Introduction
Osteochondral lesions are pathologic entities affecting the
articular cartilage and subchondral bone. In 1887, Franz
König first hypothesized the potential etiologies for loose
bodies coming from the articular surfaces of various joints.43
These lesions were originally referred to as osteochondritis
dissecans. König stated that these injuries were most commonly a result of severe trauma, though they may occasionally be due to spontaneous compromise of cartilage and the
underlying subchondral bone. Osteochondritis dissecans of
the ankle, now commonly referred to as osteochondral lesions
of the talus (OLT), was first described by Kappis in 1922.38
Since the initial description, these entities have been increasingly studied and understood, and it is currently estimated
that the incidence rate of these lesions is 27 per 100000 person-years among the active military population.64
Initially establishing the diagnosis of OLT can be challenging. Patients may present with prolonged pain, swelling, and catching following traumatic injuries to the ankle
or after seemingly innocuous incidents. However, many
OLTs also arise without specific trauma, and may be related
to repetitive injury. Others are asymptomatic and found
incidentally on plain radiographs or advanced imaging. In
patients who are symptomatic, identification of OLTs
through radiographs can be challenging because these
lesions are not always immediately evident, and thus further
imaging modalities are often required to confirm the
diagnosis.86 Computed tomography (CT) or magnetic resonance imaging (MRI) can help identify both the location
and severity of the lesion.86 Because of the increasing
awareness of these entities, as well as recent advances in
both nonoperative and operative approaches to care, we
present an updated current concepts review of the literature
on diagnosis and evidence-based recommendations for the
treatment of osteochondral lesions of the talus.