Osteochondritis dissecans of the ankle. A 20-year follow-up study

Osteochondritis dissecans of the talus: long-term results of surgical treatment

Twenty patients with osteochondritis dissecans of the ankle were reviewed for a clinical and radiographical follow-up 9 to 15 years after surgery including multiple drilling of the lesion combined with excision of loose fragments. The short-term results of surgery were satisfactory: 85 degrees of the patients were improved or cured. At follow-up, more than half of the patients had some degree of pain during activity, and swelling of the ankle, but only a few had locking or pain at rest. Only one of the 18 patients without osteoarthritis at the time of surgery had developed generalized osteoarthritis at the follow-up. Although the initial good results of surgery were demonstrated to deteriorate with time, the procedure can still be recommended in patients with longstanding symptoms.

Arthroscopic treatment of transchondral talar dome fractures

Fifteen cases of transchondral talar dome fractures treated arthroscopically at the Naval Hospital in Oakland, California, were reviewed. Roentgenograms and results from clinical examination were assessed preoperatively and at regular intervals postoperatively. Clinical followup of 18 months was obtained in all cases (range, 18 to 36 months; mean, 26 months). All lesions were treated with arthroscopic excision of fragments with abrasion and/or drilling of the remaining crater. There were nine excellent results, four good, one fair, and one poor. There were no complications. Results of arthroscopic treatment compare favorably to those of open arthrotomy.

Arthroscopic treatment of osteochondral lesions of the talar dome

Nine osteochondral lesions of the talar dome were treated arthroscopically. Two patients (a 16-year-old boy) had two recent osteochondral fractures, anterior and superior lateral, with a free fragment detached in the joint. The lesions were treated with simple ablation of the loose body. Seven old lesions were found in four men and three women, aged 18-32 years, with an osteocartilaginous, partially loose body with necrosis of the underlying bone. The lesion was posterior medial in these seven cases. Technically, arthroscopy is usually performed using an anterior approach. However, it is sometimes necessary to place the foot in the talipes equinus position to achieve articular distraction for diagnosis and treatment of posterior lesions. Treatment consisted of removal of the loose body, with curettage of the necrotic bone. The nine patients were clinically and radiologically reviewed with a follow-up period of 10-24 months. For the two osteochondral fractures, clinical results following the removal of free loose bodies in the joint were spectacular, with complete pain relief and osseous rehabilitation almost radiologically complete after 2 years. In the seven patients with an old necrotic lesion, the result was very good or good in six cases, and poor in one case. Radiologically, osseous rehabilitation occurred progressively, but remained incomplete at 2 years. This technique provides multiple advantages: minimal morbidity, 48-h hospitalization, and rapid functional recuperation without immobilization. Our results confirm the recent data in the literature (1-4).