Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Osteochondral Lesions of the Talus Workup

  • Author: Christopher F Hyer, DPM, FACFAS; Chief Editor: Anthony E Johnson, MD  more...
 
Updated: Apr 12, 2016
 

Imaging Studies

Radiography

Patients with an acute ankle injury with hemarthrosis or substantial tenderness first undergo weightbearing plain radiography (anteroposterior [AP], lateral, and mortise views). Radiographs in varying degrees of plantarflexion and dorsiflexion may help in diagnosing posteromedial and anterolateral lesions, respectively.[34]  Plain radiographs of the opposite ankle should be obtained because of a 10-25% incidence of a contralateral lesion.[35]

Magnetic resonance imaging

Magnetic resonance imaging (MRI) can be used to identify occult injuries of the subchondral bone and cartilage that may not be detected with routine radiographs.[36, 37] Postoperative MRI evaluation may also be considered to assess healing following surgical management.[38]

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.[39, 40]  T2-weighted images reveal a rim that represents instability of the osteochondral fragment.[39, 41]  Posttreatment MRI depicts a reduction or disappearance of the low signal intensity on T1-weighted images and the rim on T2-weighted images.

Next

Diagnostic Procedures

Arthroscopy may be used as the basis for staging osteochondral lesions of the talus (OLTs). In 1995, Cheng et al developed a comprehensive arthroscopic classification system (see Staging below).[42]

Previous
Next

Staging

OLTs should be staged. MRI is used to evaluate the quality of the overlying cartilage and to assess the stability of the lesion.[43]

Several staging systems have been developed on the basis of the first system that Berndt and Harty proposed in 1959 (see the first image below).[3] In 1996, Ferkel modified this classic system and developed another system, based on comuted tomography (CT) findings.[44] (See the second and third images below.) 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.

Berndt and Harty staging system for osteochondral Berndt and Harty staging system for osteochondral lesions of the talus, with grades 1-4.
Osteochondral lesions of the talus. Classification Osteochondral lesions of the talus. Classification system based on CT.
Osteochondral lesions of the talus. Modified stagi Osteochondral lesions of the talus. Modified staging system by Loomer et al.

MRI is sensitive in detecting bone signal changes. In 1999, Hepple et al devised the following staging system[45] :

  • 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 system[42] :

  • 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
Previous
 
 
Contributor Information and Disclosures
Author

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, American Podiatric Medical Association

Disclosure: Received consulting fee from Wright Medical Technology for consulting; Received royalty from Wright Medical Technology for consulting; Received consulting fee from Amniox for consulting; Received consulting fee from Stryker for none; Received consulting fee from Biomet for none.

Coauthor(s)

Gregory C Berlet, MD, FRCSC Partner, Orthopedic Foot and Ankle Center

Gregory C Berlet, MD, FRCSC 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, Royal College of Physicians and Surgeons of Canada

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Wright Medical Technology; DJO Global; Stryker; Tissue Tech; ZimmerBiomet<br/>Serve(d) as a speaker or a member of a speakers bureau for: Wright Medical Technology; Tissue Tech<br/>Received research grant from: DJO Global<br/>Received research funds from zimmer; Received royalty from SAGE, Wright Medical, Bledsoe Brace, and Stryker; Received stock or stock options from Bledsoe, Tissue Tech, and Wright Medical Technology; .

Robert D Santrock, MD Consulting Surgeon, Orthopedic Associates of Meadville, PC

Disclosure: Nothing to disclose.

Mark A Prissel, DPM Fellow, Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center

Mark A Prissel, DPM is a member of the following medical societies: American College of Foot and Ankle Surgeons, American Podiatric Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Anthony E Johnson, MD Chairman, Department of Orthopaedic Surgery, San Antonio Military Medical Center; Research Director, US Army–Baylor University Doctor of Science Program (Orthopaedic Physician Assistant); Custodian, Military Orthopaedic Trauma Registry; Associate Professor, Department of Surgery, Baylor College of Medicine; Associate Professor, The Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences

Anthony E Johnson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Healthcare Executives, American College of Sports Medicine, American Orthopaedic Association, Arthroscopy Association of North America, Association of Bone and Joint Surgeons, International Military Sports Council, San Antonio Community Action Committee, San Antonio Orthopedic Society, Society of Military Orthopaedic Surgeons, Special Operations Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Society of Military Orthopaedic Surgeons; American Academy of Orthopaedic Surgeons<br/>Received research grant from: Congressionally Directed Medical Research Program<br/>Received income in an amount equal to or greater than $250 from: Nexus Medical Consulting.

Additional Contributors

James K DeOrio, MD Associate Professor of Orthopedic Surgery, Duke University School of Medicine

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society

Disclosure: Received royalty from Merete for other; Received royalty from SBi for other; Received royalty from BioPro for other; Received honoraria from Acumed, LLC for speaking and teaching; Received honoraria from Wright Medical Technology, Inc for speaking and teaching; Received honoraria from SBI for speaking and teaching; Received honoraria from Integra for speaking and teaching; Received honoraria from Datatrace Publishing for speaking and teaching; Received honoraria from Exactech, Inc for speaking a.

Acknowledgements

Thomas H. Lee, MD (Assistant Professor of Orthopedic Surgery, Ohio State University College of Medicine; Consulting Surgeon, Orthopedic Foot and Ankle Center) is gratefully acknowledged for contributions made to this article.

References
  1. Konig F. Uber freie Korper in den gelenken. Dtsch Z Chir. 1888. 27:90-109.

  2. Kappis M. Weitere beitrage zur traumatisch-mechanischen entstehung der "spontanen" knorpela biosungen. Dtsch Z Chir. 1922. 171:13-29.

  3. Berndt AL, Harty M. Transchondral fractures (osteochondritis diseccans) of the talus. J Bone Joint Surg. 1959. 41A:988-1020.

  4. Sugimoto K, Takakura Y, Tohno Y, Kumai T, Kawate K, Kadono K. Cartilage thickness of the talar dome. Arthroscopy. 2005 Apr. 21 (4):401-4. [Medline].

  5. Bruns J, Rosenbach B, Kahrs J. [Etiopathogenetic aspects of medial osteochondrosis dissecans tali]. Sportverletz Sportschaden. 1992 Jun. 6(2):43-9. [Medline].

  6. Athanasiou KA, Niederauer GG, Schenck RC Jr. Biomechanical topography of human ankle cartilage. Ann Biomed Eng. 1995 Sep-Oct. 23(5):697-704. [Medline].

  7. Shepherd DE, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis. 1999 Jan. 58(1):27-34. [Medline].

  8. Treppo S, Koepp H, Quan EC. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. J Orthop Res. 2000 Sep. 18(5):739-48. [Medline].

  9. Christensen JC, Driscoll HL, Tencer AF. 1994 William J. Stickel Gold Award. Contact characteristics of the anklejoint. Part 2. The effects of talar dome cartilage defects. J Am Podiatr Med Assoc. 1994 Nov. 84(11):537-47. [Medline].

  10. Assenmacher JA, Kelikian AS, Gottlob C. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Foot Ankle Int. 2001 Jul. 22(7):544-51. [Medline].

  11. Anderson IF, Crichton KJ, Grattan-Smith T. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am. 1989 Sep. 71(8):1143-52. [Medline].

  12. Baker CL, Andrews JR, Ryan JB. Arthroscopic treatment of transchondral talar dome fractures. Arthroscopy. 1986. 2(2):82-7. [Medline].

  13. Parisien JS. Arthroscopic treatment of osteochondral lesions of the talus. Am J Sports Med. 1986 May-Jun. 14(3):211-7. [Medline].

  14. Pettine KA, Morrey BF. Osteochondral fractures of the talus. A long-term follow-up. J Bone Joint Surg Br. 1987 Jan. 69(1):89-92. [Medline].

  15. Van Buecken K, Barrack RL, Alexander AH. Arthroscopic treatment of transchondral talar dome fractures. Am J Sports Med. 1989 May-Jun. 17(3):350-5; discussion 355-6. [Medline].

  16. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 1986 Jul. 68(6):862-5. [Medline].

  17. Alexander AH, Lichtman DM. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up. J Bone Joint Surg Am. 1980. 62(4):646-52. [Medline].

  18. Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg Am. 1980 Jan. 62(1):97-102. [Medline].

  19. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985 Jan-Feb. 5(4):165-85. [Medline].

  20. Woods K, Harris I. Osteochondritis dissecans of the talus in identical twins. J Bone Joint Surg Br. 1995 Mar. 77(2):331. [Medline].

  21. [Guideline] Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010 May-Jun. 49 (3 Suppl):S1-19. [Medline].

  22. Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int. 2000 Feb. 21(2):119-26. [Medline].

  23. Shearer C, Loomer R, Clement D. Nonoperatively managed stage 5 osteochondral talar lesions. Foot Ankle Int. 2002 Jul. 23(7):651-4. [Medline].

  24. Donnenwerth MP, Roukis TS. Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. Arthroscopy. 2012 Dec. 28(12):1902-7. [Medline].

  25. Choi WJ, Choi GW, Kim JS, Lee JW. Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Am J Sports Med. 2013 Jan. 41(1):126-33. [Medline].

  26. Choi WJ, Park KK, Kim BS, Lee JW. Osteochondral lesion of the talus: is there a critical defect size for poor outcome?. Am J Sports Med. 2009 Oct. 37(10):1974-80. [Medline].

  27. Al-Shaikh RA, Chou LB, Mann JA. Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int. 2002 May. 23(5):381-9. [Medline].

  28. Hangody L, Kish G, Modis L. Mosaicplasty for the treatment of osteochondritis dissecans of the talus:two to seven year results in 36 patients. Foot Ankle Int. 2001 Jul. 22(7):552-8. [Medline].

  29. Brittberg M, Lindahl A, Nilsson A. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994. 331(14):889-95. [Medline].

  30. Giannini S, Vannini F, Buda R. Osteoarticular grafts in the treatment of OCD of the talus: mosaicplasty versus autologous chondrocyte transplantation. Foot Ankle Clin. 2002 Sep. 7(3):621-33. [Medline].

  31. Wiewiorski M, Miska M, Nicolas G, Valderrabano V. Revision of Failed Osteochondral Autologous Transplantation Procedure for Chronic Talus Osteochondral Lesion With Iliac Crest Graft and Autologous Matrix-Induced Chondrogenesis: A Case Report. Foot Ankle Spec. 2012 Jan 31. [Medline].

  32. Niemeyer P, Salzmann G, Schmal H, Mayr H, Südkamp NP. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc. 2012 Sep. 20(9):1696-703. [Medline].

  33. Murawski CD, Kennedy JG. Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2013 Jun 5. 95(11):1045-54. [Medline].

  34. Stroud CC, Marks RM. Imaging of osteochondral lesions of the talus. Foot Ankle Clin. 2000 Mar. 5(1):119-33. [Medline].

  35. Stone JW. Osteochondral Lesions of the Talar Dome. J Am Acad Orthop Surg. 1996 Mar. 4(2):63-73. [Medline].

  36. Loredo R, Sanders TG. Imaging of osteochondral injuries. Clin Sports Med. 2001 Apr. 20(2):249-78. [Medline].

  37. Elias I, Jung JW, Raikin SM, Schweitzer MW, Carrino JA, Morrison WB. Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems. Foot Ankle Int. 2006 Mar. 27(3):157-66. [Medline].

  38. Cuttica DJ, Shockley JA, Hyer CF, Berlet GC. Correlation of MRI edema and clinical outcomes following microfracture of osteochondral lesions of the talus. Foot Ankle Spec. 2011 Oct. 4(5):274-9. [Medline].

  39. Higashiyama I, Kumai T, Takakura Y. Follow-up study of MRI for osteochondral lesion of the talus. Foot Ankle Int. 2000 Feb. 21(2):127-33. [Medline].

  40. Mesgarzadeh M, Sapega AA, Bonakdarpour A, et al. Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging. Radiology. 1987 Dec. 165(3):775-80. [Medline].

  41. De Smet AA, Fisher DR, Burnstein MI. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol. 1990 Mar. 154(3):555-8. [Medline].

  42. Cheng MS, Ferkel RD, Applegate GR. Osteochondral lesion of the talus: A radiologic and surgical comparison. Paper presented at: Annual Meeting of the Academy of Orthopaedic Surgeons, New Orleans, La. February, 1995.

  43. Lee KB, Bai LB, Park JG, Yoon TR. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2008 Sep 9. [Medline].

  44. Ferkel RD. Articular surface defects, loose bodies, and osteophytes. Arthroscopic Surgery: The Foot and Ankle. Philadelphia, Pa: Lippincott-Raven; 1996. 145.

  45. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999 Dec. 20(12):789-93. [Medline].

  46. van Bergen CJ, van Eekeren IC, Reilingh ML, Sierevelt IN, van Dijk CN. Treatment of osteochondral defects of the talus with a metal resurfacing inlay implant after failed previous surgery: a prospective study. Bone Joint J. 2013 Dec. 95-B(12):1650-5. [Medline].

  47. Kok AC, Dunnen Sd, Tuijthof GJ, van Dijk CN, Kerkhoffs GM. Is technique performance a prognostic factor in bone marrow stimulation of the talus?. J Foot Ankle Surg. 2012 Nov-Dec. 51(6):777-82. [Medline].

  48. Kim YS, Park EH, Kim YC, Koh YG. Clinical outcomes of mesenchymal stem cell injection with arthroscopic treatment in older patients with osteochondral lesions of the talus. Am J Sports Med. 2013 May. 41(5):1090-9. [Medline].

  49. Deol PP, Cuttica DJ, Smith WB, Berlet GC. Osteochondral lesions of the talus: size, age, and predictors of outcomes. Foot Ankle Clin. 2013 Mar. 18(1):13-34. [Medline].

  50. Smyth NA, Murawski CD, Haleem AM, Hannon CP, Savage-Elliott I, Kennedy JG. Establishing proof of concept: Platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus. World J Orthop. 2012 Jul 18. 3(7):101-8. [Medline]. [Full Text].

  51. Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, et al. Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc. 2011 Dec 29. [Medline].

  52. Cohen B, Anderson R, Davis WH. Chevron-type transmalleolar osteotomy: an approach to medial talar dome lesions. Techniques in Foot and Ankle Surgery. 2002/12. 1(2):158-62.

  53. Deland JT, Young K. Medial approaches to osteochondral lesions of the talus without medial malleolar osteotomy. San Diego: American Orthopaedic Foot and Ankle Society; 2001: 75.

  54. Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, et al. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med. 2008 Sep. 36(9):1750-62. [Medline].

  55. Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B. Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Am J Sports Med. 2008 May. 36(5):873-80. [Medline].

  56. Savva N, Jabur M, Davies M, Saxby T. Osteochondral lesions of the talus: results of repeat arthroscopic debridement. Foot Ankle Int. 2007 Jun. 28(6):669-73. [Medline].

  57. Tasto JP. Arthroscopy of the subtalar joint and arthroscopic subtalar arthrodesis. Instr Course Lect. 2006. 55:555-64. [Medline].

  58. Bryant DD 3rd, Siegel MG. Osteochondritis dissecans of the talus: a new technique for arthroscopic drilling. Arthroscopy. 1993. 9(2):238-41. [Medline].

  59. Kumai T, Takakura Y, Higashiyama I. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 1999 Sep. 81(9):1229-35. [Medline].

  60. Taranow WS, Bisignani GA, Towers JD. Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int. 1999 Aug. 20(8):474-80. [Medline].

  61. Berlet GC, Mascia A, Miniaci A. Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). Arthroscopy. 1999 Apr. 15(3):312-6. [Medline].

  62. Kumai T, Takakura Y, Kitada C, Tanaka Y, Hayashi K. Fixation of osteochondral lesions of the talus using cortical bone pegs. J Bone Joint Surg Br. 2002 Apr. 84(3):369-74. [Medline].

  63. Gross AE, Agnidis Z, Hutchison CR. Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation. Foot Ankle Int. 2001 May. 22(5):385-91. [Medline].

  64. Kim CW, Jamali A, Tontz W. Treatment of post-traumatic ankle arthrosis with bipolar tibiotalar osteochondral shell allografts. Foot Ankle Int. 2002 Dec. 23(12):1091-102. [Medline].

  65. Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy. 2006 Oct. 22(10):1085-92. [Medline].

  66. Haasper C, Zelle BA, Knobloch K, Jagodzinski M, Citak M, Lotz J, et al. No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus. Arch Orthop Trauma Surg. 2008 May. 128(5):499-504. [Medline].

  67. Matricali GA, Dereymaeker GP, Luyten FP. Donor site morbidity after articular cartilage repair procedures: a review. Acta Orthop Belg. 2010 Oct. 76 (5):669-74. [Medline].

  68. Gautier E, Kolker D, Jakob RP. Treatment of cartilage defects of the talus by autologous osteochondralgrafts. J Bone Joint Surg Br. 2002 Mar. 84(2):237-44. [Medline].

  69. Sammarco GJ, Makwana NK. Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int. 2002 Aug. 23(8):693-8. [Medline].

  70. Leumann A, Valderrabano V, Wiewiorski M, Barg A, Hintermann B, Pagenstert G. Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure. Knee Surg Sports Traumatol Arthrosc. 2013 Jul 13. [Medline].

  71. Niemeyer P, Salzmann G, Schmal H, Mayr H, Südkamp NP. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc. 2011 Oct 30. [Medline].

  72. Koulalis D, Schultz W, Heyden M. Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop. 2002 Feb. (395):186-92. [Medline].

  73. Giannini S, Buda R, Grigolo B. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int. 2001 Jun. 22(6):513-7. [Medline].

  74. Browne JE, Anderson AF, Micheli LJ. Five-year multicenter outcome of autologous chondrocyte implantation of the knee: results in the first 100 consecutive patients. J Am Acad Orthop Surg. 2002.

  75. McNickle AG, Provencher MT, Cole BJ. Overview of existing cartilage repair technology. Sports Med Arthrosc. 2008 Dec. 16(4):196-201. [Medline].

  76. Coetzee JC, Giza E, Schon LC, Berlet GC, Neufeld S, Stone RM, et al. Treatment of osteochondral lesions of the talus with particulated juvenile cartilage. Foot Ankle Int. 2013 Sep. 34(9):1205-11. [Medline].

  77. Kruse DL, Ng A, Paden M, Stone PA. Arthroscopic De Novo NT(®) juvenile allograft cartilage implantation in the talus: a case presentation. J Foot Ankle Surg. 2012 Mar-Apr. 51(2):218-21. [Medline].

  78. Hatic SO 2nd, Berlet GC. Particulated juvenile articular cartilage graft (DeNovo NT Graft) for treatment of osteochondral lesions of the talus. Foot Ankle Spec. 2010 Dec. 3(6):361-4. [Medline].

  79. Lee DH, Lee KB, Jung ST, Seon JK, Kim MS, Sung IH. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med. 2012 Sep. 40(9):2023-8. [Medline].

  80. Kim YS, Park EH, Kim YC, Koh YG, Lee JW. Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteochondral lesions of the talus: second-look arthroscopic evaluation. Am J Sports Med. 2012 Dec. 40(12):2709-19. [Medline].

  81. Santrock RD, Buchanan MM, Lee TH, Berlet GC. Osteochondral lesions of the talus. Foot Ankle Clin. 2003 Mar. 8(1):73-90, viii. [Medline].

  82. Schuman L, Struijs PA, van Dijk CN. Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br. 2002 Apr. 84(3):364-8. [Medline].

  83. Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. Knee Surg Sports Traumatol Arthrosc. 2013 Aug. 21(8):1925-30. [Medline].

 
Previous
Next
 
Berndt and Harty staging system for osteochondral lesions of the talus, with grades 1-4.
Osteochondral lesions of the talus. Modified staging system by Loomer et al.
Osteochondral lesions of the talus. Classification system based on CT.
Osteochondral lesions of the talus.
Osteochondral lesions of the talus. Illustration of percutaneous transmalleolar drilling.
Osteochondral lesions of the talus. Cannulated drill placed over a guidewire.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.