Hepple and colleagues reviewed hindfoot MRI scans to characterize osteochondral lesions of the talus in detail beyond plain radiographs. They propose a revised six-stage classification based on cartilage, subchondral bone, fragment status, and cyst formation. The paper also discusses whether trauma alone explains these lesions.
When you suspect an osteochondral lesion of the talus, order MRI, not just radiographs. Nearly a third of lesions are invisible on plain film, so a normal radiograph does not exclude the diagnosis.
The Hepple system adds two clinically useful concepts the Berndt-Harty system lacks. Stage 2a versus 2b hinges on bony edema, which signals an acute, healing-active lesion. Stage 5 captures subchondral cysts, which this paper links to the worst symptoms and poorest outcomes.
Use the staging to frame decisions before arthroscopy. Early stage 1 and 2 lesions favor less invasive treatment, while stage 5 cysts predict a harder therapeutic course. The 50% lateral ligament correlation is a teaching point: trauma alone does not explain every OLT, so keep a multifactorial etiology in mind for atraumatic ankle pain.
Hepple and colleagues reviewed hindfoot MRI scans to characterize osteochondral lesions of the talus in detail beyond plain radiographs. They propose a revised six-stage classification based on cartilage, subchondral bone, fragment status, and cyst formation. The paper also discusses whether trauma alone explains these lesions.
When you suspect an osteochondral lesion of the talus, order MRI, not just radiographs. Nearly a third of lesions are invisible on plain film, so a normal radiograph does not exclude the diagnosis.
The Hepple system adds two clinically useful concepts the Berndt-Harty system lacks. Stage 2a versus 2b hinges on bony edema, which signals an acute, healing-active lesion. Stage 5 captures subchondral cysts, which this paper links to the worst symptoms and poorest outcomes.
Use the staging to frame decisions before arthroscopy. Early stage 1 and 2 lesions favor less invasive treatment, while stage 5 cysts predict a harder therapeutic course. The 50% lateral ligament correlation is a teaching point: trauma alone does not explain every OLT, so keep a multifactorial etiology in mind for atraumatic ankle pain.