Improving imaging and treatment of talar osteochondral defects

An osteochondral defect of the talus (OCDT) is a lesion of the cartilage and the underlying subchondral bone of a joint. Extensive knowledge of the cartilage repair process is essential to understand why treatments might be successful and to enable their development. This thesis addresses challenges in imaging, staging and treatment techniques that contribute to our understanding of cartilage repair and the optimization of diagnostics and treatment of OCDT in the ankle. In Part I we explore ways to optimize pre-clinical imaging to improve in-depth understanding of the cartilage healing process. Part II explores ultrasound as an alternative for MRI and CT for extensive follow-up of cartilage repair mechanisms in patients. In part III: Optimizing treatment, we critically examine the technique of two widely used, less invasive treatments to understand whether changes in the technique performance could optimize results.
This thesis concludes the following:
- There is need for a guideline outlining which imaging techniques and validated imaging scoring systems and larger high-quality studies with explicit technique descriptions
- Optical Coherence Tomography for example can assess cartilage thickness and surface morphology without biopsy with good correlation with histology.
- Ultrasound imaging is feasible as a cheaper, less invasive alternative for extensive follow up for anterior and central OCDT.
- Intra-articular infiltration in the ankle benefits from imaging using either conventional fluoroscopy or ultrasound by decreasing the amount of unintended extra-articular injections.
- Changes in microfracture depth or diameter do not affect repair tissue quality in OCDT in the goat.