Arthroscopic debridement and drilling of osteochondral lesions of the talus.

Diagnosis of OLTs requires a high index of suspicion because these lesions are rare and the symptoms can be falsely attributed to acute or chronic ankle sprains. When no abnormality is present on plain radiographs, a bone scan or MRI can reliably identify the presence of an OLT. CT scanning can provide even better detail of the location and size of the fragment and help stage these lesions and guide treatment. Arthroscopic staging is believed to be the best method to determine treatment. In a patient without an obvious loose body, initial nonoperative treatment is warranted. When nonoperative therapy fails or when a high stage lesion is present, operative options should be explored. Arthroscopic techniques provide results that are equal to or better than management by arthrotomy and have the advantages of lower morbidity and quicker overall rehabilitation time. In most cases, arthroscopic treatment involves loose body removal and debridement and drilling of the underlying bone or drilling alone for intact lesions. Although it is unknown whether such treatment can reduce the incidence of late arthrosis in a patient who has an OLT, a recent study suggested that healing occurs and the MRI appearance of the talar dome normalizes in many patients postoperatively.