Osteochondral injuries. Clinical findings.

Birk GT, DeLee JC. Clin Sports Med 2001 Apr;20(2):279-86

Osteochondral injuries are common, mainly affecting a young, active population. Failure to recognize these injuries can lead to long-term disability. A heightened awareness and understanding of the common mechanisms of injury will lead to early diagnosis and rapid recovery. This, along with improved treatment modalities, will keep any long-term disability to a minimum.

Treatment strategies in osteochondral defects of the talar dome: a systematic review.

Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN. Foot Ankle Int 2000 Feb;21(2):119-26.

The aim of this study was to investigate the results of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from 1966 to July 1998 were systematically screened. Based on our inclusion criteria 32 studies describing the results of treatment strategies for OCD of the talus were included. No randomized clinical trials (RCT’s) were identified. Fourteen studies described the results of excision alone, 11 the results of (EC), 14 the results of (ECD), 1 the results of cancellous bone grafting after EC, 1 the results of osteochondral transplantation and 3 the results of fixation. The average success rate of non-operative treatment (NT) was 45%. Comparison of different surgical procedures shows that the average highest success rate was reached by excision, curettage and drilling (ECD) (85%) followed by excision and curettage (EC) (78%) and excision alone (38%). Based on this systematic review we conclude that NT and excision alone are not to be recommended in treating talar OCD. Both EC and ECD have been shown to lead to a high percentage good/excellent results. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further prospective randomized controlled trials are required to compare the outcome of these two surgical strategies for OCD of the talus.

Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment.

Lahm A, Erggelet C, Steinwachs M, Reichelt A. Arthroscopy 2000 Apr;16(3):299-304.

Since the advent of operative ankle arthroscopy and magnetic resonance imaging (MRI) specific treatment of osteochondritis dissecans of the talus has progressed rapidly. Drilling is still the treatment of choice in early stages of osteochondritis dissecans of the talus. Rear-entry guides and preoperative planning with MRI have led to better results with this kind of treatment. Within 5 years, 42 patients (26 male and 16 female) underwent arthroscopic treatment of osteochondritis dissecans of the talus, 22 underwent percutaneous drilling, 13 cancellous bone grafting, 4 refixation, and 3 curettage. The average age of the patients was 28 years (range, 11 to 53 years). A clinical score system was used in a clinical and MRI follow-up of 19 of the patients with K-wire drilling. Up to 100 points are given in the categories pain, stability/insecurity, efficiency/pain-free walking distance, gait, differences in circumference, range of motion, and power. There was a history of trauma in 31 of the 42 patients. The majority of lesions (24 cases) were localized at the lateral talus, and these patients all had trauma. In 11 of the 18 lesions at the medial talus, there was no evidence of trauma. The 19 patients in the follow-up achieved an average of 87 points. K-wire drilling represents the chief component of early stages with intact or partially fractured cartilage surface, whereas arthroscopically controlled cancellous bone grafts after curettage are used in grade II stages only. Results of K-wire drilling are not worse than those of cancellous bone grafts; this is attributable to a generous perforation of the sclerosis. This has contributed to an improved preoperative diagnosis with MRI.

The staging of osteochondritis dissecans in the knee and ankle joints with MR tomography. A comparison with conventional radiology and arthroscopy.

Bachmann G, Jurgensen I, Siaplaouras J. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1995 Jul;163(1):38-44

PURPOSE: A prospective study was performed on 50 patients suffering from osteochondritis dissecans of the knee and ankle to define criteria for stability and fixation of osteochondral lesions. METHODS: Morphological parameters in MRI (size, fragmentation, cartilage, interface) and conventional radiology (separation, fragmentation) were registered and compared with arthroscopic staging. MRI staging based on different types of interfaces was demonstrated on T1- and T2-weighted images. RESULTS: MRI could correctly predict a Grade 1 lesion in 50%, a Grade 2 lesion in 90%, a Grade 3 lesion in 0%, and a Grade 4 lesion in 79%. Stable lesions were differentiated from unstable lesions in 90%. Radiographic findings corresponded with arthroscopic staging in only 56% of the cases because fibrotic connection may guarantee stability in cases of bony separation. CONCLUSION: MRI should be performed before therapy to select those patients who do not need surgical therapy or arthroscopy.