• Journal of Korean Foot and Ankle Society
• /
• v.16 no.1
• /
• pp.9-18
• /
• 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.

• Journal of Korean Foot and Ankle Society
• /
• v.27 no.4
• /
• pp.137-143
• /
• 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
• /
• v.24 no.2
• /
• pp.55-60
• /
• 2020

Among the various surgical treatment methods for osteochondral lesions of the talus, autologous osteochondral transplantation (AOT) is a useful procedure in cases of a large defect, subchondral cyst, and failed primary bone marrow stimulation procedure. Although bone marrow stimulation alone may not regenerate the damaged plate sufficiently, AOT has the advantage of being able to replace the subchondral bone plate and cartilage with a new one at a same time. Nevertheless, postoperative cyst formation or pain may persist and donor site morbidity is still a limitation of AOT.

• Journal of Korean Foot and Ankle Society
• /
• v.24 no.2
• /
• pp.37-41
• /
• 2020

Many articles on operative treatment strategies for osteochondral lesions of the talus (OLT) have been published. On the other hand, there are only a few reports on the conservative treatment of OLT. Understanding the natural history of OLT is essential to establishing the correct treatment. Conservative treatment might lead to comparable clinical outcomes compared to the current options of the operative treatment in isolated OLT lesions. OLT lesions can be divided into two (or possibly three) types. Hence, the prognosis and outcome of certain operative treatments should be evaluated further. The prognosis of OLT combined with instability or malalignment appears poorer than that of isolated OLT lesions. Therefore, concomitant pathologies should be evaluated together when treating patients with OLT.

• Journal of Korean Foot and Ankle Society
• /
• v.24 no.2
• /
• pp.61-68
• /
• 2020

Bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) is an interesting treatment option for osteochondral lesions of the talus with promising short- to mid-term results. The various terminologies used to describe this surgical method need to be addressed. These include bone marrow-derived cell transplantation, matrix-induced bone marrow aspirate concentrate, and matrix-associated stem cell transplantation. BMIC is a one-stage, minimally invasive surgery performed arthroscopically or using a mini-open arthrotomy approach without a malleolar osteotomy in most cases. The lesion is replaced with hyaline-like cartilage, and treatmentrelated complications are rare. BMIC is a safe and effective treatment option and should be considered in large lesions or lesions with a prior treatment history.

• Journal of Acupuncture Research
• /
• v.33 no.2
• /
• pp.181-187
• /
• 2016

Objectives : The purpose of this report is to introduce a case of osteochondral lesions of the left talus caused by ankle sprain and suggest complex traditional Korean medical care with warm needling therapy as a possible method of conservative treatment. Methods : A 20-year-old male with osteochondral lesions of the left talus complaining of ankle pain and restricted range of movement was treated mainly with warm needling therapy and other combined Korean medicine therapy from January 5, 2015 to January 12, 2015. Improvements of symptoms were measured by American Orthopaedic Foot & Ankle Society Score (AOFAS Score), Visual Analog Scale (VAS) and Range of movement (ROM). Results : During 8 days of treatment, the patient showed gradual improvement in AOFAS score, VAS at rest and at weight bearing position, as well as ROM of the ankle. Conclusion : According to the result, warm needling therapy is a possible conservative treatment for osteochondral lesions of the talus. Further studies are needed regarding possible longterm effects.

• Journal of Korean Foot and Ankle Society
• /
• v.10 no.2
• /
• pp.117-124
• /
• 2006

Purpose: This study was aimed at elucidating the pathogenesis of talar osteochondral lesion by analyzing the histopathological findings. Materials and Methods: Twenty specimens from 20 patients who underwent surgical treatment for talus osteochondral lesions were studied. Preoperative MRI images including T1, T2, and stir images were taken and cases were classified according to modification of the Anderson's classification. There were 5 cases of MRI group 1, 6 cases of group 2, 7 cases of group 3 and 2 cases of group 4. A full thickness osteochondral plug including the osteochondral lesion of the talus was harvested from each patient and reviewed histopathologic changes of osteochondral fragment using H-E staining. Mean diameter of specimens was 8.5 mm and mean depth was 10.3 mm. Pathologic changes of articular cartilage and subchondral bone were observed. Subchondral bone was divided into superficial, middle and deep zones according to depth. Cartilage formation, trabecular thickening and marrow fibrosis were observed in each zone. Results: There were detachment of the joint cartilage at the tidemark in 16 cases of 20 cases and the separated cartilages were almost necrotic on the histopathologic findings. Cartilage formation within subchondral bone was discovered beneath the tidemark in 12 cases. Trabeculae were increased and thickened in 17 cases. These pathologic changes were similar to fracture healing process and these findings were more conspicuous near the tidemark and showed transition to normal bone marrow tissue with depth. No correlation between the pathological progression and MRI stages was found. A large cyst shown on MRI's was microscopically turned out to be multiple micro-cysts accompanied by fibrovascular structure and newly formed cartilage tissue. Conclusion: The histopathologic findings of osteochondral lesions are detachment of overlying cartilage at the tidemark and subsequent changes of subchondral bone. Subchondral bone changes are summarized as cartilage formation, marrow fibrosis and trabecular thickening that mean healing process following repeated micro fractures of trabecular. These osteochondral lesions should have differed from osteochondral fractures.

• Journal of Korean Foot and Ankle Society
• /
• v.11 no.2
• /
• pp.209-215
• /
• 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.

• Journal of Korean Foot and Ankle Society
• /
• v.24 no.2
• /
• pp.48-54
• /
• 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.

• Journal of Veterinary Clinics
• /
• v.19 no.1
• /
• pp.103-106
• /
• 2002

Specific diagnosis of orthopedic disease can be diffcult in canine practice. Failure to detect the clinical signs of a disorder during physical examination of dogs with acute or chronic lameness is the most common reason for failure to make specific diagnosis. A 6-month-old, female doberman with history of swelling and non-weight-bearing lameness in the left forelimb was referred to Beterinary Teaching Hospital of Chungbuk National University. Physical examination, plain radiography, and conventional three-phase radionuclide bone scan were performed in the patient. Based on the physical exam and radiography, this case was diagnosed as elbow strain and subluxation. Conventional three-phase bone scan detected soft tissue inflammation and osteochondral lesions of elbow joint, and revealed good agreement with clinical findings. Therefore, conventional three-phase bone scan was able to provide the precise information about inflammation of soft tissue and osteochondral lesions of joint.