Acute and chronic osteochondral talus lesions

Osteochondral lesions of the talus are often not or delayed diagnosticated. They mostly are related to traumatic lesions of the upper ankle joint, where by traumatic distorsion are most common among. The degenerative change classified as osteochondrosis dissecans tali shows in the most cases also an originally traumatic generic. The classification by osteochondrosis dissecans tali in four stages by Berndt and Harty is nowadays accepted. These can be distinguished by means of several diagnostic methods. They are regarded as state-of-the-art of therapy and prognosis. Basically for diagnostic purposis the conventional X-ray in two planes with the right feet-allignement is sufficient. Despite the fact, that Szintigraphy and Computertomography for particular questions are the right tools, the MRI gives the highest amount of information. In the case of low levels of defects (Stage I and II) the conservative therapy is appropriate. In more serious cases (Stage III and IV) the surgical intervention has to be used. Beside the open surgical approach the arthroscopy has a growing importancy. In 60% of cases good long term results can be achieved. Beside some advantage there are some limits compared to the arthrotomy. The efficiency of new therapeutic methods like bone-cartilage-transplantation and chondrocyte-transplantation compared to the conventional wound toilet, microfractures and fragmentrefixation has to be proved by long term studies. The results depend on the stage and the localisation of the osteochondral lesion. In the developed stages III and IV surgical actions as wound toilet, removement of dissecate with microfragmentation respectivaly refixation are indicated, since conservative therapy methods lead undoubtedly to worse results. Generally mostly good and very good results connected with painless and weight bearing could be achieved.