title: Natural history of nonoperatively treated osteochondral lesions of the talus.
abstract: BACKGROUND
  We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time.
  
  
  METHODS
  Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI).
  
  
  RESULTS
  At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in staging or lesion size. Pain at time of follow-up correlated with the depth of the lesion at initial MRI (P < .05) and with subchondral cyst formation and presence or change of bone marrow edema at follow-up MRI (P < .05).
  
  
  CONCLUSIONS
  Minimally symptomatic OLTs did not appear to progress or worsen over time when treated nonoperatively.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Balgrist Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Klammer
authors.affiliation: Balgrist Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Gerardo J
authors.initials: GJ
authors.lastname: Maquieira
authors.affiliation: Balgrist Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Silke
authors.initials: S
authors.lastname: Spahn
authors.affiliation: Balgrist Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Vigfusson
authors.affiliation: Balgrist Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Zanetti
authors.affiliation: Balgrist Hospital, University of Zurich, Zurich, Switzerland norman.espinosa@balgrist.ch.
authors.forename: Norman
authors.initials: N
authors.lastname: Espinosa
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries; D058070:Asymptomatic Diseases; D001845:Bone Cysts / Q000473:pathology; D002358:Cartilage, Articular / Q000293:injuries*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013628:Talus; D055815:Young Adult
keywords: natural history; nonoperative; osteochondral lesion; talus