Definition

Focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage.

Location

• medial talar dome

  • usually no history of trauma

  • more posterior

  • larger and deeper than lateral lesions

• lateral talar dome 

  • usually have a traumatic history 

  • more superficial and smaller

  • more central or anterior

  • lower incidence of spontaneous healing

  • more often displaced and symptomatic

Clinical presentation

• History : inversion ankle sprain

• Symptoms

  • pain centered over ankle joint line

  • joint effusion

  • mechanical symptoms such as catching or locking

• Physical exam

  • palpation rarely reproduces pain

  • cavus hindfoot alignment

  • ROM often limited secondary to pain or effusion

  • provocative tests: evaluate for ligamentous laxity or insufficiency

Treatment

• Immobilization and non weight bearing for acute non displaced lesion

• Arthroscopy  debridement + microfracture :  for chronic lesion <1cm

• Retrograde drilling and grafting for size >1cm with intact cartilage

• Mosaicoplasty ( osteochondral grafting)

Sometimes, Malleoli’s osteotomy is needed to access to the lesion

This information is a brief, simple medical explanation. For exhaustive details, and before starting any kind of treatment, please refer to Dr.BAYOUD