Overview
- Cartilage and subchondral bone injury of the talar dome, mostly after sprain or fracture
- Medial lesions deeper and posterior, lateral shallower, anterior and more clearly traumatic
- Deep ankle pain, swelling and catching after an injury that has not settled
- MRI for size, stability and oedema, CT for cysts and planning
- Small stable lesions nonoperative first
- Under about 1.5 cm², arthroscopic debridement and marrow stimulation
- Larger or cystic lesions may need fixation, autograft or allograft
Western Health Orthopaedic Registrar presentation – Osteochondral Lesions of the Talus
Presentation by Dr Martin Blum
Osteochondral lesions of the Talus by Dr Martin Blum || Orthofracs from Orthofracs on Vimeo.
References
Aetiology
- Lateral lesions, anterolateral, shallow, wafer shaped, almost always traumatic from inversion with dorsiflexion
- Medial lesions, posteromedial, deep, cup shaped, more often atraumatic
- Atraumatic causes include idiopathic OCD, microtrauma, ischaemia and endocrine disorders
Classification
Berndt and Harty
| Stage | Description |
|---|---|
| 1 | Compression |
| 2 | Partially detached |
| 3 | Detached in its bed |
| 4 | Displaced |
| 5 (Loomer) | Subchondral cyst |
Original publication Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 1959;41-A:988-1020.
Hepple (MRI)
| Stage | Description |
|---|---|
| 1 | Cartilage damage only |
| 2a | Underlying fracture with oedema |
| 2b | Underlying fracture without oedema |
| 3 | Detached, undisplaced |
| 4 | Displaced |
| 5 | Subchondral cyst |
Original publication Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999;20(12):789-93.
Investigations
- Plantarflexed mortise view shows posterior lesions better
- MRI overestimates size because of oedema
- CT defines bony size, depth, fixability and cysts for planning
Management
- Non-operative for acute undisplaced, low grade lesions and open physes, protected weight bearing about six weeks
- Acute displaced fragments, fixation with headless screws or bioabsorbable pins
- Primary shallow lesions under about 1.5 cm squared, arthroscopic debridement and bone marrow stimulation
- Intact cartilage over a cyst, retrograde drilling and grafting
- Large, cystic or failed lesions, osteochondral autograft, allograft or MACI
- Repair lateral ligament instability at the same sitting
Prognosis
- Lesion size is the strongest predictor after bone marrow stimulation
- Cysts, older age, higher BMI and uncorrected instability worsen results
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.