Lateral talar OCDs have an increased history of a traumatic etiology in comparision to medial talar OCDs.
Lateral talar OCDs are also usually less common, smaller and more shallow than medial talar OCDS. Lateral talar OCDs are usually anterior in comparison to medial based OCDs, and are harder to treat with conservative treatment due to a lower incidence of spontaneous healing.
Canale et el. did a retrospective study of osteochondral lesions of the talus. They found that lateral lesions were associated with a history of inversion or inversion-dorsiflexion trauma, were morphologically shallow, and were more likely to become displaced in the joint and to have persistent symptoms. Medial lesions were both traumatic and atraumatic in origin, morphologically deep, and usually less symptomatic.
Flick et al. performed a retrospective study and review of the literature of osteochondritis dissecans of the talus (transchondral fractures of the talus). A history of trauma was noted in 100% of the lateral lesions and 80% of the medial talar dome lesions. Lateral dome lesions requiring surgery were approached through the standard anterolateral incision, while medial dome lesions were approached through the anterior tibial tendon sheath with grooving of the anteromedial distal tibia articular surface allowing posteriorly placed medial lesions to be reached, without medial malleolar osteotomy.
Illustration A shows a T1 coronal MRI with a lateral talar OCD.
Answer 2- Lateral talar OCDs are usually more shallow in depth than medial talar OCDs.
Answer 3- Lateral talar OCDs are harder to treat with conservative treatment due to a lower incidence of spontaneous healing.
Answer 4- Medial talar OCDs are usually more posteriorly located than lateral talar OCDs.
Answer 5- Medial talar OCDs are more common than lateral talar OCDs.
Ferkel RD, Hommen JP. Arthroscopy of the foot and ankle. In: Coughlin MJ, Mann RA, Saltzman CL,
Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg Am. 1980 Jan;62(1):97-102.
PMID:7351423 (Link to Abstract)
Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985 Jan-Feb;5(4):165-85.
PMID:3830846 (Link to Abstract)