J Korean Orthop Assoc.  2017 Aug;52(4):310-318. 10.4055/jkoa.2017.52.4.310.

Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus

• Kim HT
• Park K
• Seo CH
• Ahn TY
• Kim IH

• KMID: 2387789
• DOI: http://doi.org/10.4055/jkoa.2017.52.4.310

Abstract

PURPOSE
We compared the results between conservative and surgical treatment methods in a group of children and adolescents with osteochondritis dissecans of the talus.
MATERIALS AND METHODS
A total of 24 patients (31 ankles), who were younger than 18 years old, were included in this study. Group 1 consisted of 14 ankles (mean age at the time of treatment was 13.0 years) treated conservatively. Group 2 consisted 17 ankles (mean age at the time of treatment was 15.1 years) treated surgically. According to the Berndt and Harty classification, there were 6 ankles in class I, 4 in class II, 3 in class III, and 1 in class IV in group 1; 1 ankle in class I, 9 in class II, and 7 in class III in group 2. In group 1, there were 13 medial lesions and 1 lateral lesion; and in group 2, there were 14 medial lesions and 3 lateral lesions. The mean follow-up period was 31.9 months for group 1 and 28.9 months for group 2. Clinical and radiologic results were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the classification by Higuera et al.
RESULTS
The mean AOFAS clinical score was 91.4 in group 1 and 87.5 in group 2. According to the classification by Higuera et al., regarding clinical results, there were 6 excellent, 7 good, and 1 fair in group 1, and 5 excellent, 2 good, and 10 fair in group 2. As for radiological results, there were 13 good and 1 fair in group 1, and 10 good and 7 fair in group 2. There was no statistical difference between the two groups.
CONCLUSION
Conservative treatment provided satisfactory results for osteochondritis dissecans of the talus in children and adolescents.

Keyword

talus; osteochondritis dissecans

MeSH Terms

Adolescent
Ankle
Child
Classification
Follow-Up Studies
Foot
Humans
Osteochondritis Dissecans*
Osteochondritis*
Talus*

Figure

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  Figure 1 Schematic drawings of four stages of osteochondritis dissecans of the talus in the radiographs (classified by Berndt and Harty): Stage I is compression of the affected subchondral bone, stage II is partially attached avulsion of the transchondral bone, stage III is completely detached but not displaced, and stage IV is displaced fragment.

• 

  Figure 2 (A) Initial anteroposterior (AP) radiograph of the right ankle in a 12-year-old boy (case 3 in the group 1) showed osteochondritis dissecans of the talus located in the lateral side. He did not have any traumatic history in the affected side, but had ankle pain for several months; he was finally treated with a cast at another hospital. He was classified in accordance with the Berndt and Harty classification15) as stage II. In serial T2-weighted fat suppression coronal (B) and sagittal (C) magnetic resonance imagings (MRIs), which were taken at the time of his first visit to another hospital, the overlying chondral surface of the talus was intact and continuous with the healthy part (stage II according to the classification by Dipaola et al.16)). (B, C) The fragment was not separated from the talus contraindicating the ostechondral fracture of the talus. During the follow-up period, he experienced aggravated pain. He was then transferred to hospital and treated conservatively. (D) AP radiograph showed that the bony fragment was slightly displaced (Berndt and Harty's stage IV). A short leg cast was applied for 4 weeks and then a brace was applied for 2 months. T1-weighted coronal (E) and sagittal (F) MRIs, which were taken 4 months after conservative treatment (9 months after initial diagnosis at another hospital), showed an enlarged lesion, but with decreased pain (stage II according to the classification by Dipaloa et al.16)). (G) The last follow-up radiograph of the right ankle taken 4 years after the initial treatment showed a decreased gap in the lesion. His clinical result (by Higuera et al.18)) was good.

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  Figure 3 (A) Initial anteroposterior radiograph of the right ankle in an 11-year-old boy (case 1 in the group 1) showed osteochondritis dissecans of the talus located in the medial side. He was classified as stage III in accordance with the Berndt and Harty classification.15) He had a similar lesion in the left ankle. A short leg cast was applied for 4 weeks and subsequently a brace for 2 months. T1 weighted coronal (B) and sagittal (C) magnetic resonance imagings, which were taken four years and seven months later, showed remaining lesions (stage II according to the classification by Dipaola et al.16)). (D) The last follow-up radiograph of the right ankle, which was taken five years and six months after the initial visit, showed the lesion healing. His clinical result (classification by Higuera et al.18)) was excellent; he had mild symptoms in the right ankle during running.

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