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SA Orthopaedic Journal
versión On-line ISSN 2309-8309
versión impresa ISSN 1681-150X
SA orthop. j. vol.8 no.2 Centurion ene. 2009
CLINICAL ARTICLE
Diagnosis and treatment of osteochondral defects of the ankle
ML ReilinghI; CJA van BergenI; CN van DijkII
IMD; Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
IIMD, PhD; Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
ABSTRACT
An osteochondral defect of the talus is a lesion involving talar articular cartilage and subchondral bone. It is frequently caused by a traumatic event. The lesions may either heal, stabilise or progress to subchondral bone cysts. The subchondral cysts may develop due to the forcing of cartilaginous or synovial fluid with every step. Malalignment of the hindfoot plays an important role in the development of further degeneration. Plain radiographs may disclose the lesion. Modern imaging technology has enhanced the ability to fully evaluate and accurately determine the size and extent of the lesion, which are fundamental for proper treatment. Asymptomatic or low-symptomatic lesions are treated nonoperatively. For surgical treatment the following types of surgery are in clinical use: debridement and bone marrow stimulation, retrograde drilling, internal fixation, cancellous bone grafting, osteochondral autograft transfer, autologous chondrocyte implantation, and allograft transplantation. Although these are often successful, malalignment may persist with these treatment options. Calcaneal correction osteotomy may be suitable for osteochondral defects in select cases.
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References
1. Flick AB, 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 Jan;5(4):165-85. [ Links ]
2. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959 Sep;41-a:988-1020. [ Links ]
3. Ittner G, Jaskulka R, Fasol P. [Treatment of flake fracture of the talus]. Z Orthop Ihre Grenzgeb 1989 Mar;127(2):183-6. [ Links ]
4. Baker CL, Jr., Morales RW. Arthroscopic treatment of transchondral talar dome fractures: a long-term follow-up study. Arthroscopy 1999 Mar;15(2):197-202. [ Links ]
5. Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am 1989 Sep;71(8):1143-52. [ Links ]
6. 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 Sep;81(9):1229-35. [ Links ]
7. Schuman L, Struijs PA, van Dijk CN. Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br 2002 Apr;84(3):364-8. [ Links ]
8. Monro A. Microgeologie. Berlin: Th. Billroth; 1856. p. 236. [ Links ]
9. König F. Über freie Körper in den Gelenken. Dtsch Z Chir 1888;27:90-109. [ Links ]
10. Schachter AK, Chen AL, Reddy PD, Tejwani NC. Osteochondral lesions of the talus. J Am Acad Orthop Surg 2005 May;13(3):152-8. [ Links ]
11. van Bergen CJ, de Leeuw PA, van Dijk CN. Potential pitfall in the microfracturing technique during the arthroscopic treatment of an osteochondral lesion. Knee Surg Sports Traumatol Arthrosc 2008 Sep 23. [ Links ]
12. Zengerink M, Szerb I, Hangody L, Dopirak RM, Ferkel RD, van Dijk CN. Current concepts: treatment of osteochondral ankle defects. Foot Ankle Clin 2006 Jun;11(2):331-59, vi. [ Links ]
13. Saunders R. Fractures and fracture dislocations of the talus. In: Mann R, Coughlin M, editors. Surgery of the foot and ankle. 7 ed. St. Louis: MO: Mosby; 1991. p. 1465-518. [ Links ]
14. Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 2000 Feb;21(2):119-26. [ Links ]
15. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 2003 Jun;8(2):233-ix. [ Links ]
16. Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 2008 Jan;24(1):106-12. [ Links ]
17. Giannini S, Buda R, Faldini C, Vannini F, Bevoni R, Grandi G, et al. Surgical treatment of osteochondral lesions of the talus in young active patients. J Bone Joint Surg Am 2005;87 Suppl 2:28-41. [ Links ]
18. Bruns J. [Osteochondrosis dissecans]. Orthopade 1997 Jun;26(6):573-84. [ Links ]
19. Ray R, Coughlin E. Osteochondritis dissecans of the talus. J Bone Joint Surg 1947;29:697-706. [ Links ]
20. Steinhagen J, Niggemeyer O, Bruns J. [Etiology and pathogenesis of osteochondrosis dissecans tali]. Orthopade 2001 Jan;30(1):20-7. [ Links ]
21. Erban WK, Kolberg K. [Simultaneous mirror image osteochondrosis dissecans in identical twins]. Rofo 1981 Sep;135(3):357. [ Links ]
22. Woods K, Harris I. Osteochondritis dissecans of the talus in identical twins. J Bone Joint Surg Br 1995 Mar;77(2):331. [ Links ]
23. Anderson DV, Lyne ED. Osteochondritis dissecans of the talus: case report on two family members. J Pediatr Orthop 1984 May;4(3):356-7. [ Links ]
24. Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg Am 1980 Jan;62(1):97-102. [ Links ]
25. Chen DS, Wertheimer SJ. Centrally located osteochondral fracture of the talus. J Foot Surg 1992 Mar;31(2):134-40. [ Links ]
26. Stone JW. Osteochondral Lesions of the Talar Dome. J Am Acad Orthop Surg 1996 Mar;4(2):63-73. [ Links ]
27. Buckwalter JA, Mankin HJ. Articular cartilage: tissue design and chondrocyte-matrix interactions. Instr Course Lect 1998;47:477-86. [ Links ]
28. Junqueira L, Carneiro J, Kelly R. Kraakbeen. Functionele Histologie. 11 ed. Maarssen: Elsevier; 2007. p. 140-7. [ Links ]
29. Maroudas A, Schneiderman R. 'Free' and 'exchangeable' or 'trapped' and 'non-exchangeable' water in cartilage. J Orthop Res 1987;5(1):133-8. [ Links ]
30. Sijbrandij ES, van Gils AP, Louwerens JW, de Lange EE. Posttraumatic subchondral bone contusions and fractures of the talotibial joint: occurrence of 'kissing' lesions. AJR Am J Roentgenol 2000 Dec;175(6):1707-10. [ Links ]
31. Buckwalter JA, Mankin HJ. Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 1998;47:487-504. [ Links ]
32. Radin EL, Rose RM. Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res 1986 Dec;(213):34-40. [ Links ]
33. Aspenberg P, Van d, V. Migration, particles, and fluid pressure. A discussion of causes of prosthetic loosening. Clin Orthop Relat Res 1998 Jul;(352):75-80. [ Links ]
34. Astrand J, Skripitz R, Skoglund B, Aspenberg P. A rat model for testing pharmacologic treatments of pressure-related bone loss. Clin Orthop Relat Res 2003 Apr;(409):296-305. [ Links ]
35. Schmalzried TP, Akizuki KH, Fedenko AN, Mirra J. The role of access of joint fluid to bone in periarticular osteolysis. A report of four cases. J Bone Joint Surg Am 1997 Mar;79(3):447-52. [ Links ]
36. van der Vis HM, Aspenberg P, Marti RK, Tigchelaar W, Van Noorden CJ. Fluid pressure causes bone resorption in a rabbit model of prosthetic loosening. Clin Orthop Relat Res 1998 May;(350):201-8. [ Links ]
37. Durr HD, Martin H, Pellengahr C, Schlemmer M, Maier M, Jansson V. The cause of subchondral bone cysts in osteoarthrosis: a finite element analysis. Acta Orthop Scand 2004 Oct;75(5):554-8. [ Links ]
38. Scranton PE, Jr., McDermott JE. Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. Foot Ankle Int 2001 May;22(5):380-4. [ Links ]
39. Millington S, Grabner M, Wozelka R, Hurwitz S, Crandall J. A stereophotographic study of ankle joint contact area. J Orthop Res 2007 Nov;25(11):1465-73. [ Links ]
40. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 1976 Apr;58(3) :356-7. [ Links ]
41. Joy G, Patzakis MJ, Harvey JP, Jr. Precise evaluation of the reduction of severe ankle fractures. J Bone Joint Surg Am 1974 Jul;56(5):979-93. [ Links ]
42. Bruns J, Rosenbach B. Pressure distribution at the ankle joint. Clin Biomech (Bristol, Avon ) 1990;5:153-61. [ Links ]
43. Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T. Osteochondral lesions of the talus. Am J Sports Med 1993 Jan;21(1):13-9. [ Links ]
44. Verhagen RA, Maas M, Dijkgraaf MG, Tol JL, Krips R, van Dijk CN. Prospective study on diagnostic strategies in osteochondral lesions of the talus. Is MRI superior to helical CT? J Bone Joint Surg Br 2005 Jan;87(1):41-6. [ Links ]
45. Reis ND, Zinman C, Besser MI, Shifrin LZ, Folman Y, Torem S, et al. High-resolution computerised tomography in clinical orthopaedics. J Bone Joint Surg Br 1982;64(1):20-4. [ Links ]
46. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 1999 Dec;20(12):789-93. [ Links ]
47. Takao M, Ochi M, Uchio Y, Naito K, Kono T, Oae K. Osteochondral lesions of the talar dome associated with trauma. Arthroscopy 2003 Dec;19(10):1061-7. [ Links ]
48. Taranow WS, Bisignani GA, Towers JD, Conti SF. Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int 1999 Aug;20(8):474-80. [ Links ]
49. van Bergen CJ, de Leeuw PA, van Dijk CN. Treatment of osteochondral defects of the talus. Rev Chir Orthop Reparatrice Appar Mot 2008 Nov;94:398-408. [ Links ]
50. Alexander AH, Lichtman DM. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up. J Bone Joint Surg Am 1980;62(4):646-52. [ Links ]
51. Pettine KA, Morrey BF. Osteochondral fractures of the talus. A long-term follow-up. J Bone Joint Surg Br 1987 Jan;69(1):89-92. [ Links ]
52. Van BK, Barrack RL, Alexander AH, Ertl JP. Arthroscopic treatment of transchondral talar dome fractures. Am J Sports Med 1989 May;17(3):350-5. [ Links ]
53. Bruns J, Klima H, Rosenbach B, Lussenhop S. [Long-term results after gluing of osteochondral fragments and osteochondrosis dissecans]. LangenbecksArch Chir 1993;378(3):160-6. [ Links ]
54. Lee CK, Mercurio C. Operative treatment of osteochondritis dissecans in situ by retrograde drilling and cancellous bone graft: a preliminary report. Clin Orthop Relat Res 1981 Jul;(158):129-6. [ Links ]
55. Nash WC, Baker CL, Jr. Transchondral talar dome fractures: not just a sprained ankle. South Med J 1984 May;77(5):560-4. [ Links ]
56. Niek van DC, van Bergen CJ. Advancements in ankle arthroscopy. J Am Acad Orthop Surg 2008 Nov;16(11):635-46. [ Links ]
57. van Dijk CN, Scholte D. Arthroscopy of the ankle joint. Arthroscopy 1997 Feb;13(1):90-6. [ Links ]
58. O'Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am 1998 Dec;80(12):1795-812. [ Links ]
59. Hankemeier S, Muller EJ, Kaminski A, Muhr G. [10-year results of bone marrow stimulating therapy in the treatment of osteochondritis dissecans of the talus]. Unfallchirurg 2003 Jun;106(6):461-6. [ Links ]
60. Saxena A, Eakin C. Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med 2007 Oct;35(10):1680-7. [ Links ]
61. Mallon WJ, Wombwell JH, Nunley JA. Intra-articular talar fractures: repair using the Herbert bone screw. Foot Ankle 1989 Oct;10(2):88-92. [ Links ]
62. Shea MP, Manoli A. Osteochondral lesions of the talar dome. Foot Ankle 1993 Jan;14(1):48-55. [ Links ]
63. DeLee JC. Fractures and dislocations of the foot. In: Mann R, Coughlin M, editors. Surgery of the Foot and Ankle. 6 ed. St. Louis: MO: Mosby; 1991. p. 1465-518. [ Links ]
64. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994 Oct 6;331(14):889-95. [ Links ]
65. Petersen L, Brittberg M, Lindahl A. Autologous chondrocyte transplantation of the ankle. Foot Ankle Clin 2003 Jun;8(2):291-303. [ Links ]
66. Bazaz R, Ferkel RD. Treatment of osteochondral lesions of the talus with autologous chondrocyte implantation. Tech Foot Ankle Surg 2004;3(1):45-52. [ Links ]
67. Hangody L, Fules P. 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 2003;85-a Suppl 2:25-32. [ Links ]
68. Scranton PE, Jr., Frey CC, Feder KS. Outcome of osteochondral auto-graft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br 2006 May;88(5):614-9. [ Links ]
69. Choung D, Christensen JC. Mosaicplasty of the talus: a joint contact analysis in a cadaver model. J Foot Ankle Surg 2002 Mar;41(2):65-75. [ Links ]
70. Hangody L, Kish G, Modis L, Szerb I, Gaspar L, Dioszegi Z, et al. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int 2001 Jul;22(7):552-8. [ Links ]
71. Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P. 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 2006 Jan;34(1):55-63. [ Links ]
72. Rangger C, Kathrein A, Freund MC, Klestil T, Kreczy A. Bone bruise of the knee: histology and cryosections in 5 cases. Acta Orthop Scand 1998 Jun;69(3):291-4. [ Links ]
73. Yamamoto T, Bullough PG. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 2000 Jun;82(6):858-66. [ Links ]
74. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 1989 Feb;(239):196-206. [ Links ]
75. Hintermann B. Medial ankle instability. Foot Ankle Clin 2003 Dec;8(4):723-38. [ Links ]
76. Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 2007 Sep;462:156-68. [ Links ]
Correspondence:
Academic Medical Centre
University of Amsterdam
Department of Orthopaedic Surgery
Prof Dr C Niek van Dijk
PO Box 22660
1100 DD Amsterdam, The Netherlands
Tel: + 31 20 566-2938; Fax: +31 20 566-9117
Email: m.lammerts@amc.uva.nl, m.l.reilingh@amc.nl
The content of this article is the sole work of the authors. No benefits of any form have been derived from any commercial party related directly or indirectly to the subject of this article.
