Osteochondral lesions of the talar dome: surgical treatment in a series of30 cases

Purpose of the study We reviewed 30 cases of osteochondral lesions of the astragalar vault treat ed surgically. Material and methods Among the 30 patients, 17 participated in sports activities and 24 had a hi story of trauma. Mean delay to surgery was 10 months. Treatment included os teochonritis curettage and Pridie perforations. Direct access was used in 1 1 cases, malleolar osteotomy in 13 and arthroscopy in 6. Cancellous bone gr afts were used in 6 cases. Results Mean follow-up was 3 years 7 months (minimum 2 years). All patients had an arthroscan at last follow-up. Evaluation of post-operative outcome was base d on clinical assessment and arthroscan findings. Surgical treatment provid ed very good results in 75 p. 100 of cases with pain relief and improved wa lking distance. Discussion Our cases pointed out the important contribution of the FOG (Fracture Osteo necrosis Geode) classification to pathogenic and prognostic analysis. The B erndt and Harty classifications were not found to be useful. Conclusion In case of localized necrosis, we propose arthroscopic perforation curettag e. In case of bone loss, a direct cancellous graft may be used.