteochondral grafting is the useful operative method when the lesion is advanced stage or when previous operative treatment has failed.

• 대한족부족관절학회지
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• 제24권2호
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• pp.48-54
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• 2020

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician's preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.

• 대한족부족관절학회지
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• 제6권1호
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• pp.28-34
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• 2002

Purpose: The purpose of this study was to evaluate outcome of ankle arthroscopy with high anteromedial and anterolateral portals for osteochondral talar lesion. Materials and Methods: A prospective study was conducted between March 1992 and January 2000 by one surgeon. Total 48 patients who had osteochondral talar lesion were included. Using high anteromedial and anterolateral portals, arthroscopic treatment was performed. A functional evaluation was performed with the Karlsson scoring scale. Results: Of the 48 patients, 28 cases had anterolateral talar lesion and 18 cases had medial talar lesion and 2 cases had central lesion. The 42 cases(87.5 %) had trauma history. On Karlsson scoring scale, anterolateral talar lesion was better than medial talar lesion(p=0.035). Conclusion: Using high portals, we could get better visualization of talar dome and posterior chamber of ankle, and do some limited procedures without additional portals. Osteochondral lesions were treated successfully only when they were traumatically induced and localized without diffuse chondromalacia of talus and tibia.