Osteochondral defects of the talus: radiological appearance and surgical candidate profiling - A retrospective analysis

Abstract

Background: Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. Treatment of these lesions remains variable across the diverse cohort of these patients.

Aims: Evaluating the incidence of talus OCDs. Evaluating anatomic and morphologic data of the lesions against previous studies. Establishing if there was there any associated ligamentous injury. Determining the cohort of patients who were considered/underwent surgical intervention.

Methods: A retrospective review was performed on patients presenting to a single Scottish Hospital with Talar OCDs between 2012-2016. Data collected included radiological appearance of the lesions (location and size), clinical history, associated ligament injury, treatment given and subsequent outcome. Categorical variables were presented as count and percentage while non-parametric variables were presented as median and interquartile range.

Results: 90 new cases that matched our inclusion criteria were identified. Using the Raikin classification, the majority of injuries are in the posteromedial (26%), centrolateral (21%), and centromedial (18%) segments of the talus. Of note, no lesions were identified in the posterocentral segment. 46% of patients had an associated ligamentous injury, either in the form of a sprain or tear. Most commonly the injury involved both ATFL and CFL (82%). 70% of patients that underwent surgery had radiological evidence of ligamentous injury. No statistically significant difference was identified between the management option and the involved segment according to Orr/Raikin classifications.

Conclusion: Talus osteochondral defects are a pathology which is more common than originally thought and their treatment remain a controversial topic. Little is known about the physical history of the condition as most cases are asymptomatic, thus poorly documented by definition. There is a clear opportunity and need for further research into developing evidence-based guidelines for their management. This study tried to correlate the management of OCDs with epidemiological and radiological data.

Keywords: Ankle; Osteochondral defects; Talus; Trauma.