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Nonoperatively managed stage 5 osteochondral talar lesions.
Carl Shearer1, Richard Loomer, Doug Clement
1New Westminster Orthopaedic and Sports Medicine Clinic, BC, Canada. dloomer@telus.net
Foot & Ankle International
|July 31, 2002
Summary
Non-surgical management of stage 5 osteochondral lesions of the talus (OLT) is a viable option. Over half of patients achieve good or excellent results, with little risk of osteoarthritis, indicating a generally benign course.
Area of Science:
- Orthopedics
- Sports Medicine
- Radiology
Background:
- Osteochondral lesions of the talus (OLT) can significantly impact ankle function.
- Stage 5 OLT represents a chronic, advanced stage of these lesions.
- Non-surgical management is often considered, but its long-term efficacy for stage 5 OLT requires further investigation.
Purpose of the Study:
- To evaluate the long-term clinical and radiographic outcomes of non-surgically managed stage 5 osteochondral lesions of the talus (OLT).
- To assess the correlation between lesion size changes, development of osteoarthritis, and clinical results.
- To determine the viability and risks associated with conservative treatment for chronic OLT.
Main Methods:
- Retrospective reassessment of 35 ankles in 34 subjects with stage 5 OLT managed non-surgically.
- Clinical outcomes rated based on established criteria.
- Radiographic comparison (tomogram or CT scans, X-rays) of lesion size and degenerative changes at diagnosis and follow-up (average 38 months post-diagnosis).
Main Results:
- 54% of patients achieved good or excellent clinical results with non-surgical management.
- No significant change in lesion size was observed in 25 patients.
- Mild degenerative changes were noted in 13 of 20 ankles, but did not correlate with clinical outcomes.
- Six patients who underwent surgery after a year of non-surgical treatment were rated as poor outcomes.
Conclusions:
- Non-surgical management is a viable option for stage 5 OLT, with a low risk of significant osteoarthritis.
- Most OLTs remain radiographically stable, and changes in size poorly correlate with clinical outcomes.
- Over half of patients experience improvement, suggesting a generally benign course for stage 5 OLT, with lateral and adult-onset lesions showing better prognoses.