Treatment of Pediatric and Adolescent Talus Osteochondral Lesions

Abstract

Category: Ankle Introduction/Purpose: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Methods: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Results: Average age was 14,5 (10-18) at beginning of the treatment. 69,2% of our patients were female. Foundation of conservative treatment was activity modification. 9 of our 13 patients were treated surgically. Arthroscopic debridement and microfracture surgery as well as various techniques were applied to all operated patients. In 7 of the operated patients (n=9), the lesion was on the right side and there was a history of trauma before the complaints started. While the mean AOFAS scores of the operated patients were 47 (24-75) before the operation, it was 83.8 in the last follow-up. While the mean AOFAS scores of our conservatively treated patients were 38.2 (21-74) before treatment, the mean AOFAS scores at the last follow-up after treatment (mean follow-up 2 years) were 70 (17-100). There were no minor and major postoperative complications and no need of reoperation. At the final follow up there was significant improvement in clinical results in all patients treated surgically and conservatively. Conclusion: Talus osteochondral lesions at younger ages is an increasing problem. Conservative management with close follow up is the mainstay of the treatment. However, need of surgical treatment may be higher than expected and the short-term results of surgical with various techniques are successful.