Osteochondral Lesions (OCL) of the Talus

What is OCL?

Loose body formation

From articular and subchondral bone fracture

OCL Talus

• OCL are rare joint disorders
• Most common in knees, followed by elbows and the talus
  Talus OCL < 4%

Clinical Presentation

• Ankle inversion injury to lateral ligamentous complex
  Chronic ankle pain
  Intermittent swelling
  Weakness
  Giving way
  Locking
  Stiffness
  

Causes of OCL Talus

• Non-traumatic
  Ischaemic necrosis of the underlying subchondral bone
  Usually posteromedial lesions
  Sometimes familial
• Traumatic
  History of trauma can usually be found in many patients
  Anterolateral lesions from inversion and dorsiflexion
  Traumatic medial lesions result from inversion, plantarflexion and external rotation

Physical Examination

• Posteromedial lesion – tenderness behind medial malleolus when ankle is dorsiflexed
• Anterolateral lesion – tenderness along the anterolateral ankle joint with ankle maximally plantarflexed

Investigations

• Plain X-rays
• Bone scan
• CT-scan
• MRI
  

Treatment

• Conservative treatment initially
  Cast, immobilisation, followed by physical therapy
• Surgery
  Removal of loose body + stimulation of fibrocartilage
  Securing OLTs to talar dome – fixation, grafting
  Stimulation of hyaline-like cartilage – ACI, OATS, Mosaicplasty
  

Please note that the information contained herein is for general medical information only.
If you have any specific medical condition or queries, please consult your medical doctor.

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