Like soft-tissue impingement lesions, chondral lesions of the talus will often have nonspecific physical examination findings and normal radiographs. A high index of clinical suspicion will prompt an MRI confirming the diagnosis. Nonoperative management is similar to that of soft-tissue impingement lesions and should last for approximately 6 months before operative intervention is considered. Patients with continued pain or mechanical symptoms despite appropriate nonoperative treatment may be candidates for surgery. Lateral ligament instability may be present with a chondral lesion and is an important consideration prior to surgery.9 Chondral lesions that are treated without addressing the overlying instability tend to have a worse outcome compared to lesions treated in stable ankles.1
Unless there is evidence of a loose body on plain radiographs or MRI, initial treatment of osteochondral lesions of the talus is nonoperative. Initial treatment can consist of a period of immobilization and limited weight bearing. There are no clear guidelines in the literature that quantify the duration of immobilization or protected weight bearing. The age of the patient and the location, size, and stability of the lesion are factors that may contribute to decision making. Historically, lesions that are treated conservatively for up to 12 months still have a good outcome with appropriate surgical treatment.8 Patients with loose bodies at presentation are treated with surgery from the onset, while patients with Berndt and Harty lesions stages I through III with persistent pain, swelling, or mechanical symptoms are considered for surgery after 3 to 6 months of failed nonoperative treatment.14 With the improvements in MRI, the current trend is earlier diagnosis and treatment of osteochondral lesions. Surgical treatment of osteochondral lesions of the talus continues to rapidly evolve, and numerous techniques are available. The advantages and disadvantages of various arthroscopic and open procedures are discussed later in the chapter.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.