Información Específica - Cartílago - Treatment Of Osteochondral Lesions Of The Talus (A Systematic Review)

Knee Surg Sports Traumatol Arthrosc (2010) 18:238–246
DOI 10.1007/s00167-009-0942-6

ANKLE

Treatment of osteochondral lesions of the talus:
a systematic review
Maartje Zengerink • Peter A. A. Struijs •
Johannes L. Tol • Cornelis Niek van Dijk

Received: 4 June 2009 / Accepted: 14 September 2009 / Published online: 27 October 2009
Ó The Author(s) 2009. This article is published withopen access at Springerlink.com

Abstract The aim of this study was to summarize all
eligible studies to compare the effectiveness of treatment
strategies for osteochondral defects (OCD) of the talus.
Electronic databases from January 1966 to December 2006
were systematically screened. The proportion of the patient
population treated successfully was noted, and percentages
were calculated.For each treatment strategy, study size
weighted success rates were calculated. Fifty-two studies
described the results of 65 treatment groups of treatment
strategies for OCD of the talus. One randomized clinical
trial was identified. Seven studies described the results of
non-operative treatment, 4 of excision, 13 of excision and
curettage, 18 of excision, curettage and bone marrowstimulation (BMS), 4 of an autogenous bone graft, 2 of
transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation.
OATS, BMS and ACI scored success rates of 87, 85 and
76%, respectively. Retrograde drilling and fixation scored

M. Zengerink (&) Á P. A. A. Struijs Á C. N. van Dijk
Department ofOrthopaedic Surgery, Academic Medical Centre,
University of Amsterdam, P.O. Box 22660,
1100 DD Amsterdam, The Netherlands
e-mail: m.zengerink@amc.uva.nl
P. A. A. Struijs
e-mail: p.a.struijs@amc.uva.nl
C. N. van Dijk
e-mail: c.n.vandijk@amc.uva.nl
J. L. Tol
Sports Medicine Department,
The Hague Medical Centre Antoniushove,
P.O. Box 411, 2260 AK Leidschendam,
The Netherlands
e-mail:h.tol@mchaaglanden.nl

123

88 and 89%, respectively. Together with the newer techniques OATS and ACI, BMS was identified as an effective
treatment strategy for OCD of the talus. Because of the
relatively high cost of ACI and the knee morbidity seen in
OATS, we conclude that BMS is the treatment of choice
for primary osteochondral talar lesions. However, due to
great diversity in the articles andvariability in treatment
results, no definitive conclusions can be drawn. Further
sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should
be initiated to compare the outcome of surgical strategies
for OCD of the talus.
Keywords Ankle Á Osteochondral lesion Á Defect Á
Talus Á Systematic review Á Arthroscopy

Introduction
Symptomaticosteochondral ankle defects often require
surgical treatment. An osteochondral ankle defect is a lesion
of the talar cartilage and subchondral bone mostly caused
by a single or multiple traumatic events, leading to partial or
complete detachment of the fragment. The defects cause
deep ankle pain associated with weightbearing. Impaired
function, limited range of motion, stiffness, catching,locking and swelling may be present. These symptoms
place the ability to walk, work and perform sports at risk.
The injury was classified by Berndt and Harty in 1959
[6]. Anatomic studies on cadaver limbs demonstrated the
etiological mechanism of transchondral fractures of the
lateral border of the talar dome. As the foot is inverted on
the leg, the lateral border is compressed against the faceof
the fibula (stage I), while the collateral ligament remains
intact. Further inversion ruptures the lateral ligament and

Knee Surg Sports Traumatol Arthrosc (2010) 18:238–246

begins avulsion of the chip (stage II), which may be
completely detached but remain in place (stage III) or be
displaced by inversion (stage IV). Berndt and Harty
experimentally proved the traumatic etiology...