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Osteochondritis Dessicans of the Talus

Epidemiology

  • Talus is second most common site for OCD
  • Commonly occurs anterolaterally or posteromedially
  • 50% children present after trauma. Mean age of presentation is 13-14 years

Classification

Berndt & Hardy Grading of Osteochondritis Dessicans (OCD)
Grading Description
I undisplaced
II partially detached
III detached but not displaced
IV detached + displaced or rotated

History

  • pain
  • swelling
  • instability
  • repetitive sprains

Examination

  • ↓ ROM
  • painful ROM
  • Local tenderness

Investigations

  • Xray
    • OCD can be difficult to identify on Xray
  • MRI
    • can define extent of lesion
    • extent of sclerosis displacement
    • whether articular cartilage is intact (fluid beneath OCD fragment denotes articular cartilage breach)

Treatment

  • Course of OCD talus is more benign in children than in adults
  • Initial treatment for types 1-3 is nonoperative with cast immobilisation + protected weightbearing
  • Type 4 lesions (or failed nonoperative treatment for types 1-3) requires drilling, debridement & fixation

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