In a retrospective study of thirty-one ankles in twenty-nine patients
with osteochondral lesions, we found that lateral lesions were associated
with 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 less symptomatic. Using the
classification system of Berndt and Harty, it appeared that Stage-I and
Stage-II lesions should be treated non-operatively, regardless of location.
Stage-III medial lesions should be treated non-operatively initially but if
symptoms persist surgical excision and curettage are indicated. Stage-III
lateral lesions and all Stage-IV lesions should be treated by early
operation. Long-term results indicated that few lesions unite when treated
non-operatively. Degenerative changes in the ankle joint, whether
symptomatic or not, were common (50 per cent of the ankles) regardless of
the type of treatment.