[Osteochondral lesions of the dome of the talus with partial necrosis. Surgical treatment by curettage and filling].
There are several types of lesions of the talus, including non united fractures and true osteochondritis in adolescents. This article focuses on lesions of the dome of the talus having a large subchondral necrotic zone. The etiology of these lesions is unclear. Even when they result from trauma, this may not be the sole cause. Thirty-three similar cases were studied, allowing analysis of the radiological appearance and the value of arthro scanner data. All the cases were treated by surgery (and were subsequently classified histologically). The necrosis was treated by curettage and filling with cancellous bone grafts taken from the lower tibial epiphysis. Twenty-seven patients were followed up at least one year (average 3 years 3 months). The outcome was functionally good or very good in twenty-two cases. The anatomical reconstruction was scored by radiology as very good in nineteen patients and satisfactory in five, who had irregularities and non-homogenous appearance of the talar dome. These results justify the use of curettage and filling. Arthroscopic techniques, although appropriate for simple ablations of osteochondral fragments, do not appear to be satisfactory for treating lesions including subchondral necrosis. Filling can only be performed surgically.
Kouvalchouk
J F
JF
Service de Chirurgie Orthopédique et Traumatologie du Sport, Suresnes.
Schneider-Maunoury
G
G
Rodineau
J
J
Paszkowski
A
A
Watin-Augouard
L
L
D000293:Adolescent; D000328:Adult; D003475:Curettage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010007:Osteochondritis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010020:Osteonecrosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013628:Talus
Les lésions ostéochondrales du dôme astragalien avec nécrose partielle. Leur traitement chirurgical par curetage et comblement.