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Sections Osteochondral Lesions of the Talus
- Overview
- Presentation
- Workup
- Treatment
- Media Gallery
- References
History
In most cases, the mechanism of injury for an osteochondral lesion of the talus (OLT) is an inversion injury with simultaneous or preexisting disruption of the lateral ligamentous complex. Patients typically present with chronic ankle pain along with intermittent swelling and, possibly, weakness, stiffness, instability, and giving way.
Physical Examination
Upon physical examination, assess joint laxity with the anterior drawer test, and assess strength by comparison with the contralateral ankle. Physical examination findings of joint laxity are uncommon. Palpation may reveal tenderness behind the medial malleolus when the ankle is dorsiflexed, indicating a posteromedial lesion. Anterolateral lesions may be tender when the anterolateral ankle joint is palpated with the joint in maximal plantarflexion.
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Gautier E, Kolker D, Jakob RP. Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br. 2002 Mar. 84 (2):237-44. [QxMD MEDLINE Link].
Sammarco GJ, Makwana NK. Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int. 2002 Aug. 23 (8):693-8. [QxMD MEDLINE Link].
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Berndt and Harty staging system for osteochondral lesions of the talus, with grades 1-4.
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Osteochondral lesions of the talus. Modified staging system by Loomer et al.
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Osteochondral lesions of the talus. Classification system based on CT.
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Osteochondral lesions of the talus.
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Osteochondral lesions of the talus. Illustration of percutaneous transmalleolar drilling.
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Osteochondral lesions of the talus. Cannulated drill placed over a guidewire.
Tables
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.
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: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: NovaStep, Inc.<br/>Received income in an amount equal to or greater than $250 from: NovaStep, Inc.
Gregory C Berlet, MD, FRCSC, FAOAO Managing Partner, Orthopedic Foot and Ankle Center
Gregory C Berlet, MD, FRCSC, FAOAO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Canadian Orthopaedic Association, College of Physicians and Surgeons of Ontario, Ohio Orthopaedic Society, Royal College of Physicians and Surgeons of Canada
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: DJO Global; Stryker; Tissue Tech; ZimmerBiomet, Artelon, Ossio, BBHP, Medline, Paragon28, Restor3d<br/>Serve(d) as a speaker or a member of a speakers bureau for: Tissue tech, Artelon, Ossio, Medline, DJO, Stryker<br/> Received royalty from ZimmerBiomet; Stryker; Medline; Artelon; Ossio.
Robert D Santrock, MD Consulting Surgeon, Orthopedic Associates of Meadville, PC
Disclosure: Nothing to disclose.
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.
Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine
Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.
James K DeOrio, MD Professor of Orthopedics, Director, Duke Foot and Ankle Fellowship, Duke University Medical Center, Duke University School of Medicine; Associate Professor, Mayo Clinic College of Medicine; Clinical Assistant Professor, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Association of Graduates, United States Air Force Academy, Doctors Mayo Society, Mayo Clinic Alumni Association, Society of Air Force Clinical Surgeons, Society of Military Orthopaedic Surgeons
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Exactech; Treace Medical; Additive; Mirus; Crossroads Orthopedics<br/>Serve(d) as a speaker or a member of a speakers bureau for: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics<br/>Received income in an amount equal to or greater than $250 from: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics.
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.
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Sections Osteochondral Lesions of the Talus
- Overview
- Presentation
- Workup
- Treatment
- Media Gallery
- References
