SLR - October 2022 - Trevor Gatenby, DPM
Reference: Quinten G.H. Rikken, BSc, Issanne M.E. Wolsink, BSc, Jari Dahmen DM, BSc, Sjoerd A.S. Stufkens, MD, PhD, Gino M.M.J. Kerkhoffs, MD, PhD, 15% of talar osteochondral lesions are present bilaterally well only 1 in 3 bilateral lesions are bilaterally symptomatic. J Bone Joint Surg Am. 2022 July 21; Volume 00-A Number 00Level of Evidence: 3
Reviewed By: Trevor Gatenby, DPM
Residency Program: Scripps Mercy Hospital, San Diego, CA
Podiatric relevance: There are many etiologies for osteochondral lesions of the talus, trauma being the main cause, however hereditary factors or congenital malformation of the articular cartilage can be predisposing factors for lesion development. Although most patients will have unilateral osteochondral lesions of the talus this condition may also present bilaterally. The primary aim of this study is to determine the prevalence of bilateral osteochondral lesions of the talus with computed tomography (CT). Additionally, this present study aimed to determine the symptomatic presentation of bilateral osteochondral lesions of the talus and described demographic and radiographic characteristics. This study utilized a cross-sectional database of patients with CT proven osteochondral lesions of the talus bilaterally from 1989 until 2021 which included 1062 patients who met the inclusion criteria, of which 161 patients had bilateral osteochondral lesions of the talus
Methods: A level 3 retrospective study was performed for all patients who met the inclusion criteria of having a primary or secondary osteochondral lesion of the talus having undergone bilateral CT imaging. Patients with bilateral osteochondral lesions of the talus were grouped according to whether symptoms were present in 1 or both ankles. The primary outcome being the percentage of patients presenting with bilateral osteochondral lesions of the talus among the total number of included patients with osteochondral lesions of the talus. Radiographic evaluation of lesion characteristics was performed and for ankles with greater than 1 osteochondral lesion of the talus, the largest diameter lesion was included. Outcomes were calculated as the proportion of patients with bilateral osteochondral lesions of the talus among those who met inclusion criteria. Secondary outcomes concerned the symptomatology of patients with bilateral osteochondral lesion of the talus and in comparison of patient demographics and radiographic lesion characteristics between the unilaterally and bilaterally symptomatic groups.
Results: Of the 1062 patients who met the inclusion criteria, 161 patients with bilateral osteochondral lesions of the talus. When comparing the unilaterally symptomatic group versus bilaterally symptomatic group, 108 (67.1%) were unilaterally symptomatic and 53 (32.9%) were bilaterally symptomatic. Patients who were bilaterally symptomatic were younger 31.1 versus 36.8 years of age. When comparing the symptomatic versus asymptomatic ankles and unilaterally symptomatic group, lesion volume was higher in the symptomatic ankles compared with the contralateral asymptomatic ankles (he 0.65 versus 0.26cm³).
Conclusions: Younger patients, patients without previous ankle trauma, and patients with larger lesions may have a higher chance of having bilateral symptomatic osteochondral lesions of the talus. Radiographic and clinical follow-up can be considered to monitor potential lesion volume progression and associated symptomatology. Patients who present with symptoms and have bilateral osteochondral lesions of the talus diagnosed radiographically, only 1 in 3 patients with bilateral osteochondral lesions of the talus are bilaterally symptomatic. Prevalence of bilateral osteochondral lesions of the talus is 15%. Lesion volume is associated with the presence of symptoms. Treating team should be aware younger patients and patients without a history of trauma are at higher risk for having bilateral symptoms.