Bone Bulletin



Osteochondral lesions of the talus (OLT) are injuries involving damage to the cartilage and bone associated with the talar dome. They occur in up to 50% of ankle sprains and 73% of ankle fractures, varying in stability and severity.1 Standard weightbearing ankle radiographs may allow for visualization of the lesions if substantial bone fragmentation is involved but CT and MRI are more sensitive for subchondral bone damage and purely cartilaginous lesions, respectively (Figure 1). The majority of patients with OLT are active individuals in their 20s and 30s, and often present after sustaining an acute inversion injury.2 Trauma to the talar dome creates an ischemic environment in the joint, which ultimately leads to disintegration of the subchondral bone in addition to damage to the overlying cartilage. This may lead to generalized ankle pain, weakness, and swelling. In addition to acute trauma, these lesions may develop as a result of osteochondritis dissecans (OCD). OCD lesions commonly present in patients between 10-20 years of age and have a multifactorial etiology, including genetic predisposition and loss of blood supply to a region of the joint.3 Incidence of these lesions is higher in young athletes, suggesting that microtrauma also plays a role in OCD becoming symptomatic.

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