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Study finds largest bilateral osteochondral talar lesions are the most symptomatic

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LAS VEGAS — A retrospective chart review has elucidated new information about the prevalence and nature of bilateral osteochondral lesions of the talus, which investigators believe constitutes the first time such specific information about these injuries has been reported.

“Ten percent of patients with osteochondral lesions of the talus have bilateral involvement,” said Richard D. Ferkel, MD, of Van Nuys, Calif.

During the American Orthopaedic Foot and Ankle Society 2009 Specialty Day Meeting, held here, Ferkel presented data for 48 patients with bilateral lesions whose charts were available from his database of 526 patients with osteochondral talar lesions compiled over 23 years.

Investigators sought to better quantify the prevalence of bilateral lesions, which has ranged in the literature from 10% to 25%, and to identify which lesions were most symptomatic. They also wanted to determine which lesions were treated operatively and why.

Of the 96 bilateral lesions the investigators identified, 59 were symptomatic. “There was a significantly higher group of patients that were symptomatic the larger the surface area was,” Ferkel said.

To assess who sought treatment of their lesions, investigators divided patients into three groups according to whether they had no surgery, unilateral surgery or bilateral surgery. They found higher surgical rates among patients in the unilateral surgical group. “The surface area [of the lesion] was dramatically higher on the side that had surgery,” Ferkel noted.

Investigators found less than 50% of the lesions in the most common medial location were associated with trauma. However, most of the symptomatic lesions tended to be caused by trauma.

The researchers did not look at ankle alignment specifically as a causative factor in this study, Ferkel told moderator Gregory C. Berlet, MD, when he asked about this biomechanical component of osteochondral lesions of the talus during the paper’s discussion.

Reference:

• Ferkel RD, Hermanson E. Bilateral osteochondral lesions of the talus. Presented at the American Orthopaedic Foot and Ankle Society Specialty Day Meeting. Feb. 28, 2009. Las Vegas.