• Hong-Geun Jung, John Alistair V Carag, Jae-Yong Park, Tae-Hoon Kim, and Sung-Gyu Moon.
• Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea. jungfoot@hanmail.net
• Knee Surg Sports Traumatol Arthrosc. 2011 May 1;19(5):858-62.

PurposeComparatively little literature is available on treatment evaluations of individual osteochondral lesions of the talus (OLT), such as cystic type OLT. It is also noteworthy that controversy still exists regarding the best primary treatment option for cystic type OLT. The purpose of this study was to evaluate the clinical outcomes of arthroscopic microfracture of symptomatic cystic type OLT, irrespective of lesion size, and to verify the efficacy of enhanced ankle MRI for predicting the nature of cystic osteochondral lesions.MethodsIn this study, the authors assessed 22 patients with cystic type OLTs, who all underwent arthroscopic debridement and microfracture with a minimum of 18-month follow-up. There were 16 men and 6 women. Median patient age was 40 (20-64) years. Preoperative and postoperative VAS and AOFAS scores were evaluated.ResultsAt a median follow-up of 32 months (18-63), AOFAS scores improved from a median of 69 preoperative (29-88) to 90 postoperative (75-100) (P < 0.05); and VAS scores improved from a mean of 7.0 ± 1.8 to a mean of 1.7 ± 1.9, respectively (P < 0.05). The overall patient satisfaction rate was 86%. Gadolinium-enhanced MRI scans performed on 21 feet all showed enhancement of varying intensities (from low to high) for the cystic OLTs, implying a vasculogenic potential.ConclusionsThe study shows that arthroscopic microfracture is a desirable first-line treatment for addressing symptomatic cystic type OLT irrespective of lesion size. Enhanced ankle MRI was also found to be a useful and important for predicting the natures of cystic osteochondral lesions.Level Of EvidenceCase-series, Level IV.

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