Osteochondral lesions of the talus: Current concept.
Osteochondral lesions of the talus (OTL) are among those injuries that we should not fail to recognize, especially following any type of hindfoot injury. They were thoroughly described 15 years ago in a round table session organized by Doré and Rosset for the Société orthopédique de l'Ouest. Their physiopathology has not yet been definitely determined, even though some of the pathogenic mechanisms are known. They are best characterized using the fractures, osteonecroses, geodes (FOG) radiological classification. Both their diagnosis and their surgical treatment remain a challenge to the orthopaedic surgeon: some basic surgical principles apply to all of the lesions, such as cartilage debridement and shaving of necrotic tissues, while others will be used depending on the location and size of the lesions as well as the surgeon's experience. Finally, no specific technique appears to be superior to the others. Arthroscopy appears to be the most effective procedure for lesions smaller than 1 cm(2), whereas larger lesions should be filled, either with cancellous bone or with an osteochondral graft or using autogenous chondrocyte implantation. The data available in the literature should also incite orthopaedists to consider the results of surgical management with some modesty, and conservative management should remain among the therapeutic options.
Laffenêtre
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Pellegrin Teaching Hospital Center, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. olivier.laffenetre@chu-bordeaux.fr
D016512:Ankle Injuries / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D001175:Arthrography; D001182:Arthroscopy / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D019902:Chondrocytes / Q000637:transplantation*; D003663:Decision Trees; D005593:Fracture Fixation, Internal; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D010020:Osteonecrosis / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D013628:Talus / Q000293:injuries* / Q000601:surgery*; D014057:Tomography, X-Ray Computed