How To Diagnose And Treat Osteochondral Lesions Of The Talus
The past several “Treatment Dilemmas” columns have dealt with the treatment of chronic ankle pain subsequent to an ankle sprain (see page 92, July issue and page 88, September issue). We have dealt with the actual ligament injury and its repair, treatment of peroneal tendon injuries and also conservative care of ankle injuries. We will now discuss the final common problem, which involves the treatment options for osteochondral lesions of the talus. An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. There are three types of common lesion formation. The first is injury to the cartilage surface with an actual loss of part of the chondral surface and underlying subchondral bone. This is the most common type of injury that will require care. The second most common type is an injury to the superficial cartilage surface with a crush cartilage injury or shear tear of the cartilage surface. Finally, there is a subchondral cyst type injury with a cyst formation deep to the cartilage surface but an intact overlying cartilage and bone surface. This type of injury is fairly rare. Each type of injury will have different treatment options and require a different type of workup. In order to treat the problem properly, one must diagnose the cause, the amount of injury and the residual problem present. Furthermore, the location of the lesion will also dictate treatment options.