Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus

作者：Klammer Georg; Maquieira Gerardo J; Spahn Silke; Vigfusson Vanessa; Zanetti Marco; Espinosa Norman^*

来源：Foot & Ankle International, 2015, 36(1): 24-31.

DOI：10.1177/1071100714552480

• natural history
• nonoperative
• osteochondral lesion
• talus

Background: We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time.
Methods: Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI).
Results: At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in staging or lesion size. Pain at time of follow-up correlated with the depth of the lesion at initial MRI (P < .05) and with subchondral cyst formation and presence or change of bone marrow edema at follow-up MRI (P < .05).
Conclusion: Minimally symptomatic OLTs did not appear to progress or worsen over time when treated nonoperatively.

• 出版日期2015-1