Osteochondral lesion of the talus

NewsBot · Jan 28, 2026

Impact of lower extremity mechanical axis alignment on clinical outcomes following mosaicplasty for medial talar osteochondral lesions: A retrospective comparative study
Murat Onder et al
Source

Background
The impact of proximal lower extremity malalignment on mosaicplasty outcomes for medial talar osteochondral lesions remains unclear.
Purpose
To determine whether knee-origin varus malalignment of the mechanical axis affects clinical outcomes and cartilage repair quality after mosaicplasty for medial talar osteochondral lesions.
Methods
Forty-four patients who underwent mosaicplasty for medial talar osteochondral lesions (2020-2023) were stratified into Group 1 (varus malalignment, n = 21) and Group 2 (neutral/mild valgus, n = 23) based on standing long-leg radiographs. Visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scores were compared. Mean follow-up was 49.3 ± 26.2 months.
Results
Group 1 demonstrated significantly higher postoperative VAS scores (4.4 ± 2.0 vs. 1.5 ± 0.7, p < 0.001) and less pain improvement (ΔVAS: 4.2 ± 2.0 vs. 5.7 ± 1.1, p < 0.05) compared with Group 2. AOFAS scores were similar postoperatively (81.8 ± 9.8 vs. 85.5 ± 8.6, p = 0.075). MOCART 2.0 scores showed no significant difference (75±19 vs. 77±18, p = 0.859). Strong correlations existed between mechanical axis deviation and postoperative VAS (ρ=0.804, p < 0.001). Although some patients developed radiographically visible arthritic changes during follow-up, no patient underwent revision surgery or arthrodesis due to advanced osteoarthritis.
Conclusions
Varus malalignment was associated with higher postoperative pain scores and less pain improvement following mosaicplasty for medial talar osteochondral lesions, despite similar functional outcomes and cartilage repair quality. These findings suggest that surgical planning should consider mechanical axis alignment and that corrective realignment procedures may be warranted in select patients with significant varus deformity to optimize pain outcomes.
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NewsBot · Mar 6, 2026

Understanding Pain in Osteochondral Lesions of the Talus: A Cross-Sectional, CT‑Based Analysis Showing Limited and Inconsistent Associations With Pain
Julian J Hollander et al
Foot Ankle Int. 2026 Mar 3:10711007251413568.

Background: Patients with an osteochondral lesion of the talus (OLT) often present with deep ankle pain, but the direct relationship between structural damage and the perceived pain remains unclear. The aim of this study was therefore to determine whether pain is associated with demographic and radiologic (computed tomography [CT]-only) lesion characteristics.

Methods: This cross-sectional study was conducted in patients with symptomatic OLTs at a tertiary referral academic hospital. The primary outcome was the Pain subscale of the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the Numeric Rating Scale (NRS) for pain at rest and during walking, as well as the other FAOS subscales. Associations with patient demographics, lesion size, morphology, and location were assessed using univariate linear regression, followed by multivariate linear regression with backward selection.

Results: A total of 310 patients were included. In the final multivariate model for the FAOS Pain subscale, higher age (β = -0.18, P = .04) and smoking (β = -8.70, P < .001) were significantly associated with worse pain scores. Lesion morphology characterized by the presence of an osteochondral fragment was associated with lower NRS pain scores during walking. For NRS pain at rest, worse scores were significantly associated with female sex, higher body mass index, smoking, non-primary lesion nature, and greater lesion depth.

Conclusion: No association was found between CT-based radiologic lesion characteristics and patient-reported pain as measured by the FAOS Pain subscale. In secondary analyses, some lesion characteristics showed associations, but these were limited and directionally inconsistent. These findings suggest structural damage alone does not seem to fully explain the patient's pain. Given the CT‑only approach and other design constraints, further research is warranted.
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NewsBot · Mar 27, 2026

MRI assessment of autologous osteochondral transplantation in talus: correlation with clinical outcomes and second look
Sanbiao Liu et al
Front Sports Act Living. 2026 Jan 29:7:1657265.

Background: Autologous osteochondral transplantation (AOT) is an effective technique for treating complex osteochondral injuries of the talus. However, there is still controversy regarding the imaging assessment of its postoperative efficacy. MRI, as a non-invasive examination, is the primary method for evaluating surgical outcomes, while invasive secondary arthroscopic surgery provides a more direct and accurate evaluation of intra-articular results. The correlation between these two assessment methods and clinical outcomes remains unclear.

Purpose: To evaluate the correlation between MRI findings assessed using the MOCART scoring system and functional outcomes, as well as arthroscopic second look, in patients undergoing (AOT) for osteochondral lesions of the talus.

Methods: A retrospective analysis was conducted on 47 patients. All patients were followed for a minimum of two years postoperatively. Functional evaluations were performed at one and two years after surgery using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale (VAS). Imaging assessments utilized the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) MRI scoring system. All patients underwent secondary arthroscopy for internal fixation removal at the two-year mark, during which the International Cartilage Repair Society (ICRS) scores were recorded.

Results: There was a low correlation between the MOCART scores and both functional scores and arthroscopic scores postoperatively. At one year post-surgery, the MOCART score showed a low correlation with the AOFAS score (r = 0.27, p = 0.07, 95% CI: -0.01-0.36). By two years post-surgery, the MOCART score demonstrated a low correlation with the AOFAS score (r = 0.34, p = 0.02, 95% CI: 0.05-0.49), VAS score (r = -0.46, p < 0.05, 95% CI: -0.08 to -0.02), and ICRS score (r = 0.36, p < 0.05, 95% CI: 0.40-3.11). ICRS and AOFAS scores (r = 0.56, p < 0.05, 95% CI: 1.19-3.07), indicating a moderate correlation.

Conclusion: In autologous osteochondral transplantation (AOT) for the talus, the MOCART scores showed a low correlation with clinical function or secondary arthroscopic scores. The MRI assessment of talar cartilage repair requires more detailed evaluation.
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NewsBot · Apr 3, 2026

Functional implications of lesion morphology in untreated osteochondral lesions of the talus
Mehmet Orçun Akkurt et al
J Orthop Surg Res. 2026 Mar 31.

Background: Osteochondral lesions of the talus (OLTs) are a significant cause of chronic ankle pain and functional impairment. However, the relationship between lesion morphology and functional scores remains insufficiently studied, particularly in untreated patients who did not undergo surgical intervention. This cross-sectional study investigates the relationship between MRI-based lesion morphology and functional scores in patients with osteochondral lesions of the talus who did not undergo surgery.

Methods: This retrospective study included 182 patients diagnosed with OLT based on ankle MRI between January 2023 and March 2025. Lesion surface area and depth were measured using standardized imaging protocols. Functional scores were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Foot and Ankle Disability Index (FADI). Lesions were categorized into six anatomic regions. Demographic variables and lesion characteristics were analyzed for their associations with lower functional scores.

Results: Medial lesions accounted for 76.3% of cases, with the centromedial region being the most frequently affected (55%). Lesion location did not significantly influence functional scores. In contrast, lesion surface area demonstrated a strong negative correlation with both AOFAS (ρ = - 0.81) and FADI scores (ρ = - 0.81), while lesion depth showed a moderate negative correlation. Age was negatively associated with functional scores. Body mass index and sex did not demonstrate consistent associations.

Conclusion: These findings indicate that lesion surface area is a stronger predictor of functional impairment than lesion location or depth in the untreated state of non-surgically treated OLT. The results underscore the value of quantitative lesion assessment in the nonsurgical management of talus osteochondral defects and suggest that MRI-based lesion area measurements may help to characterize functional impairment in patients with untreated OLT.
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NewsBot · Apr 3, 2026

Autologous Osteoperiosteal Transplantation Provides Comparable Clinical and Radiologic Outcomes for Lateral and Medial Large Cystic Osteochondral Lesions of the Talus: A Propensity Score–Matched Comparative Analysis
Shuai Yang et al
Source

Background:
Autologous osteoperiosteal transplantation (AOPT) is a promising treatment for large cystic osteochondral lesions of the talus (OLTs), but the influence of lesion laterality remains unclear. The purpose of this study was to compare the clinical and radiologic outcomes of lateral vs medial large cystic OLTs treated with AOPT.
Methods:
Patients with lateral or medial large cystic OLTs who underwent AOPT between 2010 and 2023 were retrospectively reviewed. Patients were propensity matched in 1:1 ratio on sex, age, body mass index, affected side, and lesion profiles (area, depth, volume). Clinical outcomes were assessed using the visual analog scale for pain (VAS), the Foot Ankle Outcome Score (FAOS), and the ankle activity score (AAS). The final FAOS score was designated as the primary outcome measure. Radiologic outcomes were evaluated using the MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 ankle score.
Results:
A total of 22 matched patients per group were included, with a mean follow-up of 84.6 ± 45.9 months. The lateral group comprised 20 males and 2 females (mean age, 40.4 ± 11.2 years), whereas the medial group included 18 males and 4 females (mean age, 38.0 ± 8.4 years). Both groups demonstrated significant improvements in total FAOS scores (lateral: 53.4 ± 13.8 to 87.2 ± 10.1, P < .001; medial: 51.1 ± 12.6 to 89.7 ± 8.4, P < .001) and in all secondary clinical outcomes at final follow-up (all P < .001), with no intergroup differences (all P > .05). Similarly, there were no significant differences in the total MOCART 2.0 ankle score (73.8 ± 10.7 vs 73.0 ± 9.9; nonsignificant) or in any of its individual subcomponents.
Conclusion:
This cohort study demonstrated that AOPT yields comparable mid‑ to long‑term clinical and radiologic outcomes for medial and lateral large cystic OLTs, and that radiologic results were not significantly associated with clinical outcomes.
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NewsBot · Apr 4, 2026

Do small talar osteochondral defects need repair during lateral ligament reconstruction with internal brace augmentation in chronic ankle instability?
Aysha Rajeev et al
J Foot Ankle Surg. 2026 Feb 18:S1067-2516(26)00048-7.

Background: Chronic lateral ankle instability (CLAI) is frequently associated with intra-articular pathology.

Purpose of the study: The study compared functional outcomes of lateral ligament reconstruction in patients with isolated CLAI versus CLAI with concomitant talar OCD.

Study design: We conducted a retrospective review of patients who underwent lateral ligament reconstruction between January 2018 and December 2023.

Methods: Preoperative MRI was used to confirm CLAI and identify talar OCD. Patients were classified into two groups: Group A - isolated CLAI, and Group B - CLAI with talar OCD (<1 cm²). Functional outcomes were measured using the Manchester-Oxford Foot Questionnaire (MOxFQ), EQ-5D, and EQ-VAS.

Results: Seventy patients met the inclusion criteria: 39 in Group A (55.7%) and 31 in Group B (44.3%). Mean follow-up was 54.2 months (range 36.8-66.4). Group A: MOxFQ improved from 61.8 ± 20.4 to 22.5 ± 12.2; EQ-5D from 18.3 ± 7.7 to 4.4 ± 2.7; EQ-VAS from 54.6 ± 11.9 to 68.3 ± 19.8.

Group b: MOxFQ improved from 44.4 ± 10.0 to 18.0 ± 7.8; EQ-5D from 15.1 ± 2.5 to 8.5 ± 1.3; EQ-VAS from 46.7 ± 17.8 to 72.8 ± 29.3. There was no statistically significant difference in functional outcomes between the two groups (p = 0.145).

Conclusion: Lateral ligament reconstruction with suture tape augmentation in patients with chronic lateral ankle instability, with or without concomitant talar osteochondral defects, demonstrated no significant differences in functional outcomes between groups, suggesting that smaller osteochondral lesions less than 1cm2 in size may not require surgical repair.
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NewsBot · Apr 8, 2026

Arthroscopic Bone Marrow Stimulation for Non-primary Osteochondral Lesions of the Talus Yields Limited Improvements in Patient-Reported Outcomes Compared to Primary Lesions: A Prospective 2-Year
Quinten G. H. Rikken et al
Source

Background:
Our aim in this study was to prospectively assess the patient-reported clinical outcomes of arthroscopic bone marrow stimulation (BMS) for non-primary osteochondral lesions of the talus (OLT) and to compare these with primary cases at 2-year follow-up. The secondary aims were to assess the association of baseline factors with outcomes and the occurrence of adverse events.
Methods:
Patients who underwent arthroscopic BMS were prospectively included and assessed up to 2-year follow-up and were grouped according to non-primary (ie, failed previous OLT surgery) or primary BMS. Patient-reported outcomes were collected at baseline and 2-year follow-up and included the numeric rating scale (NRS) for pain and the Foot and Ankle Outcome Score (FAOS) questionnaires. The primary outcome was the improvement in NRS pain during walking, with a minimal clinically important difference (MCID) of 2.0. Adverse events concerned reoperations and complications during the study period.
Results:
Forty-four patients were included: 25 in the primary group and 19 in the non-primary group. Both groups showed a statistically significant improvement in pain and functional outcomes from preoperatively to 2-year follow-up. The improvement in the primary outcome was significantly higher in the primary group (median 3 [IQR: 1-5] out of 10) compared to the non-primary group (median 1 [IQR: 1-3] out of 10), P = .01. Moreover, 68% (95% CI 46%-85%) reached the MCID compared with 32% (95% CI 13%-57%) in the non-primary group, which was statistically significant (P = .03). Baseline variables showed no consistent association with the primary outcome, except for a moderate correlation with age and lower improvements for patients who received concomitant surgery in the primary group. None of the changes in the FAOS sub-scales showed a statistically significant difference between the two groups. Two revision procedures (non-primary group: 11% [95% CI 1%-33%] vs 0% primary group, P = .2) occurred in the non-primary group. During the study period, 1 case (non-primary group: 5% [1%-26%] vs primary group: 0%, P = .4) had a complication.
Conclusion:
The most important finding of this prospective study is that arthroscopic BMS for non-primary OLT yields a significant improvement in patient-reported outcomes compared with baseline, but an inferior improvement compared with primary OLT at 2-year follow-up. On average, approximately two-thirds of BMS-treated primary OLTs reached the MCID compared with one-third in the non-primary group.
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NewsBot · Apr 28, 2026

Radiologic Progression of Talar Osteochondral Lesions With Subchondral Cyst: A Median 98-Month Observational Study
Jae Hyeon Seo et al
Foot Ankle Int. 2026 Apr 28:10711007261424901.

Background: This retrospective observational cohort study aims to evaluate long-term radiologic progression in nonoperatively managed cystic osteochondral lesions of the talus (OLT), and to (1) identify predictors of radiologic cyst progression, particularly related to subchondral bony integrity, and (2) examine whether radiologic progression is dissociated from changes in clinical outcomes.MethodsAmong 78 cases of OLT with subchondral cysts, 56 patients treated non-operatively for a median of 98 months (>6 years) were included and categorized into 3 groups based on the annual rate of cyst volume change (mm3/y): (1) increased, (2) not changed, and (3) decreased. Factors were assessed using standing ankle radiographs, computed tomography, and magnetic resonance imaging. Additionally, the correlation between radiologic progression and clinical outcomes was analyzed.

Results: Approximately three-quarters of patients clustered around minimal change, with less than an 8-mm3/y increase or even a decrease in cyst volume, and the median annual cyst volume change for the entire cohort was only 0.3 mm3/y. In contrast, cases in the upper quartile of the distribution demonstrated substantially faster cyst enlargement, with a mean annual increase of approximately 137 mm3/y. The ±8-mm3/y thresholds corresponded to the 25th and 75th percentiles of the annual cyst volume change distribution and were used to define radiologic progression groups. Multivariable regression analysis identified 3 significant factors: larger initial cyst volume (odds ratio [OR] 1.002, 95% CI: 1.000-1.004, P = .03), bone marrow (BM) edema (OR 10.189, 95% CI: 1.68-61.97, P = .012), and wall breakage (OR 16.942, 95% CI: 2.73-105.35, P = .002). However, cyst size progression showed no correlation with clinical symptoms (P > .05). Notably, none of the cases progressed to OA.ConclusionA substantial number of OLT with subchondral cysts demonstrated radiologic stability, spontaneous reduction, or slow progression in cyst volume during long-term observation. We found no correlation between changes in cyst size and clinical symptoms.
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Osteochondral lesion of the talus

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Osteochondral lesion of the talus

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Osteochondral Lesions in Surgically Treated Hallux Valgus

Is a osteochondral lesion of the distal tibia something that heals by it's self.

Fracture/tendonosis/osteochondral lesion

Osteochondral defect 3rd metatarsal head

Osteochondral Defect - 3.5 years later

Osteochondral Defect at Medial Talar Dome: Preferred Treatment?

Tactile function of the foot in children with upper motor neuron lesions

Share This Page

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