Bilateral osteochondral lesions of the talus

Osteochondral lesions of the talus (OLT) are relatively uncommon but may be a cause of significant pain and disability. Although the majority of patients have an osteochondral lesion of the talus that is unilateral, bilateral involvement has been reported in 10% to 25% of cases. In addition, factors that cause one side to be symptomatic and the contralateral side to be asymptomatic have never been evaluated.

A database containing all patients at our institution with an OLT has been maintained for the past 23 years. This was reviewed and patients with bilateral involvement identified. A chart review was performed to determine location and size of the OLT, which were symptomatic, associated with trauma, and required surgery.

Between 1984 and 2007, 526 patients with an OLT were seen. Fifty-two patients had bilateral OLT, for an overall bilateral incidence of 10%. Of these, 16 patients required no surgery (Group 1), 31 required only unilateral surgery (Group 2), and five required bilateral surgery (Group 3). 88% of the OLT were located medially. Symptomatic talar lesions were significantly larger compared to asymptomatic OLT (p < 0.01). Of those that required only unilateral surgery, the size of the OLT eventually requiring surgery was significantly larger (p < 0.01).

The overall incidence of bilateral involvement was 10%. A majority of patients with bilateral involvement had the OLT located on the medial side. A larger surface area appeared to be related to the presence of symptoms and the need for surgery.