Osteochondritis dissecans lesions of the talus in adolescent athletes: Outcomes and management of arthroscopic surgery

Background

Osteochondritis dissecans (OCD) causes joint pain in children. Treatment consists of conservative management or surgery depending on injury staging; however, duration of conservative treatment, surgical modality and postoperative protocols are not well-established. This study aims to evaluate the outcomes of symptomatic OCD of the talus treated by arthroscopic-assisted management and drilling of the talar bed with or without fixation.

Methods

A retrospective review was performed on 12 adolescents with symptomatic OCD. Data extracted included: age, gender, body mass index, sporting activity, mechanism of injury (MOI), operative modality and duration of follow-up. AOFAS Ankle-Hindfoot, Alexander/Lichtman, and Berndt and Harty outcome scores were used.

Results

Twelve patients were studied (9 girls, 3 boys). The average age was 14.2 years. MOI included: sprain (66.7 %), sporting activity (25 %) and trauma (8.3 %). Berndt and Hardy classification included: Stage 3 (4) and Stage 4 (8). All failed conservative treatment for at least 6 months. Surgery included: arthroscopic-assisted arthrotomy and drilling of the talar bed with or without fragment fixation. Duration of follow-up averaged 23.1 months (range, 3–58 months). At final follow-up, the AOFAS score averaged 96.0. Alexander/Lichtman and Berndt and Hardy scores were all excellent.

Conclusion

In the pediatric population with OCD lesions of the talus who have failed an initial 6-month conservative trial prior to operative management, arthroscopy can help assess for instability prior to definitive treatment. Arthroscopic-assisted drilling to stimulate healing and/or open reduction internal fixation of the fragment can result in excellent outcomes and return to sporting activity.