Osteochondral Lesions of the Talus

  • P. A. D. van Dijk
  • C. N. van Dijk


This chapter gives an overview of the pathophysiology and classification, patient history, clinical examination, and diagnostics of osteochondral lesions of the talus. Moreover, it provides a step-by-step description of anterior ankle arthroscopy technique in treating these lesions.


Talus Ankle Osteochondral lesions Arthroscopy 


  1. 1.
    Zengerink M, et al. Current concepts: treatment of osteochondral ankle defects. Foot Ankle Clin. 2006;11(2):331–59, viCrossRefGoogle Scholar
  2. 2.
    Lippert MJ, Hawe W, Bernett P. Surgical therapy of fibular capsule-ligament rupture. Sportverletz Sportschaden. 1989;3(1):6–13.CrossRefGoogle Scholar
  3. 3.
    van Dijk CN. On diagnostic strategies in patients with severe ankle sprain. Amsterdam: University of Amsterdam; 1994.Google Scholar
  4. 4.
    Bosien WR, Staples OS, Russell SW. Residual disability following acute ankle sprains. J Bone Joint Surg Am. 1955;37-A(6):1237–43.CrossRefGoogle Scholar
  5. 5.
    Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 1959;41-A:988–1020.CrossRefGoogle Scholar
  6. 6.
    Sgaglione NA, et al. Arthroscopic-assisted anterior cruciate ligament reconstruction with the semitendinosus tendon: comparison of results with and without braided polypropylene augmentation. Arthroscopy. 1992;8(1):65–77.CrossRefGoogle Scholar
  7. 7.
    Cheng JC, Ferkel RD. The role of arthroscopy in ankle and subtalar degenerative joint disease. Clin Orthop Relat Res. 1998;349:65–72.CrossRefGoogle Scholar
  8. 8.
    Anderson IF, et al. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am. 1989;71(8):1143–52.CrossRefGoogle Scholar
  9. 9.
    Reilingh ML, et al. Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skelet Radiol. 2010;39(11):1103–8.CrossRefGoogle Scholar
  10. 10.
    van Bergen CJ, Reilingh ML, van Dijk CN. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant. Knee Surg Sports Traumatol Arthrosc. 2011;19(6):999–1003.CrossRefGoogle Scholar
  11. 11.
    Knupp M, et al. Effect of supramalleolar varus and valgus deformities on the tibiotalar joint: a cadaveric study. Foot Ankle Int. 2011;32(6):609–15.CrossRefGoogle Scholar
  12. 12.
    Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985;5(4):165–85.CrossRefGoogle Scholar
  13. 13.
    Erban WK, Kolberg K. Simultaneous mirror image osteochondrosis dissecans in identical twins. RöFo. 1981;135(3):357.PubMedGoogle Scholar
  14. 14.
    Woods K, Harris I. Osteochondritis dissecans of the talus in identical twins. J Bone Joint Surg (Br). 1995;77(2):331.CrossRefGoogle Scholar
  15. 15.
    Anderson DV, Lyne ED. Osteochondritis dissecans of the talus: case report on two family members. J Pediatr Orthop. 1984;4(3):356–7.CrossRefGoogle Scholar
  16. 16.
    Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 2004;86-A(6):1336.CrossRefGoogle Scholar
  17. 17.
    Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg Am. 1980;62(1):97–102.CrossRefGoogle Scholar
  18. 18.
    Frenkel SR, Di Cesare PE. Degradation and repair of articular cartilage. Front Biosci. 1999;4:D671–85.CrossRefGoogle Scholar
  19. 19.
    Van der Vis HM, et al. Fluid pressure causes bone resorption in a rabbit model of prosthetic loosening. Clin Orthop Relat Res. 1998;350:201–8.Google Scholar
  20. 20.
    Kadoya Y, et al. Bone formation and bone resorption in failed total joint arthroplasties: histomorphometric analysis with histochemical and immunohistochemical technique. J Orthop Res. 1996;14(3):473–82.CrossRefGoogle Scholar
  21. 21.
    Madry H, van Dijk CN, Mueller-Gerbl M. The basic science of the subchondral bone. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):419–33.CrossRefGoogle Scholar
  22. 22.
    van Dijk CN, et al. The natural history of osteochondral lesions in the ankle. Instr Course Lect. 2010;59:375–86.PubMedGoogle Scholar
  23. 23.
    Arnoldi CC, Lemperg R, Linderholm H. Immediate effect of osteotomy on the intramedullary pressure in the femoral head and neck in patients with degenerative osteoarthritis. Acta Orthop Scand. 1971;42(5):454–5.PubMedGoogle Scholar
  24. 24.
    Arnoldi CC, Lemperg K, Linderholm H. Intraosseous hypertension and pain in the knee. J Bone Joint Surg (Br). 1975;57(3):360–3.CrossRefGoogle Scholar
  25. 25.
    Mach DB, et al. Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience. 2002;113(1):155–66.CrossRefGoogle Scholar
  26. 26.
    Irie K, et al. Calcitonin gene-related peptide (CGRP)-containing nerve fibers in bone tissue and their involvement in bone remodeling. Microsc Res Tech. 2002;58(2):85–90.CrossRefGoogle Scholar
  27. 27.
    Simon WH. Scale effects in animal joints. II. Thickness and elasticity in the deformability of articular cartilage. Arthritis Rheum. 1971;14(4):493–502.CrossRefGoogle Scholar
  28. 28.
    van Dijk CN, et al. Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc. 2010;18(5):570–80.CrossRefGoogle Scholar
  29. 29.
    Gomoll AH, et al. The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):434–47.CrossRefGoogle Scholar
  30. 30.
    van Bergen CJA, et al. Diagnosis: history, physical examination, imaging, and arthroscopy: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int. 2018;39(1_suppl):3S–8S.CrossRefGoogle Scholar
  31. 31.
    Gianakos AL, et al. Current management of talar osteochondral lesions. World J Orthop. 2017;8(1):12–20.CrossRefGoogle Scholar
  32. 32.
    O'Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010;38(2):392–404.CrossRefGoogle Scholar
  33. 33.
    Looze CA, et al. Evaluation and management of osteochondral lesions of the talus. Cartilage. 2017;8(1):19–30.CrossRefGoogle Scholar
  34. 34.
    van Bergen CJ, de Leeuw PA, van Dijk CN. Treatment of osteochondral defects of the talus. Rev Chir Orthop Reparatrice Appar Mot. 2008;94(8 Suppl):398–408.CrossRefGoogle Scholar
  35. 35.
    van Bergen CJ, et al. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities. World J Orthop. 2015;6(11):944–53.CrossRefGoogle Scholar
  36. 36.
    Verhagen RA, et al. Prospective study on diagnostic strategies in osteochondral lesions of the talus. Is MRI superior to helical CT? J Bone Joint Surg (Br). 2005;87(1):41–6.CrossRefGoogle Scholar
  37. 37.
    Tol JL, et al. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int. 2000;21(2):119–26.CrossRefGoogle Scholar
  38. 38.
    Loveday D, Clifton R, Robinson A. Interventions for treating osteochondral defects of the talus in adults. Cochrane Database Syst Rev. 2010;8:CD008104.Google Scholar
  39. 39.
    Zengerink M, et al. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):238–46.CrossRefGoogle Scholar
  40. 40.
    Donnenwerth MP, Roukis TS. Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. Arthroscopy. 2012;28(12):1902–7.CrossRefGoogle Scholar
  41. 41.
    Verhagen RA, et al. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin. 2003;8(2):233–42, viii-ix.CrossRefGoogle Scholar
  42. 42.
    Lambers KTA, et al. No superior surgical treatment for secondary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):2158–70.CrossRefGoogle Scholar
  43. 43.
    Dahmen J, et al. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):2142–57.CrossRefGoogle Scholar
  44. 44.
    Thompson JP, Loomer RL. Osteochondral lesions of the talus in a sports medicine clinic. A new radiographic technique and surgical approach. Am J Sports Med. 1984;12(6):460–3.CrossRefGoogle Scholar
  45. 45.
    Schuman L, Struijs PA, van Dijk CN. Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg (Br). 2002;84(3):364–8.CrossRefGoogle Scholar
  46. 46.
    van Dijk CN. In: van Dijk CN, editor. Ankle arthroscopy - techniques developed by the Amsterdam foot and ankle school, vol. 1. 1st ed. Berlin: Springer; 2014.Google Scholar
  47. 47.
    Tol JL, Verheyen CP, van Dijk CN. Arthroscopic treatment of anterior impingement in the ankle. J Bone Joint Surg (Br). 2001;83(1):9–13.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • P. A. D. van Dijk
    • 1
    • 2
    • 3
  • C. N. van Dijk
    • 4
    • 2
    • 3
    • 5
    • 6
  1. 1.Department of General SurgeryOLVG - westAmsterdamThe Netherlands
  2. 2.Academic Center for Evidence Based Sports Medicine (ACES)AmsterdamThe Netherlands
  3. 3.Amsterdam Collaboration for Health and Safety in Sports (ACHSS)AmsterdamThe Netherlands
  4. 4.Department of Orthopedic SurgeryAmsterdam University Medical CentersAmsterdamThe Netherlands
  5. 5.FIFA Medical Center of ExcellenceMadridSpain
  6. 6.FIFA Medical Center of ExcellencePortoPortugal

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