Osteochondral Lesions of the Talus: Predictors of Clinical Outcome

Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 +/- 13.7 (range, 12 to 73) years. The average followup was 37.2 +/- 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 +/- 0.67 cm(2). There were 20 lesions larger than 1.5 cm(2) and 110 lesions smaller than 1.5 cm(2). There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm(2) and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions are often associated with inferior functional outcomes and may require a more extensive initial procedure.