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Osteochondral Injuries of Talus

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Sports Injuries
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Abstract

Osteochondral lesions (OCL) of the talus are being recognized as an increasingly frequent sports injury. They can be found as a concomitant injury in up to 50 % of all ankle sprains (Saxena and Eakin 2007). Damage to articular cartilage at the ankle can lead to osteoarthritis in midterm or long term, which can significantly affect quality of life and restrict sports and recreation activities.

The management of OCL of the talus remains a challenge to the treating physician. The etiology and pathophysiology of OCL of the talus are not clearly known yet. Even though trauma seems to be the most common cause, it is likely that a variety of etiological factors may play a substantial role in the development of OCL. MRI is the gold standard imaging tool for radiographic diagnostic of OCL of the talus. However, conventional weight-bearing radiographs should routinely be done for standard diagnostics, exclusion of fractures, and evaluation of biomechanical alignment. Symptomatic and/or deep OCL on the talus should be treated surgically, because these lesions rarely improve clinically with conservative treatment. There are several different surgical treatment strategies, which are described in this chapter. Advantages and disadvantages are discussed and indications for the surgical treatment are described.

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References

  • Baier C et al (2013) Bisphosphonates or prostacyclin in the treatment of bone-marrow oedema syndrome of the knee and foot. Rheumatol Int 33(6):1397–1402

    Google Scholar 

  • Baltzer AW, Arnold JP (2005) Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy 21:159–166

    Article  PubMed  Google Scholar 

  • Bartl C, Imhoff A, Bartl R (2012) Treatment of bone marrow edema syndrome with intravenous ibandronate. Arch Orthop Trauma Surg 132:1781–1788

    Article  PubMed  Google Scholar 

  • Becher C, Driessen A, Thermann H (2008) Microfracture technique for the treatment of articular cartilage lesions of the talus. Orthopade 37(196):198–203

    Google Scholar 

  • Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41-A:988–1020

    CAS  PubMed  Google Scholar 

  • Bodo G et al (2000) Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse. Acta Vet Hung 48:343–354

    Article  CAS  PubMed  Google Scholar 

  • Brittberg M (2010) Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologous chondrocyte implantation procedure. Am J Sports Med 38:1259–1271

    Article  PubMed  Google Scholar 

  • Chen AC, Lee MS, Lin SS, Pan LC, Ueng SW (2010) Augmentation of osteochondral repair with hyperbaric oxygenation: a rabbit study. J Orthop Surg Res 5:91

    Article  PubMed Central  PubMed  Google Scholar 

  • Chew KT, Tay E, Wong YS (2008) Osteochondral lesions of the talus. Ann Acad Med Singap 37:63–68

    PubMed  Google Scholar 

  • Cox LG et al (2011) The role of pressurized fluid in subchondral bone cyst growth. Bone 49:762–768

    Article  CAS  PubMed  Google Scholar 

  • Fink C et al (2001) Computer-assisted retrograde drilling of osteochondral lesions of the talus. Orthopade 30:59–65

    Article  CAS  PubMed  Google Scholar 

  • Flick AB, Gould N (1985) Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle 5:165–185

    Article  CAS  PubMed  Google Scholar 

  • Geerling J et al (2009) Initial outcomes of 3-dimensional imaging-based computer-assisted retrograde drilling of talar osteochondral lesions. Am J Sports Med 37:1351–1357

    Article  PubMed  Google Scholar 

  • Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25:168–175

    PubMed  Google Scholar 

  • Giannini S et al (2005) Surgical treatment of osteochondral lesions of the talus in young active patients. J Bone Joint Surg Am 87(Suppl 2):28–41

    Article  PubMed  Google Scholar 

  • Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B (2008) Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Am J Sports Med 36:873–880

    Article  PubMed  Google Scholar 

  • Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22:1085–1092

    Article  PubMed  Google Scholar 

  • Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 85-A(Suppl 2):25–32

    PubMed  Google Scholar 

  • Hangody L, Feczko P, Bartha L, Bodo G, Kish G (2001) Mosaicplasty for the treatment of articular defects of the knee and ankle. Clin Orthop Relat Res 2001(391 Suppl):S328–S336

    Google Scholar 

  • Imhoff AB, König U (2003) Arthroscopic based staging of osteochondral lesions (OCL) of the knee. Diagnostic and classification. Arthroskopie 2003(16):23–28

    Google Scholar 

  • Imhoff AB et al (2011) Osteochondral transplantation of the talus: long-term clinical and magnetic resonance imaging evaluation. Am J Sports Med 39:1487–1493

    Article  PubMed  Google Scholar 

  • Konig F (1888) Uber freie Korper in den Gelenken. Dtsh Z Chi 1888(27):90–109

    Google Scholar 

  • Kono M, Takao M, Naito K, Uchio Y, Ochi M (2006) Retrograde drilling for osteochondral lesions of the talar dome. Am J Sports Med 34:1450–1456

    Article  PubMed  Google Scholar 

  • Kreuz PC et al (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med 34:55–63

    Article  PubMed  Google Scholar 

  • Lahm A, Erggelet C, Steinwachs M, Reichelt A (2000) Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. Arthroscopy 16:299–304

    Article  CAS  PubMed  Google Scholar 

  • Lee CK, Mercurio C (1981) Operative treatment of osteochondritis dissecans in situ by retrograde drilling and cancellous bone graft: a preliminary report. Clin Orthop Relat Res 1981(158):129–126

    Google Scholar 

  • Leumann A et al (2011) A novel imaging method for osteochondral lesions of the talus–comparison of SPECT-CT with MRI. Am J Sports Med 39:1095–1101

    Article  PubMed  Google Scholar 

  • Link TM et al (2006) Normal and pathological MR findings in osteochondral autografts with longitudinal follow-up. Eur Radiol 16:88–96

    Article  PubMed  Google Scholar 

  • Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T (1993) Osteochondral lesions of the talus. Am J Sports Med 21:13–19

    Article  CAS  PubMed  Google Scholar 

  • Nishitani K et al (2009) Positive effect of alendronate on subchondral bone healing and subsequent cartilage repair in a rabbit osteochondral defect model. Am J Sports Med 37(Suppl 1):139S–147S

    Article  PubMed  Google Scholar 

  • O’Driscoll SW (1998) The healing and regeneration of articular cartilage. J Bone Joint Surg Am 80:1795–1812

    PubMed  Google Scholar 

  • O’Loughlin PF, Heyworth BE, Kennedy JG (2010) Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 38:392–404

    Article  PubMed  Google Scholar 

  • Pagenstert GI et al (2009) SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg (Br) 91:1191–1196

    Article  CAS  Google Scholar 

  • Paul J et al (2009) Donor-site morbidity after osteochondral autologous transplantation for lesions of the talus. J Bone Joint Surg Am 91:1683–1688

    Article  CAS  PubMed  Google Scholar 

  • Paul J, Brucker PU, Vogt S, Imhoff AB (2010) OATS and mega OATS. Why, when and how. In: Brittberg M, Imhoff AB, Madry H, Mandelbaum B (eds) Cartilage repair – current concepts. ESSKA, DJO Publications, Surrey, pp 107–117

    Google Scholar 

  • Paul J et al (2012) Sports activity after osteochondral transplantation of the talus. Am J Sports Med 40:870–874

    Article  PubMed  Google Scholar 

  • Petje G et al (2004) Pharmacological management of aseptic osteonecrosis in children. Expert Opin Pharmacother 5:1455–1462

    Article  CAS  PubMed  Google Scholar 

  • Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E (2007) The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med 35:80–85

    Article  PubMed  Google Scholar 

  • Saxena A, Eakin C (2007) Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med 35:1680–1687

    Article  PubMed  Google Scholar 

  • Trattnig S, Millington SA, Szomolanyi P, Marlovits S (2007) MR imaging of osteochondral grafts and autologous chondrocyte implantation. Eur Radiol 17:103–118

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Valderrabano V et al (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl 1):105S–111S

    Article  PubMed  Google Scholar 

  • Valderrabano V, Miska M, Leumann A, Wiewiorski M (2013) Reconstruction of osteochondral lesions of the talus with autologous spongiosa grafts and autologous matrix-induced chondrogenesis. Am J Sports Med 41(3):519–527

    Article  PubMed  Google Scholar 

  • van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18:570–580

    Article  PubMed Central  PubMed  Google Scholar 

  • Wiewiorski M et al (2011) Autologous matrix-induced chondrogenesis aided reconstruction of a large focal osteochondral lesion of the talus. Arch Orthop Trauma Surg 131:293–296

    Article  PubMed  Google Scholar 

  • Wiewiorski M, Barg A, Valderrabano V (2013) Autologous matrix-induced chondrogenesis in osteochondral lesions of the talus. Foot Ankle Clin 18:151–158

    Article  PubMed  Google Scholar 

  • Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18:238–246

    Article  PubMed Central  PubMed  Google Scholar 

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Correspondence to A. B. Imhoff .

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Paul, J., Barg, A., Pagensteert, G., Valderrabano, V., Imhoff, A.B. (2014). Osteochondral Injuries of Talus. In: Doral, M., Karlsson, J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36801-1_143-1

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  • DOI: https://doi.org/10.1007/978-3-642-36801-1_143-1

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