Awareness and treatment of talar osteochondral lesions after ankle injuries

An osteochondral lesion is defined by damage to the articular cartilage and the underlying subchondral bone. They can occur at every age but are often seen in the young and active population. They cause impairment because of deep joint pain with major limitations for the patient. This thesis specifically focusses on osteochondral lesions of the talus (OCLT).
It is frequently described as an uncommon diagnosis, however, exact incidence rates are unclear. Numerous types of surgical treatment strategies exist but there is no clear consensus which surgical intervention is considered preferable for which type of lesion.
The general aim of this thesis was therefore to evaluate the incidence of traumatic OCLTs and to review respective treatment options for OCLTs. We found that a high amount of OCLTs are preceded by ankle injuries with up to 71% of patients reporting a history of ankle trauma (fractures excluded). Furthermore, in up to 47% of all ankle fractures a concomitant type of chondral or osteochondral damage is described. Based on our research we would advise that, if possible, fixation of an OCLT should be the primary surgical treatment of choice to preserve the more superior hyaline cartilage which would give better outcomes at longer term. When the lesion is not fixable, bone marrow stimulation is still a viable option if the lesion is not too large. The work in this thesis will aid and direct surgeons in their clinical decision making when diagnosing and treating patients with ankle injuries and subsequent OCLTs.