Ankle bone morphology affects the size of non-trauma related osteochondral lesions of the talus in skeletally immature children

The etiology of osteochondral lesions of the talus (OLT) is not entirely clear. Between 49% and 59% of children are reported to have a history of injury-based lesions, which is less than that reported in adults (61%–98%) [[1], [2], [3]]. Idiopathic lesions, where there is no obvious injury, have been reported to have etiologies that may include regional vascular compromise, genetic predisposition, ankle instability, and abnormal morphology of the ankle [[4], [5], [6], [7], [8], [9], [10]]. Since 2018, there have been several reports on the correlation between OLTs and bone morphology. Teramoto et al. analyzed 19 patients with OLTs using 3-dimensional computed tomography (3D-CT) [8]. Their findings showed that patients with lesions had significantly different size and angle of the medial malleolus and the anterior opening angle of the talus compared with the controls [8]. In 2020, Masqijo et al. described the longer trochlea tali arc (TaL) in children and adolescent patients with OLTs using magnetic resonance imaging (MRI) [5]. Therefore, the bone morphology of the ankle seems to affect the development of OLTs.

Several studies have suggested that the size of an OLT is one of the most important factors; it is generally accepted that large lesions have worse postoperative clinical outcomes than small lesions [[11], [12], [13]]. Therefore, evaluating the size of OLTs is clinically important in selecting appropriate surgical procedures depending on the size of OLTs. However, to our knowledge, there are currently no reports of a correlation between bone morphology and the size of OLTs. By identifying the specific bone morphology that affects the size of OLTs, it may be possible to identify the etiology of OLT in skeletally immature children. In addition, when patients have this specific bone morphology with OLT, effective treatments for the etiology of OLT need to be considered.

This study aimed to elucidate what bone morphology factors affect the size of lesions that develop with and without injury, and to investigate the cause of lesions that develop without injury. The present study hypothesized that the size of OLTs that develop in the absence of injury in skeletally immature children is affected by specific bone morphology.

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