Nonoperatively managed stage 5 osteochondral talar lesions.

Thirty-five ankles in 34 subjects with non-surgically managed stage 5 (chronic) osteochondral lesions of the talus (OLT) were reassessed an average of 38 months post diagnosis--88 months post symptom onset. The overall clinical result was rated good or excellent in 54%, fair in 17% and poor in 29%. Six patients opted for surgery--arthroscopic drilling--after a trial of one year of nonsurgical treatment and were therefore rated as poor. Tomogram or CT scans at the time of diagnosis and follow-up were compared in 25 patients. We found no significant change in lesion size and there was a poor correlation between change in lesion size and clinical outcome. X-rays performed at follow-up on 20 patients showed mild degenerative changes in 13 of 20 ankles with OLT. No correlation was found between the presence of degenerative changes and the clinical outcome. We conclude that: 1. Non-surgical management of stage 5 OLT is a viable option with little or no risk of developing significant osteoarthritis. 2. Most lesions remain radiographically stable. 3. There is a poor correlation between changes in lesion size and clinical outcome. However, the few patients with lesions which decrease significantly in size tend to do well and those with lesions which increase significantly in size do poorly. 4. The development of mild radiographic changes of OA does not correlate with clinical outcome. 5. The general course of stage 5 OLT is benign with over half of the patients improving to good or excellent results with non-surgical management. 6. Lateral lesions tend to do better than medial ones. 7. Adult onset lesions tend to do better than juvenile onset lesions.