Arthroscopic treatment of osteochondral lesions of the talar dome: A retrospective study of 48 cases

We treated 48 symptomatic osteochondral lesions of the talar dome arthrosco pically. Of these, 18 patients had an osteochondral fracture with a loose f ragment located in every case on the anteriolateral side of the talus. Trea tment consisted of removal (16 cases) or fixation (2 cases) of the bone fra gment. Thirty patients had chronic lesions (27 subchondral necrosis with a sequestrum and 3 extensive cysts). The lesion was posteromedial in 27 cases and the treatment consisted of removal of the sequestrum with curettage of the subchondral bone necrosis (27 cases) or transchondral drilling if the cartilage surface was intact (3 cases). All the patients were clinically an d radiogically reviewed with a mean follow-up of 5 years (7 months to 11 ye ars). Patients treated for an osteochondral fracture obtained significant b etter results (16 excellent or good results out of 18 cases) than those tre ated for chronic lesions (20 excellent or good results out of 30 cases). On radiographic examination, we noticed that, even at the longest follow-up, the bone healing was usually incomplete and the bone defect persisted indef initely in case of extensive subchondral bone necrosis. The articular surfa ce could be seen in 11 cases (8 computed arthrotomographies, 1 magnetic res onance imaging, and 2 second-look arthroscopies). The fibrous cartilaginous surface was apparently regular in 6 cases without any clear correlation wi th our clinical results. This study suggests that we must make a distinctio n between osteochondral fractures (recent or not healed) located in the ant erolateral part of the talar dome, which carry a good prognosis, and necrot ic lesions located medially, which are less likely to have a favorable outc ome.