title: Treatment of osteochondral defects of the talus in children.
abstract: OBJECTIVE
  Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects in skeletally immature children.
  
  
  METHODS
  Thirty-six (97%) of 37 eligible patients with a symptomatic primary osteochondral talar defect were evaluated after a median follow-up of 4 years (range 1-12 years). Clinical assessment included the Berndt and Harty outcome question, Ogilvie-Harris score, Visual Analog Scale pain score (at rest, during walking and during running), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the SF-36. Weight-bearing radiographs were compared with preoperative radiographs with the use of an ankle osteoarthritis classification system.
  
  
  RESULTS
  Ninety-two per cent of the initially conservatively treated children [mean age 13 years (SD 2)] were eventually scheduled to undergo surgery. After fixation of the fragment, seven cases (78%) reported a good Berndt and Harty outcome, and two cases (22%) a fair outcome; the median AOFAS score was 95.0 (range 77-100). After debridement and bone marrow stimulation, 13 cases (62%) reported a good Berndt and Harty outcome, three cases (14%) a fair outcome, and five cases (24%) a poor outcome; the median AOFAS score was 95.0 (range 45-100). No signs of degenerative changes were seen in both groups at follow-up.
  
  
  CONCLUSIONS
  Fixation and debridement and bone marrow stimulation of an osteochondral talar defect are both good surgical options after failed conservative treatment.
  
  
  METHODS
  Retrospective case series, Therapeutic, Level IV.
authors.affiliation: Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Reilingh
authors.forename: G M M J
authors.initials: GM
authors.lastname: Kerkhoffs
authors.forename: C J A
authors.initials: CJ
authors.lastname: Telkamp
authors.forename: P A A
authors.initials: PA
authors.lastname: Struijs
authors.forename: C N
authors.initials: CN
authors.lastname: van Dijk
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D054544:Arthroplasty, Subchondral; D002648:Child; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D010008:Osteochondritis Dissecans / Q000601:surgery* / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D013628:Talus / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
references.citation: J Bone Joint Surg Br. 2002 Mar;84(2):237-44
references.pmid: 11922365
references.citation: Foot Ankle Clin. 2004 Dec;9(4):737-44, vi
references.pmid: 15498704
references.citation: Clin Orthop Relat Res. 2009 Dec;467(12):3307-20
references.pmid: 19449082
references.citation: J Bone Joint Surg Am. 1993 Aug;75(8):1233-42
references.pmid: 8354685
references.citation: J Clin Epidemiol. 1998 Nov;51(11):1055-68
references.pmid: 9817123
references.citation: J Pediatr Orthop. 2003 Sep-Oct;23(5):617-25
references.pmid: 12960624
references.citation: Clin Orthop Relat Res. 1984 Dec;(191):121-8
references.pmid: 6499303
references.citation: J Am Acad Orthop Surg. 2005 May-Jun;13(3):152-8
references.pmid: 15938604
references.citation: Arthroscopy. 2003 Apr;19(4):360-7
references.pmid: 12671618
references.citation: J Foot Ankle Surg. 2007 Mar-Apr;46(2):65-74
references.pmid: 17331864
references.citation: Arch Orthop Trauma Surg. 1992;112(1):23-7
references.pmid: 1482614
references.citation: J Bone Joint Surg Am. 1959 Sep;41-A:988-1020
references.pmid: 13849029
references.citation: J Bone Joint Surg Br. 1997 Mar;79(2):280-4
references.pmid: 9119857
references.citation: Foot Ankle Clin. 2002 Sep;7(3):651-67
references.pmid: 12512415
references.citation: J Bone Joint Surg Br. 1995 Mar;77(2):331
references.pmid: 7706361
references.citation: Knee Surg Sports Traumatol Arthrosc. 2010 Feb;18(2):238-46
references.pmid: 19859695
references.citation: Clin Orthop Relat Res. 1979 Oct;(144):264-8
references.pmid: 535235
references.citation: J Bone Joint Surg Am. 2013 Mar 20;95(6):519-25
references.pmid: 23515986
references.citation: Foot Ankle Int. 2001 May;22(5):380-4
references.pmid: 11428755
references.citation: Zentralbl Chir. 2004 Dec;129(6):470-5
references.pmid: 15616910
references.citation: J Clin Epidemiol. 1998 Nov;51(11):903-12
references.pmid: 9817107
references.citation: Foot Ankle Int. 2000 Feb;21(2):119-26
references.pmid: 10694023
references.citation: J Pediatr Orthop. 1998 May-Jun;18(3):328-32
references.pmid: 9600558
references.citation: J Bone Joint Surg Br. 1993 May;75(3):437-40
references.pmid: 8496216
references.citation: Arthroscopy. 2012 Jul;28(7):985-92
references.pmid: 22342200
references.citation: Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):570-80
references.pmid: 20151110
references.citation: Rofo. 1981 Sep;135(3):357
references.pmid: 6212345
references.citation: Arthroscopy. 1999 Mar;15(2):197-202
references.pmid: 10210079
references.citation: J Bone Joint Surg Br. 2002 Apr;84(3):369-74
references.pmid: 12002495
references.citation: Knee Surg Sports Traumatol Arthrosc. 2012 Sep;20(9):1696-703
references.pmid: 22037894
references.citation: Foot Ankle Int. 1994 Jul;15(7):349-53
references.pmid: 7951968
references.citation: Knee Surg Sports Traumatol Arthrosc. 2012 Aug;20(8):1420-31
references.pmid: 22669362
references.citation: J Bone Joint Surg Br. 2002 Apr;84(3):364-8
references.pmid: 12002494
references.citation: Orthop Traumatol Surg Res. 2011 Jun;97(4):461-2; author reply 463
references.pmid: 21596641
references.citation: J Bone Joint Surg Am. 1999 Sep;81(9):1229-35
references.pmid: 10505519