Osteochondral lesions of the talus

Abstract

Background and purpose - The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Patients and methods - This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3-10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results - No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle-hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Interpretation - Nonoperative treatment can be considered a good option for patients with OCL.

Figure 1.

Flowchart of study participants.

Figure 2.

A 29-year-old man with OCL. (A) Initial standing radiograph and (C) initial MRI showed medial OCL. (D) CT at 1-year follow-up, (B) standing radiograph and (E) CT at 9-year follow-up showed no change in lesion size. The AOFAS ankle–hindfoot score improved from 92 to 100.

Figure 3.

A 53-year-old man with OCL. (A) Initial standing radiograph and (C) CT. (B) Standing radiograph and (D) CT at 7-year follow-up. The lesion size decreased, and the AOFAS ankle–hindfoot score improved from 73 to 100.

Figure 4.

A 48-year-old man with OCL. (A) Initial standing radiograph and (C) MRI. (B) Standing radiograph and (D) CT at 3.8-year follow-up. Although the lesion size increased, the AOFAS ankle–hindfoot score improved from 71 to 80.

Figure 5.

A 59-year-old man with OCL. (A) Initial MRI and (B) CT at 4-year follow-up. Although we recommended surgery to the patient at the first visit, the patient refused the operation because the symptoms were tolerable. The lesion size was increased on the CT at 4-year follow-up. However, the patient did not have worse symptoms and still did not want surgery.