Osteochondral injuries of talus

Osteochondral lesions (OCL) of the talus are being recognized as an increasingly frequent sports injury. They can be found as a concomitant injury in up to 50 % of all ankle sprains (Saxena and Eakin 2007). Damage to articular cartilage at the ankle can lead to osteoarthritis in midterm or long term, which can significantly affect quality of life and restrict sports and recreation activities. The management of OCL of the talus remains a challenge to the treating physician. The etiology and pathophysiology of OCL of the talus are not clearly known yet. Even though trauma seems to be the most common cause, it is likely that a variety of etiological factors may play a substantial role in the development of OCL. MRI is the gold standard imaging tool for radiographic diagnostic of OCL of the talus. However, conventional weight-bearing radiographs should routinely be done for standard diagnostics, exclusion of fractures, and evaluation of biomechanical alignment. Symptomatic and/or deep OCL on the talus should be treated surgically, because these lesions rarely improve clinically with conservative treatment. There are several different surgical treatment strategies, which are described in this chapter. Advantages and disadvantages are discussed and indications for the surgical treatment are described.