What's New? Osteochondral Lesions of the Talus (OLT)

Using the general term osteochondral lesions of the talus is a disservice to patients and physicians alike. Individual characteristics like bone marrow edema (BME), location, depth, and mechanism, all impact symptoms, prognosis, and treatment. Teasing out prognostic variables can help set more accurate guide expectations.

Edema as a prognostic variable

In their 2024 study published this month, Li et al. concluded that the severity of the preoperative BME negatively affected short-term clinical outcomes following arthroscopic bone marrow stimulation (BMS) for OLTs. This finding aligns with a previous study by Cuttica et al., which examined the correlation between MRI detected edema and clinical outcomes after microfracture treatment of OLT. The authors developed an MRI grading system for postoperative BME and concluded that presence of edema on MRI after drilling OLTs was an objective measure of outcome, with patients exhibiting greater edema intensity experiencing inferior clinical outcomes.

Hot off the press: outcomes with marrow stimulation

Last month, Rikken et al. published a study on the long-term outcomes of BMS for OLT. With a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%, where survival was defined as the absence of repeat surgery. At 15 and 20 years of follow-up, the survival rate appeared to remain stable.