Ankle and Foot: Osteochondritis Dissecans of the TalusPediatric and Adolescent Sports Traumatology

Juvenile osteochondritis dissecans (OD) of the talus is a rare disease, affecting subchondral bone and, secondarily, articular cartilage in a skeletal immature population, usually sited in the medial part of the talus. An aseptic bone necrosis is the most accredited pathogenesis whose natural healing is probably blocked by micro-traumas, causing an osteochondral injury. Clinically, asymptomatic cases are possible, but a mild chronic pain is usually present, often accompanied by swelling, stiffness, or locking. A specific classification is not available following the radiographic Berndt and Hardy’s. The most suitable treatment is conservative in the first stages of the disease and it is generally the first step to attempt especially in younger patients. A loose body is instead an indication to surgical fixation, while drilling or regenerative procedures are based on the subchondral bone sclerosis and surgeons experience and preferences. Microfractures are to be considered only for small-sized injuries. Mosaicplasty and osteochondral autograft may cause donor-site morbidity and are scarcely reported in OD. Regenerative techniques and fresh allografts are granting good results in osteochondral lesions and few reports of OD among larger case series are available, but further studies are required.