eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Osteochondral Lesions of the Talus: Workup

Author: Gregory C Berlet, MD, FRCS(C), Clinical Assistant Professor of Orthopedics, Chief of Foot and Ankle Surgery, Department of Orthopedic Surgery, Ohio State University College of Medicine and Public Health
Coauthor(s): Christopher F Hyer, DPM, FACFAS, Foot and Ankle Surgeon, Director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center; Robert D Santrock, MD, Consulting Surgeon, Orthopedic Associates of Meadville, PC
Contributor Information and Disclosures

Updated: Feb 26, 2009

Workup

Imaging Studies

  • Patients with an acute ankle injury with hemarthrosis or substantial tenderness first undergo weightbearing plain radiography (anteroposterior, lateral, and mortise views).
    • Radiographs in varying degrees of plantarflexion and dorsiflexion may help in diagnosing posteromedial and anterolateral lesions, respectively.21
    • Plain radiographs of the opposite ankle should be obtained because of a 10-25% incidence of a contralateral lesion.22
  • MRI can be used to identify occult injuries of the subchondral bone and cartilage that may not be detected with routine radiographs.20,23
    • Classic MRI findings include areas of low signal intensity on T1-weighted images, which suggests sclerosis of the bed of the talus and indicates a chronic lesion.24,25
    • T2-weighted images reveal a rim that represents instability of the osteochondral fragment.24,26
    • Posttreatment MRI depicts a reduction or disappearance of the low signal intensity on T1-weighted images and the rim on T2-weighted images.

Diagnostic Procedures

  • In 1995, Cheng et al developed a comprehensive arthroscopic classification system (see Staging, below).27

Staging

Osteochondral lesions of the talus (OLTs) should be staged. MRI is used to evaluate the quality of the overlying cartilage and to assess the stability of the lesion.28

Several staging systems have been developed on the basis of the first system that Berndt and Harty proposed in 1959.3

Berndt and Harty staging system for osteochondral...

Berndt and Harty staging system for osteochondral lesions of the talus, with grades 1-4.

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Berndt and Harty staging system for osteochondral...

Berndt and Harty staging system for osteochondral lesions of the talus, with grades 1-4.


In 1996, Ferkel modified this classic system and developed another system, based on CT.29

Osteochondral lesions of the talus. Classificatio...

Osteochondral lesions of the talus. Classification system based on CT.

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Osteochondral lesions of the talus. Classificatio...

Osteochondral lesions of the talus. Classification system based on CT.


Osteochondral lesions of the talus. Modified stag...

Osteochondral lesions of the talus. Modified staging system by Loomer et al.

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Osteochondral lesions of the talus. Modified stag...

Osteochondral lesions of the talus. Modified staging system by Loomer et al.


Ferkel's system corresponds to the stages in the Berndt and Harty classification but also considers fragment separation, the presence of subchondral cysts, and the extent of osteonecrosis.

  • MRI is sensitive in detecting bone signal changes. In 1999, Hepple et al devised the following staging system30 :
    • Stage 1 - Articular cartilage damage only
    • Stage 2 - Cartilage injury with underlying fracture
      • Stage 2a - Cartilage injury with underlying fracture and edema
      • Stage 2b - Cartilage injury with underlying fracture but no edema
    • Stage 3 - Detached (rim signal) but not displaced fragment
    • Stage 4 - Displaced fragment
    • Stage 5 - Subchondral cyst formation
  • Cheng et al developed the following arthroscopic staging system27 :
    • Stage A - Smooth, intact, but soft or ballotable; stable
    • Stage B - Rough surface; stable
    • Stage C - Fibrillation/fissuring; stable
    • Stage D - Flap present or bone exposed; unstable
    • Stage E - Loose, undisplaced fragment; unstable
    • Stage F - Displaced fragment; unstable

More on Osteochondral Lesions of the Talus

Overview: Osteochondral Lesions of the Talus
Workup: Osteochondral Lesions of the Talus
Treatment: Osteochondral Lesions of the Talus
Follow-up: Osteochondral Lesions of the Talus
Multimedia: Osteochondral Lesions of the Talus
References
Further Reading
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References

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Further Reading

Related eMedicine topics

 Talus, Fractures

Congenital Vertical Talus

Osteochondritis Dissecans

Ankle Fracture 

 Ankle Arthroscopy

Osteochondral Grafting of Articular Cartilage Injuries

General Principles of Internal Fixation

Clinical guidelines
ACR Appropriateness Criteria® suspected ankle fractures. American College of Radiology - Medical Specialty Society.  1995 (revised 2005).  4 pages.  NGC:004633
 

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Keywords

osteochondral lesions of the talus, talar, talus, talar lesion, talus lesion, osteochondritis dissecans, OCD, subchondral bone fracture, transchondral talus fractures, OLT, knee fracture, elbow fracture, ankle fracture, joint disorder, osteochondral autograft transfer system, autologous chondrocyte transplantation, Cheng classification system, Berndt and Harty classification system, Ferkel classification system

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Contributor Information and Disclosures

Author

Gregory C Berlet, MD, FRCS(C), Clinical Assistant Professor of Orthopedics, Chief of Foot and Ankle Surgery, Department of Orthopedic Surgery, Ohio State University College of Medicine and Public Health
Gregory C Berlet, MD, FRCS(C) is a member of the following medical societies: American Medical Association, American Orthopaedic Foot and Ankle Society, Canadian Medical Association, Canadian Orthopaedic Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher F Hyer, DPM, FACFAS, Foot and Ankle Surgeon, Director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center
Christopher F Hyer, DPM, FACFAS is a member of the following medical societies: American College of Foot and Ankle Surgeons and American Podiatric Medical Association
Disclosure: Nothing to disclose.

Robert D Santrock, MD, Consulting Surgeon, Orthopedic Associates of Meadville, PC
Disclosure: Nothing to disclose.

Medical Editor

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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