title: Treatment of post-traumatic osteochondral lesions of the talus: a four-step approach.
abstract: OBJECTIVE
  The purpose of this retrospective study was to assess the treatment of post-traumatic osteochondral lesions (OCLs) of the ankle with a four-step protocol.
  
  
  METHODS
  Thirty-eight patients with at least one MRI-documented OCL of the ankle were treated from 2004 to 2010. Median age at surgery was 39 years (range: 18-52). Mean lesion size was 1.0 cm(2) (SD: 0.2). All patients underwent a four-step surgical procedure including synovectomy, debridement and microfractures of the OCL, capsular shrinkage, and bracing and non-weightbearing for 21 days. Clinical assessment included objective examination, the AOFAS ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and Sefton articular stability scale. MRI scans were taken 18 months after surgery in all patients.
  
  
  RESULTS
  Follow-up examination at an average of 4 years (SD: 1.1) after surgery showed significant improvement of all variables compared to pre-operative values (P < 0.05). Most patients rated their outcome as good/excellent. MRI scans taken 18 months after surgery documented completely repaired lesion in 27 ankles, slight bone marrow oedema with partially repaired defect in 9 patients, and visible defect in 2 ankles.
  
  
  CONCLUSIONS
  Based on the present results, we propose a comprehensive four-step protocol as a safe and clinically effective treatment option in patients with post-traumatic OCLs of the ankle.
authors.affiliation: U.O.S.D. Chirurgia Articolare Mininvasiva (Minimally Invasive Articular Surgery Unit), Istituto Ortopedico G. Pini, Milan, Italy. alberto.ventura@doctoral.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Ventura
authors.forename: Clara
authors.initials: C
authors.lastname: Terzaghi
authors.forename: Claudio
authors.initials: C
authors.lastname: Legnani
authors.forename: Enrico
authors.initials: E
authors.lastname: Borgo
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D054544:Arthroplasty, Subchondral; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D003646:Debridement; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000074402:Synovectomy; D013628:Talus / Q000293:injuries* / Q000601:surgery*; D055815:Young Adult