Treatment of osteochondral defects of the talus

An osteochondral defect (OCD) of the talus involves the articular cartilage and subchondral bone. It most frequently appears in the second and third decade of life. A traumatic insult, usually ankle sprain, is the most frequent etiologic factor. The typical symptom is persistent or intermittent deep ankle pain during or after activity. Plain radiographs may disclose the lesion. For further diagnostic evaluation, computed tomography (CT) scanning is preferred for because it visualizes the bony defect. The integrity of the subchondral bone seems crucial in the development and the treatment of OCDs.
The general aim of this thesis was to improve the outcome for the patient by optimizing arthroscopic treatment and evaluating alternative treatment. The specific aims were to review and summarize the literature, evaluate primary arthroscopic treatment, improve preoperative planning, accelerate after treatment, analyze a novel metal resurfacing inlay implant, develop an animal model specifically for talar OCDs, investigate the effect of demineralized bone matrix and platelet-rich plasma, and improve the reporting of outcomes. These aims were investigated in a total of 17 chapters.
The most important findings were: CT scans of the ankle in full plantar flexion are reliable in the preoperative planning of arthroscopic treatment. Almost half of the talar dome is accessible in the anterior working area. Arthroscopic treatment of primary OCDs remains successful in the long term. A novel metal resurfacing inlay implant is a promising treatment for secondary OCDs. Demineralized bone matrix and platelet-rich plasma do not improve healing of OCDs in goats.