Background: Osteochondral lesions of the talus (OLT) are relatively uncommon but may be a cause of significant pain and disability. Although the majority of patients have an osteochondral lesion of the talus that is unilateral, bilateral involvement has been reported in 10% to 25% of cases. In addition, factors that cause one side to be symptomatic and the contralateral side to be asymptomatic have never been evaluated.
Materials and methods: A database containing all patients at our institution with an OLT has been maintained for the past 23 years. This was reviewed and patients with bilateral involvement identified. A chart review was performed to determine location and size of the OLT, which were symptomatic, associated with trauma, and required surgery.
Results: Between 1984 and 2007, 526 patients with an OLT were seen. Fifty-two patients had bilateral OLT, for an overall bilateral incidence of 10%. Of these, 16 patients required no surgery (Group 1), 31 required only unilateral surgery (Group 2), and five required bilateral surgery (Group 3). 88% of the OLT were located medially. Symptomatic talar lesions were significantly larger compared to asymptomatic OLT (p < 0.01). Of those that required only unilateral surgery, the size of the OLT eventually requiring surgery was significantly larger (p < 0.01).
Conclusion: The overall incidence of bilateral involvement was 10%. A majority of patients with bilateral involvement had the OLT located on the medial side. A larger surface area appeared to be related to the presence of symptoms and the need for surgery.