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Osteosynthesis and Trauma Care 2005; 13(2): 118-124
DOI: 10.1055/s-2005-836329
Case Report

© Georg Thieme Verlag Stuttgart · New York

Ankle Sprain and Medial Osteochondral Lesion of the Talus: Report of a Case with Unclear Symptomatology and the Value of Open Curettage and Drilling in the Presence of a Cartilage Defect and Subchondral Osteosclerosis

X. Crevoisier1 , N. Theumann2 , A. Boubaker3 , F. Chevalley1
  • 1Service Universitaire d'Orthopédie et de Traumatologie de l'Appareil Moteur, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  • 2Service Universitaire de Radiodiagnostic et Radiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  • 3Service Universitaire de Médecine Nucléaire, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
Further Information

Publication History

Publication Date:
31 May 2005 (online)

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Abstract

A case of medial posttraumatic osteochondral lesion of the talus (OCLT) in a 25-year-old patient is reported. The potentially unclear symptomatology associated with this type of lesion is emphasized, and the imaging procedures as well as the classification systems based on these procedures are reviewed. The value of open surgery for curettage and drilling of a large zone of chondral defect with underlying osteosclerosis of the medial talar dome is evaluated. Compared to standard radiography and bone scan, magnetic resonance imaging (MRI) appears to correlate well with the intraoperative findings and is therefore useful as both a diagnostic and a prognostic tool. Our observations suggest that, even when a large zone of osteosclerosis underlies a medial chondral defect, drilling alone of this zone - after curettage of the detached cartilage - may be sufficient to lead to a good functional result. Bleeding out the healthy underlying cancellous bone through the drilling holes made in the sclerotic zone may be sufficient to restore part of the vitality and stability of the medial talar dome and is less invasive than osteochondral grafting.

Key words

talus - osteochondral lesion - ankle sprain

References

  • 1 Al-Shaikh R A, Chou L B, Mann J A, Dreeben S M, Prieskorn D. Autologous osteochondral grafting for talar cartilage defects.  Foot Ankle Int. 2002;  23 381-389
    CrossrefPubMedGoogle Scholar
  • 2 Anderson I F, Crichton K J, Grattan-Smith T, Cooper R A, Brazier D. Osteochondral fractures of the dome of the talus.  J Bone Joint Surg [Am]. 1989;  71 1143-1152
    PubMedGoogle Scholar
  • 3 Assenmacher J A, Kelikian A S, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study.  Foot Ankle Int. 2001;  22 544-551
    CrossrefPubMedGoogle Scholar
  • 4 Bauer M, Jonsson K, Linden B. Osteochondritis dissecans of the ankle. A 20-year follow-up study.  J Bone Joint Surg [Br]. 1987;  69 93-96
    PubMedGoogle Scholar
  • 5 Berndt A L, Harty M. Transchondral fractures of the talus.  J Bone Joint Surg [Am]. 1959;  41 988-1020
    PubMedGoogle Scholar
  • 6 Bohndorf K. Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification.  Eur Radiol. 1998;  8 103-112
    CrossrefPubMedGoogle Scholar
  • 7 Bohndorf K. Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures).  Skeletal Radiol. 1999;  28 545-560
    CrossrefPubMedGoogle Scholar
  • 8 Bohndorf K, Imhof H, Schibany N. [Diagnostic imaging of acute and chronic osteochondral lesions of the talus].  Orthopäde. 2001;  30 12-19
    CrossrefPubMedGoogle Scholar
  • 9 Borrelli A H, Arenson D J. Centrally located osteochondral fractures.  J Am Podiatr Med Assoc. 1988;  78 526-528
    PubMedGoogle Scholar
  • 10 Bosien W R, Staples O S, Russel S W. Residual disability following ankle sprains.  J Bone Joint Surg [Am]. 1955;  37 1237-1243
    PubMedGoogle Scholar
  • 11 Campbell C J, Ranawat C S. Osteochondritis dissecans: The question of etiology.  J Trauma. 1966;  6 201-221
    CrossrefPubMedGoogle Scholar
  • 12 Canale S T, Belding R H. Osteochondral lesions of the talus.  J Bone Joint Surg [Am]. 1980;  62 97-102
    PubMedGoogle Scholar
  • 13 Chang E, Lenczner E. Osteochondritis dissecans of the talar dome treated with an osteochondral autograft.  Can J Surg. 2000;  43 217-221
    PubMedGoogle Scholar
  • 14 Chen D S, Wertheimer S J. Centrally located osteochondral fracture of the talus.  J Foot Surg. 1992;  31 134-140
    PubMedGoogle Scholar
  • 15 De Smet A A, Fisher D R, Burnstein M I, Graf B K, Lange R H. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients.  AJR Am J Roentgenol. 1990;  154 555-558
    PubMedGoogle Scholar
  • 16 Dipaola J D, Nelson D W, Colville M R. Characterizing osteochondral lesions by magnetic resonance imaging.  Arthroscopy. 1991;  7 101-104
    CrossrefPubMedGoogle Scholar
  • 17 Draper S D, Fallat L M. Autogenous bone grafting for the treatment of talar dome lesions.  J Foot Ankle Surg. 2000;  39 15-23
    PubMedGoogle Scholar
  • 18 Flick A B, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions.  Foot Ankle. 1985;  5 165-185
    CrossrefPubMedGoogle Scholar
  • 19 Gautier E, Kolker D, Jakob R P. Treatment of cartilage defects of the talus by autologous osteochondral grafts.  J Bone Joint Surg [Br]. 2002;  84 237-244
    PubMedGoogle Scholar
  • 20 Hangody L, Kish G, Modis L, Szerb I, Gaspar L, Dioszegi Z, Kendik Z. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients.  Foot Ankle Int. 2001;  22 552-558
    CrossrefPubMedGoogle Scholar
  • 21 Hepple S, Winson I G, Glew D. Osteochondral lesions of the talus: a revised classification.  Foot Ankle Int. 1999;  20 789-793
    CrossrefPubMedGoogle Scholar
  • 22 Higashiyama I, Kumai T, Takakura Y, Tamail S. Follow-up study of MRI for osteochondral lesion of the talus.  Foot Ankle Int. 2000;  21 127-133
    PubMedGoogle Scholar
  • 23 Hutchinson B L, Wardle D J. Diagnosis and treatment of talar tilt and its relationship to the occurrence of transchondral fractures: a retrospective study.  J Foot Surg. 1991;  30 151-155
    PubMedGoogle Scholar
  • 24 Jarde O, Trinquier-Lautard J L, Garate F, de Lestang M, Vives P. [Osteochondral lesions of the talar dome: surgical treatment in a series of 30 cases].  Rev Chir Orthop Reparatrice Appar Mot. 2000;  86 608-615
    PubMedGoogle Scholar
  • 25 Josten C, Rose T. [Acute and chronic osteochondral lesions of the talus].  Orthopäde. 1999;  28 500-508
    CrossrefPubMedGoogle Scholar
  • 26 Kappis M. Weitere Beiträge zur traumatisch-mechanischen Entstehung der „spontanen” Knorpelablösung (sogenannte Osteochondritis Dissecans).  Dtsche Z Chir. 1922;  171 13
    PubMedGoogle Scholar
  • 27 Kelberine F, Frank A. Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases.  Arthroscopy. 1999;  15 77-84
    PubMedGoogle Scholar
  • 28 Kitaoka H B, Alexander I J, Adelaar R S, Nunley J A, Myerson M S, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.  Foot Ankle Int. 1994;  15 349-353
    CrossrefPubMedGoogle Scholar
  • 29 Kumai T, Takakura Y, Higashiyama I, Tamai S. Arthroscopic drilling for the treatment of osteochondral lesions of the talus.  J Bone Joint Surg [Am]. 1999;  81 1229-1235
    PubMedGoogle Scholar
  • 30 Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T. Osteochondral lesions of the talus.  Am J Sports Med. 1993;  21 13-19
    CrossrefPubMedGoogle Scholar
  • 31 Loredo R, Sanders T G. Imaging of osteochondral injuries.  Clin Sports Med. 2001;  20 249-278
    PubMedGoogle Scholar
  • 32 Mandracchia V J, Buddecke D E, Giesking J L. Osteochondral lesions of the talar dome. A comprehensive review with retrospective study.  Clin Podiatr Med Surg. 1999;  16 725-742
    PubMedGoogle Scholar
  • 33 Mendicino R W, Lee M S, Grossman J P, Shromoff P J. Oblique medial malleolar osteotomy for the management of talar dome lesions.  J Foot Ankle Surg. 1998;  37 516-523
    PubMedGoogle Scholar
  • 34 Monro A. Part of the cartilage of the joint, separated and ossified. Medical essays and observations.  Edinburgh. 1856;  4 305-306
    PubMedGoogle Scholar
  • 35 Mulfinger G L, Trueta J. The blood supply of the talus.  J Bone Joint Surg [Br]. 1970;  52 160-167
    PubMedGoogle Scholar
  • 36 Ogilvie-Harris D J, Sarrosa E A. Arthroscopic treatment after previous failed open surgery for osteochondritis dissecans of the talus.  Arthroscopy. 1999;  15 809-812
    PubMedGoogle Scholar
  • 37 Parisien J S. Arthroscopic treatment of osteochondral lesions of the talus.  Am J Sports Med. 1986;  14 211-217
    CrossrefPubMedGoogle Scholar
  • 38 Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus.  J Bone Joint Surg [Am]. 1986;  68 862-865
    PubMedGoogle Scholar
  • 39 Seil R, Rupp S, Pape D, Dienst M, Kohn D. [Approach to open treatment of osteochondral lesions of the talus].  Orthopäde. 2001;  30 47-52
    CrossrefPubMedGoogle Scholar
  • 40 Shea M P, Manoli A. Osteochondral lesions of the talar dome.  Foot Ankle. 1993;  14 48-55
    PubMedGoogle Scholar
  • 41 Steinhagen J, Niggemeyer O, Bruns J. [Etiology and pathogenesis of osteochondrosis dissecans tali].  Orthopäde. 2001;  30 20-27
    CrossrefPubMedGoogle Scholar
  • 42 Thompson J P, Loomer R L. Osteochondral lesions of the talus in a sports medicine clinic. A new radiographic technique and surgical approach.  Am J Sports Med. 1984;  12 460-463
    PubMedGoogle Scholar
  • 43 Tol J L, Struijs P A, Bossuyt P M, Verhagen R A, Dijk C N van. Treatment strategies in osteochondral defects of the talar dome: a systematic review.  Foot Ankle Int. 2000;  21 119-126
    CrossrefPubMedGoogle Scholar
  • 44 Yvars M F. Osteochondral fractures of the dome of the talus.  Clin Orthop. 1976;  114 185-191
    PubMedGoogle Scholar

Dr. Xavier Crevoisier

Hôpital Orthopédique de la Suisse Romande

Pierre-Decker 4

1005 Lausanne

Switzerland

Phone: +41/21/5 45 05 01

Fax: +41/21/5 45 06 25

Email: xavier.crevoisier@hospvd.ch

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