Osteochondral lesion of the talus: possible treatment options for Thailand
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Published
Sep 24, 2018
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Abstract
Osteochondral defects (OCDs) of the talus is a broad term used to describe an injury or abnormality of the talar cartilage and adjunct bone. The treatment options vary from non-surgical treatment to a variety of surgical treatments depending on patient signs and symptoms. This review aims to provide an overview of treatment strategies that could be made available in Thailand. The pros and cons of several techniques including conservative treatment, fixation, microfracture, OAT and antegrade or retrograde drilling are discussed. We also provide suggestions for future development in OCDs of the talus care.
Keywords: osteochondral lesion of the talus, Thailand, conservative treatment, fixation, microfracture, osteochondral autografttransplantation, antegrade drilling, retrograde drilling
References
Badekas, T., Takvorian, M., & Souras, N. (2013). Treatment principles for osteochondral lesions in foot and ankle. Int Orthop, 37(9), 1697-1706. doi:10.1007/s00264-013-2076-1
Bae, S., Lee, H. K., Lee, K., Lim, S., Rim, N. J., Kim, J. S., & Cho, J. (2012). Comparison of arthroscopic and magnetic resonance imaging findings in osteochondral lesions of the talus. Foot Ankle Int, 33(12), 1058-1062. doi:Doi: 10.3113/fai.2012.105810.3113/fai.2012.1058
Boraiah, S., Paul, O., Parker, R. J., Miller, A. N., Hentel, K. D., & Lorich, D. G. (2009). Osteochondral lesions of talus associated with ankle fractures. Foot Ankle Int, 30(6), 481-485. doi:10.3113/fai.2009.0481
Chen, H., Hoemann, C. D., Sun, J., Chevrier, A., McKee, M. D., Shive, M. S., . . . Buschmann, M. D. (2011). Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair. J Orthop Res, 29(8), 1178-1184. doi:10.1002/jor.21386
Choi, J. I., & Lee, K. B. (2016). Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 24(7), 2140-2147. doi:10.1007/s00167-015-3511-1
Choi, W. J., Choi, G. W., Kim, J. S., & Lee, J. W. (2013). Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Am J Sports Med, 41(1), 126-133. doi:10.1177/0363546512453302
Choi, W. J., Park, K. K., Kim, B. S., & Lee, J. W. (2009). Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med, 37(10), 1974-1980. doi:10.1177/0363546509335765
Cuttica, D. J., Smith, W. B., Hyer, C. F., Philbin, T. M., & Berlet, G. C. (2011). Osteochondral lesions of the talus: predictors of clinical outcome. Foot Ankle Int, 32(11), 1045-1051. doi:10.3113/ fai.2011.1045
Ferkel, R. D., Zanotti, R. M., Komenda, G. A., Sgaglione, N. A., Cheng, M. S., Applegate, G. R., & Dopirak, R. M. (2008). Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med, 36(9), 1750-1762. doi:10.1177/0363546508316773
Fraser, E. J., Savage-Elliott, I., Yasui, Y., Ackermann, J., Watson, G., Ross, K. A., . . . Kennedy, J. G. (2016). Clinical and MRI Donor Site Outcomes Following Autologous Osteochondral Transplantation for Talar Osteochondral Lesions. Foot Ankle Int, 37(9), 968-976. doi:10.1177/1071100716649 461
Gianakos, A. L., Hannon, C. P., Ross, K. A., Newman, H., Egan, C. J., Deyer, T. W., & Kennedy, J. G. (2015). Anterolateral tibial osteotomy for accessing osteochondral lesions of the talus in autologous osteochondral transplantation: functional and t2 MRI analysis. Foot Ankle Int, 36(5), 531-538. doi:10.1177/1071100714563308
Gormeli, G., Karakaplan, M., Gormeli, C. A., Sarikaya, B., Elmali, N., & Ersoy, Y. (2015). Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial. Foot Ankle Int, 36(8), 891-900. doi:10.1177/1071100715578435
Guney, A., Akar, M., Karaman, I., Oner, M., & Guney, B. (2015). Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 23(8), 2384-2389. doi:10.1007/s00167-013-2784-5
Han, S. H., Lee, J. W., Lee, D. Y., & Kang, E. S. (2006). Radiographic changes and clinical results of osteochondral defects of the talus with and without subchondral cysts. Foot Ankle Int, 27(12), 1109-1114. doi:10.1177/107110070602701218
Hyer, C. F., Berlet, G. C., Philbin, T. M., & Lee, T. H. (2008). Retrograde drilling of osteochondral lesions of the talus. Foot Ankle Spec, 1(4), 207-209. doi:10.1177/1938640008321653
Kennedy, J. G., & Murawski, C. D. (2011). The Treatment of Osteochondral Lesions of the Talus with Autologous Osteochondral Transplantation and Bone Marrow Aspirate Concentrate: Surgical Technique. Cartilage, 2(4), 327-336. doi:10.1177/1947603511400726
Kennedy, J. G., Suero, E. M., O'Loughlin, P. F., Brief, A., & Bohne, W. H. (2008). Clinical tips: retrograde drilling of talar osteochondral defects. Foot Ankle Int, 29(6), 616-619. doi:10.3113/fai.2008.0616
Kerkhoffs, G. M., Reilingh, M. L., Gerards, R. M., & de Leeuw, P. A. (2016). Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc, 24(4), 1265-1271. doi:10.1007/s00167-014-3057-7
Klammer, G., Maquieira, G. J., Spahn, S., Vigfusson, V., Zanetti, M., & Espinosa, N. (2015). Natural history of nonoperatively treated osteochondral lesions of the talus. Foot Ankle Int, 36(1), 24-31. doi:10.1177/1071100714552480
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(9), 1450-1456. doi:10.1177/0363546506287300
Kraeutler, M. J., Chahla, J., Dean, C. S., Mitchell, J. J., Santini-Araujo, M. G., Pinney, S. J., & Pascual-Garrido, C. (2017). Current Concepts Review Update. Foot Ankle Int, 38(3), 331-342. doi:10.1177/1071100716677746
Kumai, T., Takakura, Y., Higashiyama, I., & Tamai, S. (1999). Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am, 81(9), 1229-1235.
Kumai, T., Takakura, Y., Kitada, C., Tanaka, Y., & Hayashi, K. (2002). Fixation of osteochondral lesions of the talus using cortical bone pegs. J Bone Joint Surg Br, 84(3), 369-374.
Lee, D. H., Lee, K. B., Jung, S. T., Seon, J. K., Kim, M. S., & Sung, I. H. (2012). Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med, 40(9), 2023-2028. doi:10.1177/0363546512455316
Lee, K. B., Park, H. W., Cho, H. J., & Seon, J. K. (2015). Comparison of Arthroscopic Microfracture for Osteochondral Lesions of the Talus With and Without Subchondral Cyst. Am J Sports Med, 43(8), 1951-1956. doi:10.1177/0363546515584755
Lee, K. B., Yang, H. K., Moon, E. S., & Song, E. K. (2008). Modified step-cut medial malleolar osteotomy for osteochondral grafting of the talus. Foot Ankle Int, 29(11), 1107-1110. doi:10.3113/fai. 2008.1107
Lee, M., Kwon, J. W., Choi, W. J., & Lee, J. W. (2015). Comparison of Outcomes for Osteochondral Lesions of the Talus With and Without Chronic Lateral Ankle Instability. Foot Ankle Int, 36(9), 1050-1057. doi:10.1177/1071100715581477
Liu, W., Liu, F., Zhao, W., Kim, J. M., Wang, Z., & Vrahas, M. S. (2011). Osteochondral autograft transplantation for acute osteochondral fractures associated with an ankle fracture. Foot Ankle Int, 32(4), 437-442. doi:10.3113/fai.2011.0437
Mann, R. A., & Coughlin, M. J. (1993). Surgery of the foot and ankle (6th ed.). St. Louis: Mosby.
McGahan, P. J., & Pinney, S. J. (2010). Current concept review: osteochondral lesions of the talus. Foot Ankle Int, 31(1), 90-101. doi:10.3113/fai.2010.0090
Mei-Dan, O., Carmont, M. R., Laver, L., Mann, G., Maffulli, N., & Nyska, M. (2012). Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med, 40(3), 534-541. doi:10.1177/0363546511431238
Min, B. H., Choi, W. H., Lee, Y. S., Park, S. R., Choi, B. H., Kim, Y. J., . . . Yoon, J. H. (2013). Effect of different bone marrow stimulation techniques (BSTs) on MSCs mobilization. J Orthop Res, 31(11), 1814-1819. doi:10.1002/jor.22380
Mintz, D. N., Tashjian, G. S., Connell, D. A., Deland, J. T., O'Malley, M., & Potter, H. G. (2003). Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy, 19(4), 353-359. doi:10.1053/jars.2003.50041
Murawski, C. D., & Kennedy, J. G. (2013). Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am, 95(11), 1045-1054. doi:10.2106/jbjs.l.00773
Nakagawa, S., Hara, K., Minami, G., Arai, Y., & Kubo, T. (2010). Arthroscopic fixation technique for osteochondral lesions of the talus. Foot Ankle Int, 31(11), 1025-1027. doi:10.3113/fai.2010.1025
Bae, S., Lee, H. K., Lee, K., Lim, S., Rim, N. J., Kim, J. S., & Cho, J. (2012). Comparison of arthroscopic and magnetic resonance imaging findings in osteochondral lesions of the talus. Foot Ankle Int, 33(12), 1058-1062. doi:Doi: 10.3113/fai.2012.105810.3113/fai.2012.1058
Boraiah, S., Paul, O., Parker, R. J., Miller, A. N., Hentel, K. D., & Lorich, D. G. (2009). Osteochondral lesions of talus associated with ankle fractures. Foot Ankle Int, 30(6), 481-485. doi:10.3113/fai.2009.0481
Chen, H., Hoemann, C. D., Sun, J., Chevrier, A., McKee, M. D., Shive, M. S., . . . Buschmann, M. D. (2011). Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair. J Orthop Res, 29(8), 1178-1184. doi:10.1002/jor.21386
Choi, J. I., & Lee, K. B. (2016). Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 24(7), 2140-2147. doi:10.1007/s00167-015-3511-1
Choi, W. J., Choi, G. W., Kim, J. S., & Lee, J. W. (2013). Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Am J Sports Med, 41(1), 126-133. doi:10.1177/0363546512453302
Choi, W. J., Park, K. K., Kim, B. S., & Lee, J. W. (2009). Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med, 37(10), 1974-1980. doi:10.1177/0363546509335765
Cuttica, D. J., Smith, W. B., Hyer, C. F., Philbin, T. M., & Berlet, G. C. (2011). Osteochondral lesions of the talus: predictors of clinical outcome. Foot Ankle Int, 32(11), 1045-1051. doi:10.3113/ fai.2011.1045
Ferkel, R. D., Zanotti, R. M., Komenda, G. A., Sgaglione, N. A., Cheng, M. S., Applegate, G. R., & Dopirak, R. M. (2008). Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med, 36(9), 1750-1762. doi:10.1177/0363546508316773
Fraser, E. J., Savage-Elliott, I., Yasui, Y., Ackermann, J., Watson, G., Ross, K. A., . . . Kennedy, J. G. (2016). Clinical and MRI Donor Site Outcomes Following Autologous Osteochondral Transplantation for Talar Osteochondral Lesions. Foot Ankle Int, 37(9), 968-976. doi:10.1177/1071100716649 461
Gianakos, A. L., Hannon, C. P., Ross, K. A., Newman, H., Egan, C. J., Deyer, T. W., & Kennedy, J. G. (2015). Anterolateral tibial osteotomy for accessing osteochondral lesions of the talus in autologous osteochondral transplantation: functional and t2 MRI analysis. Foot Ankle Int, 36(5), 531-538. doi:10.1177/1071100714563308
Gormeli, G., Karakaplan, M., Gormeli, C. A., Sarikaya, B., Elmali, N., & Ersoy, Y. (2015). Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial. Foot Ankle Int, 36(8), 891-900. doi:10.1177/1071100715578435
Guney, A., Akar, M., Karaman, I., Oner, M., & Guney, B. (2015). Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 23(8), 2384-2389. doi:10.1007/s00167-013-2784-5
Han, S. H., Lee, J. W., Lee, D. Y., & Kang, E. S. (2006). Radiographic changes and clinical results of osteochondral defects of the talus with and without subchondral cysts. Foot Ankle Int, 27(12), 1109-1114. doi:10.1177/107110070602701218
Hyer, C. F., Berlet, G. C., Philbin, T. M., & Lee, T. H. (2008). Retrograde drilling of osteochondral lesions of the talus. Foot Ankle Spec, 1(4), 207-209. doi:10.1177/1938640008321653
Kennedy, J. G., & Murawski, C. D. (2011). The Treatment of Osteochondral Lesions of the Talus with Autologous Osteochondral Transplantation and Bone Marrow Aspirate Concentrate: Surgical Technique. Cartilage, 2(4), 327-336. doi:10.1177/1947603511400726
Kennedy, J. G., Suero, E. M., O'Loughlin, P. F., Brief, A., & Bohne, W. H. (2008). Clinical tips: retrograde drilling of talar osteochondral defects. Foot Ankle Int, 29(6), 616-619. doi:10.3113/fai.2008.0616
Kerkhoffs, G. M., Reilingh, M. L., Gerards, R. M., & de Leeuw, P. A. (2016). Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc, 24(4), 1265-1271. doi:10.1007/s00167-014-3057-7
Klammer, G., Maquieira, G. J., Spahn, S., Vigfusson, V., Zanetti, M., & Espinosa, N. (2015). Natural history of nonoperatively treated osteochondral lesions of the talus. Foot Ankle Int, 36(1), 24-31. doi:10.1177/1071100714552480
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(9), 1450-1456. doi:10.1177/0363546506287300
Kraeutler, M. J., Chahla, J., Dean, C. S., Mitchell, J. J., Santini-Araujo, M. G., Pinney, S. J., & Pascual-Garrido, C. (2017). Current Concepts Review Update. Foot Ankle Int, 38(3), 331-342. doi:10.1177/1071100716677746
Kumai, T., Takakura, Y., Higashiyama, I., & Tamai, S. (1999). Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am, 81(9), 1229-1235.
Kumai, T., Takakura, Y., Kitada, C., Tanaka, Y., & Hayashi, K. (2002). Fixation of osteochondral lesions of the talus using cortical bone pegs. J Bone Joint Surg Br, 84(3), 369-374.
Lee, D. H., Lee, K. B., Jung, S. T., Seon, J. K., Kim, M. S., & Sung, I. H. (2012). Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med, 40(9), 2023-2028. doi:10.1177/0363546512455316
Lee, K. B., Park, H. W., Cho, H. J., & Seon, J. K. (2015). Comparison of Arthroscopic Microfracture for Osteochondral Lesions of the Talus With and Without Subchondral Cyst. Am J Sports Med, 43(8), 1951-1956. doi:10.1177/0363546515584755
Lee, K. B., Yang, H. K., Moon, E. S., & Song, E. K. (2008). Modified step-cut medial malleolar osteotomy for osteochondral grafting of the talus. Foot Ankle Int, 29(11), 1107-1110. doi:10.3113/fai. 2008.1107
Lee, M., Kwon, J. W., Choi, W. J., & Lee, J. W. (2015). Comparison of Outcomes for Osteochondral Lesions of the Talus With and Without Chronic Lateral Ankle Instability. Foot Ankle Int, 36(9), 1050-1057. doi:10.1177/1071100715581477
Liu, W., Liu, F., Zhao, W., Kim, J. M., Wang, Z., & Vrahas, M. S. (2011). Osteochondral autograft transplantation for acute osteochondral fractures associated with an ankle fracture. Foot Ankle Int, 32(4), 437-442. doi:10.3113/fai.2011.0437
Mann, R. A., & Coughlin, M. J. (1993). Surgery of the foot and ankle (6th ed.). St. Louis: Mosby.
McGahan, P. J., & Pinney, S. J. (2010). Current concept review: osteochondral lesions of the talus. Foot Ankle Int, 31(1), 90-101. doi:10.3113/fai.2010.0090
Mei-Dan, O., Carmont, M. R., Laver, L., Mann, G., Maffulli, N., & Nyska, M. (2012). Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med, 40(3), 534-541. doi:10.1177/0363546511431238
Min, B. H., Choi, W. H., Lee, Y. S., Park, S. R., Choi, B. H., Kim, Y. J., . . . Yoon, J. H. (2013). Effect of different bone marrow stimulation techniques (BSTs) on MSCs mobilization. J Orthop Res, 31(11), 1814-1819. doi:10.1002/jor.22380
Mintz, D. N., Tashjian, G. S., Connell, D. A., Deland, J. T., O'Malley, M., & Potter, H. G. (2003). Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy, 19(4), 353-359. doi:10.1053/jars.2003.50041
Murawski, C. D., & Kennedy, J. G. (2013). Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am, 95(11), 1045-1054. doi:10.2106/jbjs.l.00773
Nakagawa, S., Hara, K., Minami, G., Arai, Y., & Kubo, T. (2010). Arthroscopic fixation technique for osteochondral lesions of the talus. Foot Ankle Int, 31(11), 1025-1027. doi:10.3113/fai.2010.1025
Keywords
osteochondral lesion of talus; Thailand; conservative treatment; fixation; microfracture; osteochondral autograft transplantation; antegrade drilling; retrograde drilling
Section
Research Articles
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How to Cite
RASAMIMONGKOL, Supachok; TANGSRIPONG, Piroon.
Osteochondral lesion of the talus: possible treatment options for Thailand.
Naresuan University Journal: Science and Technology (NUJST), [S.l.], v. 26, n. 3, p. 1-14, sep. 2018.
ISSN 2539-553X.
Available at: <https://www.journal.nu.ac.th/NUJST/article/view/Vol-26-No-3-2018-1-14>. Date accessed: 24 apr. 2024.
doi: https://doi.org/10.14456/nujst.2018.6.