Treatment of Osteochondral Lesions of the Talus in Athletes

Abstract

The definition of osteochondral lesion of the talus (OLT) is any defect involving both the articular surface and the subchondral bone of the talus. Many of these lesions are associated with acute ankle injury. Although many classification schemes for OLT have been proposed, Berndt and Harty's 4-staging classification is most commonly used. Stage 4 lesions and symptomatic lesions under grade 3 are usually recommended to surgical treatment. The treatment approach for athletes should be more elaborate due to the need for an early return to play. Several different types of treatment are described for OLTs in athletes, including bone marrow stimulation, osteochondral autograft transfer system, and autogenous chondrocyte implantation. Osteochondral autograft transfer system shows good clinical outcome and has the advantages that could be applied to large defect and recurred lesions, however, it has some disadvantages in terms of the complications related with the donor site and the difficult approach to the medial lesions. Although autogenous chondrocyte implantation has been extensively applied for treating OLTs with successful clinical outcomes, it has some limitations that apply to athletes in terms of the 2-stage and complicated procedure and the insurance issues. Bone marrow stimulation being a simple and cost-effective procedure associated with a low complication rate and low postoperative pain has faster return to play and is recommended the first-line treatment for the OLTs of athletes.://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서 론 거골 골연골 병변(osteochondral lesion of the talus)은 1737년 Monro 1) 에 의해 처음 소개된 이래로 박리성 골연골염(osteo-chondritis dissecans), 거골원개 골절(talar dome fracture), 골연골 골절(osteochondral fracture) 등 다양한 용어로 불리며 그 발생 기전이나 치료 방법에 대해 지속적으로 연구되어 왔다. 그리고 1959년 Berndt와 Harty 2) 에 의하여 이 질환에 대한 분류가 처음 발표되었다. 거골 골연골 병변은 거골의 관절 연골과 연골하골에 발생하