Osteochondral Lesions of the Talar Dome

Dinshaw Pardiwala, Sanjay Soni, Nandan Rao, Pradeep Mandapalli

Volume 3 | Issue 2 | May – Aug 2018 | Page 13-19


Author: Dinshaw Pardiwala [1], Sanjay Soni [1], Nandan Rao [1], Pradeep Mandapalli [1].

[1] Arthroscopy & Sports Orthopaedics Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.

Address of Correspondence
Dr. Dinshaw Pardiwala
Arthroscopy & Sports Orthopaedics Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
Email: Dinshaw.Pardiwala@relianceada.com


Abstract

Osteochondral lesions of the talar dome (OLT) are common, with up to 50% of acute ankle sprains and fractures developing some form of articular cartilage injury. Although the optimal treatment of OLT has remained controversial, in general, a non-displaced lesion with intact articular cartilage should be treated non-operatively with immobilization and restriction of activity. Surgical treatment is indicated for separated or displaced lesions, or If conservative treatment fails to relieve pain in undisplaced lesions. Surgical treatment aims to restore the articular surface with a repair tissue similar to native cartilage and to provide long-term symptomatic relief. If the size of the lesion is not larger than 15 mm, or deeper than 7 mm, bone marrow stimulation technique (BMS) including excision of loose osteochondral fragments, curettage of the crater, and drilling or microfracture can be performed via an anterior or posterior arthroscopic approach. Although BMS has been proven to be an effective treatment for symptomatic patients with small osteochondral lesions of the talus, the reparative tissue formed is fribrocartilage with less durability compared to normal hyaline cartilage. Evidence suggests that large and deep lesions (>15mm diameter, >7 mm depth), or failed previous BMS techniques, should be treated with a replacement strategy such as autologous chondrocyte implantation or osteochondral autograft transfer. Autologous chondrocyte implantation techniques require a two-stage procedure, the first for chondrocyte harvest and the second for implantation after in-vitro culture expansion. Theoretically, the transplantation of chondrocyte-like cells into the defect will result in hyaline-like repair tissue. Osteochondral autograft transfer replaces the defect with a cylinder of viable hyaline cartilage and bone from a donor site in the ipsilateral knee. The need for a malleolar osteotomy and difficulty in gaining perpendicular access to the talar dome is the major limitation of this technique.


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How to Cite this article: Pardiwala D, Soni S, Rao N, Mandapalli P. Osteochondral Lesions of the Talar Dome. Asian Journal Arthroscopy. May-Aug 2018;3(2):13-19.

 


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