Osteochondral Lesions of the Talus
Osteochondral Lesions of the Talus
abstract & commentary
Synopsis: Higashiyama and colleagues described the preoperative MRI findings in patients with osteochondral lesions of the talus and how these changes reverse after successful surgical intervention.
Source: Higashiyama I, et al. Follow-up study of MRI for osteochondral lesion of the talus. Foot Ankle Int 2000;21(2): 127-133.
Twenty-two ankles in 21 patients had mri examinations before and after treatment of their talar lesions. Higashiyama and colleagues used T1- and T2- weighted images. The clinical symptoms were improved basically in all patients postoperatively. The T1 image diminished after surgery and all low signal T2-weighted images disappeared after arthroscopic drilling. High signal T2-weighted image changes seen in 13 cases before treatment disappeared in 10 of these postoperatively.
Higashiyama et al concluded that surgical treatment reduced the abnormal stress of the underlying bone elements caused by the unstable osteochondral fragment, leading to the reduction of the low intensity area. The loss of the T2-weighted images was considered indicative of obliteration of the interface between the fragment and the talar bed with bony union.
MRI imaging of the osteochondral lesions of the talus seems to be an effective tool for postoperative evaluation, thereby allowing the surgeon the ability to assess the need for further treatment.
Comment by James P. Tasto, MD
Osteochondral lesions of the talus have been classified as I through IV in terms of their stability. They are classically located anterolaterally or posteromedially on the talus.1 The work-up for a patient with sometimes normal x-rays and persistent ankle pain that does not appear to be of soft tissue origin should involve the judicious use of an MRI scan.2 The choice and type of surgical intervention is centered around the integrity of the fragment. This dictates whether it is replaced and stabilized, or removed and the area curetted, drilled, or abraded.
The immediate short-term results in the treatment of osteochondritis dissecans of the talus, whether it be an anterolateral lesion or posteromedial lesion, are usually good, and the patient usually can return to sporting activities. However, long-term results in these cases, particularly when they involve removal of a large, nonviable fragment, are less optimistic and may lead to subsequent degenerative changes in the ankle. It is useful for the clinician to be aware of the various classifications and locations of these lesions, as well as the appropriate surgical intervention and encouraging short-term results.
References
- Anderson IF, et al. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am 1989;71: 1143-1152.
- Dipaola JD, et al. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 1991;7:101-104.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.