The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article:
Osteochondral lesions (OCLs) occur in up to 70%
of sprains and fractures involving the ankle. Atraumatic aetiologies have
also been described. Techniques such as microfracture, and replacement
strategies such as autologous osteochondral transplantation, or
autologous chondrocyte implantation are the major forms of surgical
treatment. Current literature suggests that microfracture is indicated
for lesions up to 15 mm in diameter, with replacement strategies
indicated for larger or cystic lesions. Short- and medium-term results
have been reported, where concerns over potential deterioration
of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of
OCLs, as they potentially enhance the biological environment for
a natural healing response. Further research is required to establish
the critical size of defect, beyond which replacement strategies
should be used, as well as the most appropriate use of biological augmentation.
This paper reviews the current evidence for surgical management
and use of biological adjuncts for treatment of osteochondral lesions
of the talus. Cite this article:
High complication rates and technical difficulties of intramedullary fixation in children with osteogenesis imperfecta has prompted the modification of existing rod systems. The Sheffield telescoping intramedullary road has T-piece which is permanently fixed and is expanded to reduce metaphyseal migration. This study analyses the outcome of this rod system over an 11 year period in two tertiary referral hospitals. 60 rods were inserted in the lower limbs of 19 children with osteogenesis imperfecta. All children had multiple fractures of the bones before rod insertion. 39 rods were inserted into femur, of which 3 were exchange and 4 revision procedures. 21 rods were inserted into tibia. Eight children had intramedullary rodding of both femur and tibia bilaterally. The outcome was measured in terms of incidence of refractures, mobility status, functional improvement and rod related complications. Our series demonstrates that there is significant reduction in refractures and improvement in the functional status of children with osteogenesis imperfecta following intramedullary fixation. The frequent complication of T-piece separation and the need for re-operation has been overcome with Sheffield modification of rod design. But the incidence of the rod, particularly at the proximal end of femur remains high and further improvement in the design is desirable.
