Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 12, pp 1765–1771 | Cite as

Clinical and MRI results after microfracture of osteochondral lesions of the talus

  • B. KuniEmail author
  • H. Schmitt
  • D. Chloridis
  • K. Ludwig
Arthroscopy and Sports Medicine



Arthroscopic microfracture (AM) of osteochondral lesions of the talus is used to induce intrinsic refilling of the defect and reduce pain. The aim of this retrospective study was to investigate the clinical state after AM and the MRI outcome.


A total of 22 patients [10 women, 12 men, 31 years old (mean, 13–68 range)] treated for osteochondral lesions of the talus by AM were examined 2 years (median) postoperatively and pre- and postoperative MRI results compared. Swelling/effusion, articular constriction, joint pain, and range of motion restriction were documented. Clinical state was evaluated using the AOFAS hindfoot score. MRI was used to assess the size of the defect, presence of bone marrow edema, cysts and effusion, thickness of repair tissue, and integrity of the cartilage.


In all but six cases, the defect was located at the medial shoulder of the talus. The postoperative AOFAS score at follow-up was 87.5 points (median 36–100 points range). Seven patients were free of pain, 11 had “mild, occasional” pain, 1 “moderate daily”, and 3 “severe, almost always present” pain (AOFAS). The defect volume was significantly reduced from 377 mm3 preoperatively (median, interquartile distance: 417 mm3) to 249 mm3 postoperatively (median, IQD: 336 mm3, p = 0.019, Wilcoxon). In 7 cases, the defect was completely filled, in 11 partially and in 4 only slightly.


After AM of osteochondral lesions of the talus, 18 of 22 patients had no or mild, occasional pain at 2 years follow-up. On MRI, the lesion volume had been reduced and filling with repair tissue was found.


Cartilage defect Osteochondral lesion Microfracture Ankle joint Talus MRI 



The authors would like to thank Sherryl Sundell for English grammar revision.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    McGahan PJ, Pinney SJ (2010) Current concept review: osteochondral lesions of the talus. Foot Ankle Int 31(1):90–101. doi: 10.3113/FAI.2010.0090 PubMedCrossRefGoogle Scholar
  2. 2.
    Kappis M (1922) Weitere Beiträge zur traumatisch-mechanischen Entstehung der spontanen Knorpelablösung (sogen. osteochondritis dissecans). Dtsch Z Chir 171:13–29CrossRefGoogle Scholar
  3. 3.
    Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41(A):988–1020PubMedGoogle Scholar
  4. 4.
    Bruns J, Behrens P (1998) Osteochondrosis dissecans. Ätiologische und pathophysiologische Aspekte. Arthroskopie 11:166–176CrossRefGoogle Scholar
  5. 5.
    Steinhagen J, Niggemeyer O, Bruns J (2001) Etiology and pathogenesis of osteochondrosis dissecans tali. Orthopade 30(1):20–27PubMedCrossRefGoogle Scholar
  6. 6.
    Stroud CC, Marks RM (2000) Imaging of osteochondral lesions of the talus. Foot Ankle Clin 5(1):119–133PubMedGoogle Scholar
  7. 7.
    van Bergen CJ, de Leeuw PA, van Dijk CN (2008) Treatment of osteochondral defects of the talus. Rev Chir Orthop Reparatrice Appar Mot 94(8):398–408. doi: 10.1016/j.rco.2008.09.003 PubMedCrossRefGoogle Scholar
  8. 8.
    Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T (1993) Osteochondral lesions of the talus. Am J Sports Med 21(1):13–19PubMedCrossRefGoogle Scholar
  9. 9.
    Meftah M, Katchis SD, Scharf SC, Mintz DN, Klein DA, Weiner LS (2011) SPECT/CT in the management of osteochondral lesions of the talus. Foot Ankle Int 32(3):233–238. doi: 10.3113/FAI.2011.0233 PubMedCrossRefGoogle Scholar
  10. 10.
    Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, Dopirak RM (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36(9):1750–1762. doi: 10.1177/0363546508316773 PubMedCrossRefGoogle Scholar
  11. 11.
    Schuman L, Struijs PA, van Dijk CN (2002) Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br 84(3):364–368PubMedCrossRefGoogle Scholar
  12. 12.
    Steadman JR, Rodkey WG, Singleton SB, Briggs KK (1997) Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Techn Orthop 7:300–304CrossRefGoogle Scholar
  13. 13.
    Niemeyer P, Salzmann G, Schmal H, Mayr H, Sudkamp NP (2011) Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1729-0 PubMedGoogle Scholar
  14. 14.
    Giannini S, Battaglia M, Buda R, Cavallo M, Ruffilli A, Vannini F (2009) Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10 year follow-up clinical and magnetic resonance imaging T2-mapping evaluation. Am J Sports Med 37(1):112S–118S. doi: 10.1177/0363546509349928 PubMedCrossRefGoogle Scholar
  15. 15.
    Wiewiorski M, Leumann A, Buettner O, Pagenstert G, Horisberger M, Valderrabano V (2011) Autologous matrix-induced chondrogenesis aided reconstruction of a large focal osteochondral lesion of the talus. Arch Orthop Trauma Surg 131(3):293–296. doi: 10.1007/s00402-010-1048-9 PubMedCrossRefGoogle Scholar
  16. 16.
    Baltzer AW, Arnold JP (2005) Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy 21(2):159–166. doi: 10.1016/j.arthro.2004.10.021 PubMedCrossRefGoogle Scholar
  17. 17.
    Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22(10):1085–1092. doi: 10.1016/j.arthro.2006.05.016 PubMedCrossRefGoogle Scholar
  18. 18.
    Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26(8):583–589. doi: 894977 PubMedGoogle Scholar
  19. 19.
    Becher C, Driessen A, Thermann H (2008) Microfracture technique for the treatment of articular cartilage lesions of the talus. Orthopade 37(3):196, 198–203. doi: 10.1007/s00132-008-1213-9 Google Scholar
  20. 20.
    Lee KB, Bai LB, Chung JY, Seon JK (2010) Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18(2):247–253. doi: 10.1007/s00167-009-0914-x PubMedCrossRefGoogle Scholar
  21. 21.
    Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24(1):106–112. doi: 10.1016/j.arthro.2007.07.022 PubMedCrossRefGoogle Scholar
  22. 22.
    Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, Atay OA, Uzumcugil A, Atesok K, Kaya D (2011) Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1856-7 Google Scholar
  23. 23.
    Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H (2010) Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc 18(5):656–663. doi: 10.1007/s00167-009-1036-1 PubMedCrossRefGoogle Scholar
  24. 24.
    Marlovits S, Striessnig G, Resinger CT, Aldrian SM, Vecsei V, Imhof H, Trattnig S (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52(3):310–319. doi: 10.1016/j.ejrad.2004.03.014 PubMedCrossRefGoogle Scholar
  25. 25.
    Potter HG, Foo LF (2006) Magnetic resonance imaging of articular cartilage: trauma, degeneration, and repair. Am J Sports Med 34(4):661–677. doi: 10.1177/0363546505281938 PubMedCrossRefGoogle Scholar
  26. 26.
    Schneider T, Fink B, Jerosch J, Assheuer J, Ruther W (1998) The value of magnetic resonance imaging as postoperative control after arthroscopic treatment of osteochondritis dissecans. Arch Orthop Trauma Surg 117(4–5):235–239PubMedCrossRefGoogle Scholar
  27. 27.
    Apprich S, Trattnig S, Welsch GH, Noebauer-Huhmann IM, Sokolwski M, Hirschfeld C, Stelzeneder D, Domayer S (2012) Assessment of articular cartilage repair tissue after matrix-associated autologous chondrocyte transplantation or the microfracture technique in the ankle joint using diffusion-weighted imaging at 3 Tesla. Osteoarthr Cartil. doi: 10.1016/j.joca.2012.03.008 Google Scholar
  28. 28.
    Domayer SE, Apprich S, Stelzeneder D, Hirschfeld C, Sokolowski M, Kronnerwetter C, Chiari C, Windhager R, Trattnig S (2012) Cartilage repair of the ankle: first results of T2 mapping at 7.0 T after microfracture and matrix associated autologous cartilage transplantation. Osteoarthr Cartil. doi: 10.1016/j.joca.2012.04.015 Google Scholar
  29. 29.
    Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14(11):1119–1125. doi: 10.1016/j.joca.2006.05.003 PubMedCrossRefGoogle Scholar
  30. 30.
    Mithoefer K, Williams RJ, 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87(9):1911–1920. doi: 10.2106/JBJS.D.02846 PubMedCrossRefGoogle Scholar
  31. 31.
    Cuttica DJ, Shockley JA, Hyer CF, Berlet GC (2011) Correlation of MRI edema and clinical outcomes following microfracture of osteochondral lesions of the talus. Foot Ankle Spec 4(5):274–279. doi: 10.1177/1938640011411082 PubMedCrossRefGoogle Scholar
  32. 32.
    Guo QW, Hu YL, Jiao C, Yu CL, Ao YF (2010) Arthroscopic treatment for osteochondral lesions of the talus: analysis of outcome predictors. Chin Med J (Engl) 123(3):296–300Google Scholar
  33. 33.
    Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25(3):168–175. doi: 594999 PubMedGoogle Scholar
  34. 34.
    Lahm A, Erggelet C, Steinwachs M, Reichelt A (2000) Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. Arthroscopy 16(3):299–304. doi: S0749806300535968 PubMedCrossRefGoogle Scholar
  35. 35.
    Ettl V, Kenn W, Radke S, Kirschner S, Goerttler-Krauspe I, Vispo-Seara JL (2001) The role of MRI in therapy and follow-up after surgical treatment of osteochondrosis dissecans of the talus. Z Orthop Ihre Grenzgeb 139(2):157–162. doi: 10.1055/s-2001-15049 PubMedCrossRefGoogle Scholar
  36. 36.
    Jurgensen I, Bachmann G, Schleicher I, Haas H (2002) Arthroscopic versus conservative treatment of osteochondritis dissecans of the knee: value of magnetic resonance imaging in therapy planning and follow-up. Arthroscopy 18(4):378–386. doi: S0749806302445021 PubMedCrossRefGoogle Scholar
  37. 37.
    Higashiyama I, Kumai T, Takakura Y, Tamail S (2000) Follow-up study of MRI for osteochondral lesion of the talus. Foot Ankle Int 21(2):127–133PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • B. Kuni
    • 1
    Email author
  • H. Schmitt
    • 1
    • 2
  • D. Chloridis
    • 1
  • K. Ludwig
    • 1
    • 3
  1. 1.Department of Orthopedics, Trauma Surgery and Spinal Cord InjuryClinic for Orthopedics and Trauma Surgery, Heidelberg University HospitalHeidelbergGermany
  2. 2.ATOS Klinik HeidelbergHeidelbergGermany
  3. 3.Department of Diagnostic and Interventional RadiologyKlinikum HerfordHerfordGermany

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