Large osteochondral lesions of the talus

primary treatment with autologous cancellous bone grafting and inverted autologous periosteal flap

Abstract

Introdcution: Big osteochondral lesions have been historically a challenge of treatment. They represent a high percentage of persistent pain and defect recurrence after ankle arthroscopy and microfractures. The treatment of these lesions with cancellous bone grafting and periosteal flap has been well documented in the literature as a successful revision procedure for those patients who did not have good results after primary surgery. Being these big osteochondral lesions (>150mm square) the most likely to fail, we decided to treat them with cancellous bone grafting and inverted periosteal flap as the primary procedure. We present our experience with 14 patients and an average of four years follow up. Methods: The 14 patients were evaluated prior and after surgery with the AOFAS scale. Results: The average improvement were 35 points. The group showed no recurrence of the lesions during the average of four year follow up. Conclusion: Since most of these lesions occur in a young and physically active population, we consider that any effort towards the prevention of ankle arthritis should be encouraged