Like soft-tissue impingement lesions of the ankle, chondral and osteochondral lesions of the talus will usually present after failed conservative treatment of a presumed ankle sprain. The clinical presentation will be similar to soft-tissue impingement lesions and may include pain, swelling, instability, or catching.8 The physical examination is usually nonspecific, and point tenderness over the lesion may be the only finding. A careful assessment of the lateral ligaments should be made since instability of these ligaments will have implications in the treatment of the talar lesion.1,9 Radiographic examination includes anteroposterior, lateral, and mortise views of the ankle. Stress views can be obtained if lateral ligament laxity is detected on physical examination. Lateral lesions result from inversion and dorsiflexion of the ankle causing impaction between the anterolateral talus and the fibula. The lesions are typically thin, wafer-shaped osteo-chondral fragments located over the anterolateral talar dome, more likely to be symptomatic, and more closely associated with a history of trauma. Medial lesions result from combined plantarflexion, inversion, and external rotation. The lesions are usually located over the posteromedial talar dome and typically appear as a deep, cup-shaped defect. Unlike lateral lesions, many patients with medial lesions will have no history of trauma.8 Historically, the classification system proposed by
Figure 67-2 A, Ankle held in plantarflexion with pressure over anterolateral joint line. B, Ankle ranged from plantarflexed to dorsiflexed position. C, Ankle ranged from plantarflexed to dorsiflexed position with pressure over anterolateral joint line. Worsening pain over pressure alone is a positive test for anterolateral impingement.
Bemdt and Harty10 in 1959 has been used to classify osteochondral lesions of the talus: stage I, a small compression fracture; stage II, incomplete avulsion of the fragment; stage III, complete avulsion of the fragment without displacement; and stage IV complete avulsion of the fragment with displacement. Although computed tomography scans and bone scans have been used to further evaluate osteochondral lesions seen on plain films, recent advancements in MRI have made it the preferred diagnostic tool. MRI allows visualization of the articular cartilage and can evaluate the location, size, and stability of a lesion. A recent report has shown that cartilage-sensitive pulse sequence MRI has correlated well with surgical findings and is useful in identifying patients who would benefit from operative versus nonoperative treatment.11
Was this article helpful?
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.