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

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
• 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
• 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
• 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
• 5 Berndt A L, Harty M. Transchondral fractures of the talus.  J Bone Joint Surg [Am]. 1959;  41 988-1020
• 6 Bohndorf K. Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification.  Eur Radiol. 1998;  8 103-112
• 7 Bohndorf K. Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures).  Skeletal Radiol. 1999;  28 545-560
• 8 Bohndorf K, Imhof H, Schibany N. [Diagnostic imaging of acute and chronic osteochondral lesions of the talus].  Orthopäde. 2001;  30 12-19
• 9 Borrelli A H, Arenson D J. Centrally located osteochondral fractures.  J Am Podiatr Med Assoc. 1988;  78 526-528
• 10 Bosien W R, Staples O S, Russel S W. Residual disability following ankle sprains.  J Bone Joint Surg [Am]. 1955;  37 1237-1243
• 11 Campbell C J, Ranawat C S. Osteochondritis dissecans: The question of etiology.  J Trauma. 1966;  6 201-221
• 12 Canale S T, Belding R H. Osteochondral lesions of the talus.  J Bone Joint Surg [Am]. 1980;  62 97-102
• 13 Chang E, Lenczner E. Osteochondritis dissecans of the talar dome treated with an osteochondral autograft.  Can J Surg. 2000;  43 217-221
• 14 Chen D S, Wertheimer S J. Centrally located osteochondral fracture of the talus.  J Foot Surg. 1992;  31 134-140
• 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
• 16 Dipaola J D, Nelson D W, Colville M R. Characterizing osteochondral lesions by magnetic resonance imaging.  Arthroscopy. 1991;  7 101-104
• 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
• 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
• 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
• 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
• 21 Hepple S, Winson I G, Glew D. Osteochondral lesions of the talus: a revised classification.  Foot Ankle Int. 1999;  20 789-793
• 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
• 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
• 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
• 25 Josten C, Rose T. [Acute and chronic osteochondral lesions of the talus].  Orthopäde. 1999;  28 500-508
• 26 Kappis M. Weitere Beiträge zur traumatisch-mechanischen Entstehung der „spontanen” Knorpelablösung (sogenannte Osteochondritis Dissecans).  Dtsche Z Chir. 1922;  171 13
• 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
• 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
• 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
• 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
• 31 Loredo R, Sanders T G. Imaging of osteochondral injuries.  Clin Sports Med. 2001;  20 249-278
• 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
• 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
• 34 Monro A. Part of the cartilage of the joint, separated and ossified. Medical essays and observations.  Edinburgh. 1856;  4 305-306
• 35 Mulfinger G L, Trueta J. The blood supply of the talus.  J Bone Joint Surg [Br]. 1970;  52 160-167
• 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
• 37 Parisien J S. Arthroscopic treatment of osteochondral lesions of the talus.  Am J Sports Med. 1986;  14 211-217
• 38 Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus.  J Bone Joint Surg [Am]. 1986;  68 862-865
• 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
• 40 Shea M P, Manoli A. Osteochondral lesions of the talar dome.  Foot Ankle. 1993;  14 48-55
• 41 Steinhagen J, Niggemeyer O, Bruns J. [Etiology and pathogenesis of osteochondrosis dissecans tali].  Orthopäde. 2001;  30 20-27
• 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
• 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
• 44 Yvars M F. Osteochondral fractures of the dome of the talus.  Clin Orthop. 1976;  114 185-191