Ankle Sprain and Medial Osteochondral Lesion of the Talus: Report of a Case with Unclear Symptomatology and the Value of Open Curettage and Drilling in the Presence of a Cartilage Defect and Subchondral Osteosclerosis

X. Crevoisier; N. Theumann; A. Boubaker; F. Chevalley

doi:10.1055/s-2005-836329

Osteosynthesis and Trauma Care, Inhaltsverzeichnis

Osteosynthesis and Trauma Care 2005; 13(2): 118-124
DOI: 10.1055/s-2005-836329

Case Report

Ankle Sprain and Medial Osteochondral Lesion of the Talus: Report of a Case with Unclear Symptomatology and the Value of Open Curettage and Drilling in the Presence of a Cartilage Defect and Subchondral Osteosclerosis

X. Crevoisier¹ , N. Theumann² , A. Boubaker³ , F. Chevalley¹

¹Service Universitaire d'Orthopédie et de Traumatologie de l'Appareil Moteur, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
²Service Universitaire de Radiodiagnostic et Radiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
³Service Universitaire de Médecine Nucléaire, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

Abstract

A case of medial posttraumatic osteochondral lesion of the talus (OCLT) in a 25-year-old patient is reported. The potentially unclear symptomatology associated with this type of lesion is emphasized, and the imaging procedures as well as the classification systems based on these procedures are reviewed. The value of open surgery for curettage and drilling of a large zone of chondral defect with underlying osteosclerosis of the medial talar dome is evaluated. Compared to standard radiography and bone scan, magnetic resonance imaging (MRI) appears to correlate well with the intraoperative findings and is therefore useful as both a diagnostic and a prognostic tool. Our observations suggest that, even when a large zone of osteosclerosis underlies a medial chondral defect, drilling alone of this zone - after curettage of the detached cartilage - may be sufficient to lead to a good functional result. Bleeding out the healthy underlying cancellous bone through the drilling holes made in the sclerotic zone may be sufficient to restore part of the vitality and stability of the medial talar dome and is less invasive than osteochondral grafting.

Key words

talus - osteochondral lesion - ankle sprain

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Referenzen

References

1 Al-Shaikh R A, Chou L B, Mann J A, Dreeben S M, Prieskorn D. Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int. 2002; 23 381-389
2 Anderson I F, Crichton K J, Grattan-Smith T, Cooper R A, Brazier D. Osteochondral fractures of the dome of the talus. J Bone Joint Surg [Am]. 1989; 71 1143-1152
3 Assenmacher J A, Kelikian A S, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Foot Ankle Int. 2001; 22 544-551
4 Bauer M, Jonsson K, Linden B. Osteochondritis dissecans of the ankle. A 20-year follow-up study. J Bone Joint Surg [Br]. 1987; 69 93-96
5 Berndt A L, Harty M. Transchondral fractures of the talus. J Bone Joint Surg [Am]. 1959; 41 988-1020
6 Bohndorf K. Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Eur Radiol. 1998; 8 103-112
7 Bohndorf K. Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures). Skeletal Radiol. 1999; 28 545-560
8 Bohndorf K, Imhof H, Schibany N. [Diagnostic imaging of acute and chronic osteochondral lesions of the talus]. Orthopäde. 2001; 30 12-19
9 Borrelli A H, Arenson D J. Centrally located osteochondral fractures. J Am Podiatr Med Assoc. 1988; 78 526-528
10 Bosien W R, Staples O S, Russel S W. Residual disability following ankle sprains. J Bone Joint Surg [Am]. 1955; 37 1237-1243
11 Campbell C J, Ranawat C S. Osteochondritis dissecans: The question of etiology. J Trauma. 1966; 6 201-221
12 Canale S T, Belding R H. Osteochondral lesions of the talus. J Bone Joint Surg [Am]. 1980; 62 97-102
13 Chang E, Lenczner E. Osteochondritis dissecans of the talar dome treated with an osteochondral autograft. Can J Surg. 2000; 43 217-221
14 Chen D S, Wertheimer S J. Centrally located osteochondral fracture of the talus. J Foot Surg. 1992; 31 134-140
15 De Smet A A, Fisher D R, Burnstein M I, Graf B K, Lange R H. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol. 1990; 154 555-558
16 Dipaola J D, Nelson D W, Colville M R. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy. 1991; 7 101-104
17 Draper S D, Fallat L M. Autogenous bone grafting for the treatment of talar dome lesions. J Foot Ankle Surg. 2000; 39 15-23
18 Flick A B, 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; 5 165-185
19 Gautier E, Kolker D, Jakob R P. Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg [Br]. 2002; 84 237-244
20 Hangody L, Kish G, Modis L, Szerb I, Gaspar L, Dioszegi Z, Kendik Z. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int. 2001; 22 552-558
21 Hepple S, Winson I G, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999; 20 789-793
22 Higashiyama I, Kumai T, Takakura Y, Tamail S. Follow-up study of MRI for osteochondral lesion of the talus. Foot Ankle Int. 2000; 21 127-133
23 Hutchinson B L, Wardle D J. Diagnosis and treatment of talar tilt and its relationship to the occurrence of transchondral fractures: a retrospective study. J Foot Surg. 1991; 30 151-155
24 Jarde O, Trinquier-Lautard J L, Garate F, de Lestang M, Vives P. [Osteochondral lesions of the talar dome: surgical treatment in a series of 30 cases]. Rev Chir Orthop Reparatrice Appar Mot. 2000; 86 608-615
25 Josten C, Rose T. [Acute and chronic osteochondral lesions of the talus]. Orthopäde. 1999; 28 500-508
26 Kappis M. Weitere Beiträge zur traumatisch-mechanischen Entstehung der „spontanen” Knorpelablösung (sogenannte Osteochondritis Dissecans). Dtsche Z Chir. 1922; 171 13
27 Kelberine F, Frank A. Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. Arthroscopy. 1999; 15 77-84
28 Kitaoka H B, Alexander I J, Adelaar R S, Nunley J A, Myerson M S, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994; 15 349-353
29 Kumai T, Takakura Y, Higashiyama I, Tamai S. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg [Am]. 1999; 81 1229-1235
30 Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T. Osteochondral lesions of the talus. Am J Sports Med. 1993; 21 13-19
31 Loredo R, Sanders T G. Imaging of osteochondral injuries. Clin Sports Med. 2001; 20 249-278
32 Mandracchia V J, Buddecke D E, Giesking J L. Osteochondral lesions of the talar dome. A comprehensive review with retrospective study. Clin Podiatr Med Surg. 1999; 16 725-742
33 Mendicino R W, Lee M S, Grossman J P, Shromoff P J. Oblique medial malleolar osteotomy for the management of talar dome lesions. J Foot Ankle Surg. 1998; 37 516-523
34 Monro A. Part of the cartilage of the joint, separated and ossified. Medical essays and observations. Edinburgh. 1856; 4 305-306
35 Mulfinger G L, Trueta J. The blood supply of the talus. J Bone Joint Surg [Br]. 1970; 52 160-167
36 Ogilvie-Harris D J, Sarrosa E A. Arthroscopic treatment after previous failed open surgery for osteochondritis dissecans of the talus. Arthroscopy. 1999; 15 809-812
37 Parisien J S. Arthroscopic treatment of osteochondral lesions of the talus. Am J Sports Med. 1986; 14 211-217
38 Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg [Am]. 1986; 68 862-865
39 Seil R, Rupp S, Pape D, Dienst M, Kohn D. [Approach to open treatment of osteochondral lesions of the talus]. Orthopäde. 2001; 30 47-52
40 Shea M P, Manoli A. Osteochondral lesions of the talar dome. Foot Ankle. 1993; 14 48-55
41 Steinhagen J, Niggemeyer O, Bruns J. [Etiology and pathogenesis of osteochondrosis dissecans tali]. Orthopäde. 2001; 30 20-27
42 Thompson J P, Loomer R L. Osteochondral lesions of the talus in a sports medicine clinic. A new radiographic technique and surgical approach. Am J Sports Med. 1984; 12 460-463
43 Tol J L, Struijs P A, Bossuyt P M, Verhagen R A, Dijk C N van. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int. 2000; 21 119-126
44 Yvars M F. Osteochondral fractures of the dome of the talus. Clin Orthop. 1976; 114 185-191

Dr. Xavier Crevoisier

Hôpital Orthopédique de la Suisse Romande

Pierre-Decker 4

1005 Lausanne

Switzerland

Telefon: +41/21/5 45 05 01

Fax: +41/21/5 45 06 25

eMail: xavier.crevoisier@hospvd.ch