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Osteochondral injuries of the talus

Sports Injuries: Prevention, Diagnosis, Treatment, and Rehabilitation, Page: 649-663
2012
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Book Chapter Description

Osteochondral lesions of the talar dome are frequent problems in athletes causing pain and disability. Lateral lesions are almost always associated with an ankle sprain, which is a common sports injury where medial lesions are rarely associated with trauma. Radiographic classification is more appropriate for acute lesions while chronic lesions should be classified according to magnetic resonance imaging (MRI) which is the most valuable diagnostic method. Arthroscopic excision of displaced fragments with a maximum diameter of 10–15 mm is the treatment of choice in acute lesions. Fixation of larger fragments is recommended for acute cases. Observation can be selected as a treatment method only for chronic lesions without pain; however, this is controversial for athletes. Degenerative changes are rare but possible. If the cartilage is intact, arthroscopy-assisted retrograde drilling under fluoroscopic guidance is performed. If there is a defect in the cartilage, the lesion is curetted arthroscopically. Special flexible and open curets should be available for arthroscopic curettage. Drilling or microfracture methods must be employed to make sure the floor of the lesion is bleeding. If the cavity produced by curettage is deep, grafting of the lesion might be considered. If the diameter of the defect is larger than 10–15 mm, advanced procedures such as osteochondral grafting or autologous chondrocyte transfers may be required. Early arthroscopy of the ankle is worthwhile for athletes after an ankle injury.

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