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PubMed2003

Chondroblastoma of the talus treated with osteochondral autograft transfer from the lateral femoral condyle.

Chondroblastoma is a benign cartilaginous lesion of bone. When occurring in a position juxtaposed to articular cartilage, treatment is directed at removal of the tumor with preservation of the articular cartilage. In this case, a chondroblastoma of the talus with erosion into the articular cartilage was treated with transfer of an osteochondral autograft from the ipsilateral femoral condyle. At two-year follow-up, the patient was symptom free and magnetic resonance imaging revealed complete incorporation of the graft. This case is presented as a representative example of osteochondral autograft transfer surgery (OATS) for the treatment of chondroblastoma.

Adult↗
PubMed2003

Malunion following trimalleolar fracture with posterolateral subluxation of the talus--reconstruction including the posterior malleolus.

Malunion after a malleolar fracture can include a displaced posterior malleolus with associated posterolateral subluxation of the talus. Corrective osteotomy including the posterior malleolus was performed in four patients. Joint congruity was obtained in every case. The patients were followed for 46 to 80 months postoperatively. They all experienced an improvement in pain and three of four patients were unlimited in their walking capacity. Mild to moderate residual symptoms were frequent. The symptoms were attributed to the damage of the cartilage and soft-tissues both from the initial injury and from weightbearing on the incongruous joint. Discrete, non-progressive osteophytes were seen in all patients. Delay in reconstruction did not preclude a good result, although early reoperation is felt to be preferable.

Adult↗
PubMed2005

Results of microfracture in the treatment of articular cartilage defects of the talus.

BACKGROUND: The microfracture technique has been used successfully for the treatment of cartilage defects in the knee. The purpose of this study was to evaluate the microfracture technique in the treatment of osteochondral and degenerative chondral defects of the talus. METHODS: In a prospective study, 30 ankles in 30 consecutive patients (17 men and 13 women; average age, 41 years; range 20 to 74 years were treated with arthroscopic microfracture. Twenty patients had osteochondral defects and 10 had degenerative chondral defects. Patients were evaluated with clinical examination and MRI preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS: At a mean followup of 2 years (range 22 to 27 months), 29 patients were available for follow-up. The results for all ankles according to the Hannover Scoring System were 45% excellent, 38% good, and 17% satisfactory. Results in patients older than 50 years were not inferior to those in younger patients. Visual Analog Score revealed an average of 8 +/- 2 for pain (preoperatively 3 +/- 2; p < or = 0.001), 8 +/- 2 for function (preoperatively 3 +/- 2; p < or = 0.001) and 8 +/- 2 for satisfaction (preoperatively 2 +/- 2; p < or = 0.001). MRI and arthroscopic assessment suggested the presence of cartilage in the microfractured area. CONCLUSIONS: At short-term followup, the microfracture technique appeared to repair severe cartilage damage with a good functional outcome. Age was not shown to be a limiting factor.

Adult↗
PubMed2006

Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems.

BACKGROUND: MRI findings are used in several staging systems to help determine appropriate treatment. The purposes of this study were to evaluate longitudinal changes in MRI characteristics of osteochondral lesions of the talus (OLT) and to evaluate published staging systems in a cohort of nonoperatively treated patients. METHODS: Twenty-nine patients were identified; MR images were reviewed for location, size, and interface signal of OLT as well as cysts, marrow edema and osteoarthritis. Lesions were classified as unchanged, progressed, or improved based on changes in size or interface signal. Each lesion was assigned a stage based on four different staging systems. RESULTS: Of the 29 lesions, 13 progressed, seven improved, and nine were unchanged over an average followup of 13.7 months. In the 13 that progressed, marrow edema remained present in ten and developed in two. Four had persistent cysts and four developed new cysts. Two had progression of osteoarthritis and two developed it anew. In the seven that improved, six had some degree of marrow edema that persisted and one had a persistent cyst. Initial staging changed for at least one classification system in 16 (55%) of the 29 lesions at followup. Change in stage was primarily due to development (four of 16) or disappearance of cysts or progression of the lesion in the extent of bone marrow edema (five of 16). CONCLUSIONS: OLT did not invariably progress over the short-term without operative intervention. Because some cysts and bone marrow edema resolved on MRI, they may not be reliable signs of lesion severity nor show progression of degenerative changes. Since these findings determine the stage and severity of OLT in some staging systems, they may require reconsideration and adjustment of the current staging systems.

Adolescent↗
PubMed2006

Radiographic changes and clinical results of osteochondral defects of the talus with and without subchondral cysts.

BACKGROUND: Subchondral cysts are a type of osteochondral defect of the talus and can be a source of chronic ankle pain. The treatment modality of this cystic lesion is similar to that of other osteochondral defects, but results from previous reports are controversial. Therefore, we compared the clinical results and radiographic changes in small subchondral talar cystic lesions (less than 1.5 cm2) to other noncystic defects after arthroscopic operations without bone grafting. METHODS: The review covered about 2 years (January, 2001 to April, 2003) and included 38 patients with an average age of 36.9 years. Followup ranged from 24 to 36 months. Arthroscopic microfracture or abrasion arthroplasty was performed on 20 defects with subchondral cysts and 18 defects without cysts. Clinical results were assessed by the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS); radiographic changes were assessed by the transverse long diameter and the area (mm2) of the cyst on digital radiographs using a PACS (Picture Archiving Communication System). RESULTS: At the last followup, AOFAS clinical scores improved similarly in cystic and noncystic defects. The average diameter of the cysts decreased from 8 +/- 2 mm to 6 +/- 2 mm (p < 0.01). The area attributed to the cyst also decreased, from 49 +/- 17 mm2 (24 to 84 mm2) to 23 +/- 8 mm2 (4 to 34 mm2) (p < 0.01). There were no differences in the clinical results between the cystic and noncystic defects. CONCLUSIONS: Good clinical and radiographic results were obtained after arthroscopic treatment of osteochondral defects with a small subchondral cyst. Our results suggest that a small cystic lesion can be treated by arthroscopic microfracture or abrasion arthroplasty and that the existence of a small cyst in an osteochondral defect lesion may not affect the postoperative prognosis.

Adult↗
PubMedDate not supplied

Occult injuries of the talus diagnosed by bone scan and tomography.

Five patients, four women and one man, were found to have an osteochondral lesion of one of the talar joints. All patients had normal plain radiographs of the ankle and foot and were referred to us as a second or third consultation for undiagnosed ankle and hindfoot pain. Bone scans of the tali demonstrated the specific talar joint that was injured, and tomography confirmed the presence of an osteochondral lesion. The average delay in the diagnosis between the onset of symptoms and the initiation of treatment was over 10 months. Bone scanning is an effective diagnostic tool in locating injuries of the talus not appreciated on routine x-ray.

Adult↗
PubMed1986

Subchondral pathways to the superior surface of the human talus.

The suggestion that the blood supply to subchondral bone plays an active role in the nutrition of adult articular cartilage is a source of controversy. Morphological confirmation of the presence of subchondral defects extending through the basal cartilage layer of the adult human talus is presented. Perfusion of a fluorescent dye through these breaks offers the possibility that they may serve as active pathways for the transport of nutrients to the cartilage. The distribution patterns of the defects in areas of intermittent cartilage loading is noted and its significance is discussed.

Cartilage, Articular↗
PubMed1987

Treatment of the congenital vertical talus: a retrospective review of 36 feet with long-term follow-up.

To ascertain whether one type of treatment of the congenital vertical talus was superior to others, we conducted a retrospective analysis of 36 congenital vertical tali in 21 patients whose average follow-up of 14 years was considered to be unusually lengthy. Ten patients (48%) had an underlying primary diagnosis, and 13 patients (62%) had at least one other secondary congenital abnormality. None of the surgical techniques produced significantly better results than any other one according to criteria involving shoewear, range of motion, and degree of pain. Subtalar and talotibial motion were frequently restricted, with or without prior arthrodesis. Pain generally was not an immediate or long-term problem. To maintain maximal foot mobility, we recommend a one-stage soft tissue correction alone in the child under 3 years of age. In older, untreated children or those in whom conservative treatments have failed, a subtalar or triple arthrodesis may be necessary.

Adolescent↗
PubMed1990

Fracture of the entire posterior process of the talus: a case report.

A 31-year-old man sustained a displaced fracture of the entire posterior process of the talus. Despite anatomic reduction and internal fixation, limitation of ankle and subtalar joint motion persisted at follow-up, 32 months after the injury. Great toe dorsiflexon was also limited, presumably from flexor hallucis longus tethering behind the ankle joint. The fracture healed without evidence of avascular necrosis of either the talar body or the posterior fragment.

Adult↗
PubMed1993

Peroneus longus tendon sling in revision surgery for congenital vertical talus: a new surgical technique.

When faced with revision surgery for recurrent congenital vertical talus deformity, the tibialis anterior tendon may be deficient or absent as a result of the initial procedure. This tendon cannot then be used as a dynamic sling to dorsiflex the talar neck. We present two cases in which the peroneus longus tendon was transferred dorsally into the talar neck as an alternative to an absent tibialis anterior tendon. Excellent corrections were achieved and maintained. The use of this tendon has not been described previously in surgery for this condition.

Child↗
PubMed1994

Intraosseous hemangioma of the talus: a case report.

A 35-year-old female patient presented to us with a lesion in the talus that on AP-roentgenographic view simulated an osteoid osteoma. Final pathology revealed it to be an intraosseous hemangioma. An intraosseous hemangioma at this site is extremely uncommon and has not been previously reported.

Adult↗
PubMed1995

Treatment outcome of major fractures of the talus.

Twenty-six patients with major fractures of the talus were studied to assess the long-term outcome. The patients were admitted to a university teaching hospital and major trauma center from 1983 to 1991. The study excluded isolated fractures of the talar dome and posterior tubercle. Fifteen patients were treated using internal fixation and 11 patients were treated using nonsurgical methods. Avascular necrosis was detected in only four of the 26 patients. Subtalar osteoarthritis was a significant problem in 61%. Seven of these patients have come to secondary fusion procedures, with another three contemplating fusion procedures at the time of review. Only one patient developed significant avascular necrosis requiring a fusion procedure. Only three of 26 patients had not returned to work at a mean 6 years after their injury. Eleven of the 26 (42%) had not returned to their premorbid activity level. The majority of these patients (25/26) had sustained multiple injuries, which compromised the functional recovery from the talar injury. Early accurate diagnosis and anatomical reduction gave the best results. The low incidence of avascular necrosis in this study has been attributed to early anatomical stabilization of the fracture. We believe an early CT scan can more accurately assess the severity of the talar fracture and offers the best information for an appropriate treatment plan.

Adult↗
PubMed1995

Posteromedial process fractures of the talus.

In this report, we present the diagnosis and clinical outcome of four patients with fractures of the posteromedial process of the talus. In two patients, the posteromedial process fracture was missed initially, which led to painful nonunions. One patient was treated with excision of a nonunion, and the other patient with a nonunion refused further surgery. Two patients underwent ORIF through a posteromedial approach. CT scans were useful in defining the fracture in all four patients. Cast treatment was recommended for displaced fractures or fractures without significant subtalar joint involvement. ORIF was recommended for displaced fractures with significant subtalar joint involvement.

Adult↗
PubMed1996

Osteonecrosis of the talus: treatment by hindfoot fusion.

The results were reviewed for 11 ankles (10 patients) that had been treated with various hindfoot arthrodeses because of symptomatic osteonecrosis of the talus. Follow-up averaged 6.5 years (range, 2-15 years). A functional assessment using a modified Mazur grading system was performed both before surgery and at final follow-up. Data were also collected on the duration of the procedure, intraoperative findings, and the patient's assessment of postoperative cosmesis (excellent, good, fair, or poor). Radiographs were analyzed to determine the interval from the procedure until bony union. Nine of the 11 arthrodeses (82%) fused with the primary procedure and achieved excellent Mazur ratings (mean, 86 points; range, 81-90 points). The average interval until radiographic fusion was 7 months (range, 4-13 months). All eight patients (nine fusions) with successful fusions graded their cosmetic outcomes as excellent or good. The average length of the procedure was 148 minutes (range, 130-300 minutes), compared with an average of 92 minutes (range, 62-151 minutes) for ankle arthrodeses performed by the same surgeons in rheumatoid or osteoarthritic ankles (P < 0.001) and 102 minutes (range, 75-164 minutes) from a report in the literature. Two of the procedures were complicated by nonunions secondary to infections. In one patient, after treatment by debridement and intravenous antibiotics, reinfection and chronic osteomyelitis developed with a subsequent below-knee amputation. The other patient was treated successfully with debridement, antibiotics, and subsequent revision arthrodesis, which fused solidly at 9 months with an excellent result. We conclude that hindfoot arthrodeses for osteonecrosis can be technically demanding, but, despite having a long time to bony union, they can have an excellent clinical outcome.

Adult↗
PubMed1997

Chronic ankle pain caused by osteoid osteoma of the neck of the talus.

Five patients with osteoid osteomas of the talar neck were treated at the Hospital for Special Surgery between 1981 and 1992. The course of care leading to definitive diagnosis and treatment was reviewed. All five of the patients had night pain relieved by aspirin or nonsteroidal anti-inflammatory drugs. One of the five reported associated trauma. The average time from onset of symptoms to correct diagnosis was 2.5 years. Juxta-articular osteoid osteoma can cause a small spur that resembles a traction spur on the neck of the talus. Anterior ankle impingement was the most common misdiagnosis. Initial treatments included arthroscopic spur debridement or synovectomy, casting for fracture, and repeated nerve blocks for reflex sympathetic dystrophy. The five patients were cured by en bloc excision of the lesion. In the diagnosis of osteoid osteoma, a history of relief of pain with aspirin is important. Plain radiographs and a bone scan are useful. Fine cut computed tomography scanning or magnetic resonance imaging are the best studies for making a definitive diagnosis. Localization by computed tomography guided needle placement or intraoperative radionuclide scanning are recommended to find the lesion for excision. Intraoperative radiographs of the excised lesion should be used to confirm complete removal.

Adult↗
PubMed1997

Intraosseous gouty invasion of the talus.

A 34-year-old man presents with a cystic lesion of the talus that has developed over the last 3 years and a history of a single first metatarsophalangeal attack of gout. Radiodiagnostic studies confirmed the cyst and an associated osteochondritic lesion but showed no evidence of avascular necrosis. At arthroscopy, chalk-like material was removed from the cyst, which was histologically compatible with tophaceous gout. The lesion was debrided, and the patient was then treated with antihyperuricemic medication; radiographic evidence of cyst resorption was seen after 9 months of treatment.

Adult↗
PubMed1997

Early one-stage reconstruction of congenital vertical talus.

A simple, one-stage surgical reconstruction was performed on 20 feet with congenital vertical talus in 13 consecutive children. A newly devised outcome scoring system with seven clinical and eight radiographic parameters was utilized to determine correction of all feet at average follow-up of 41 months. There were no excellent, 17 good, 3 fair, and no poor results, with few associated perioperative complications. Clinically, mild postoperative stiffness of ankle and subtalar motion was occasionally noted. Radiographically, many feet had mild residual forefoot abduction with midfoot sagging at the talonavicular joint. Despite these mild postoperative abnormalities, good correction with plantigrade, painless feet was generally obtained when this procedure was performed in children younger than 27 months of age.

Child, Preschool↗