Foot & Ankle International - June 2017 - 616

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Figure 1. Magnetic resonance imaging of a patient from the
Healthy Weight Group (body mass index at surgery 22.5):
right ankle, sagittal view. In the image on the left examination
performed at T0 osteochondral lesion of the talar dome can
be seen, extended from anterior to posterior for about 11
mm. The lesion is characterized by full-thickness erosion of the
cartilage and depression of cancellous subchondral bone, with
sclerotic edges and intense perilesional edema. In the central
image examination performed at T2, the osteochondral defect
is reduced, with microcystic alterations and decrease of the
surrounding edema. On the right examination performed at T3,
reduction of the edema of the cancellous bone is evident, with
good coverage of the osteochondral defect.

Figure 2. Computed tomographic scan of a patient from the
Healthy Weight Group (body mass index at surgery 22.5):
right ankle, coronal view. In the image on the left examination
performed at T0, the presence of an osteochondral lesion on the
lateral shoulder of the talar dome is seen. In the central image
examination performed at T2, there is a substantially unchanged
size, subchondral bone with sclerotic edges, and reduced edema
around the lesion. On the right examination performed at T3,
reparative processes of the lateral osteochondral lesion of the
talar dome are evident.

appeared to affect the outcome and the incidence for osteochondral lesions of the knee, scarce evidence has been
reported in the literature regarding the talus.2,5,35,36,41 In our
group of patients, we noted a significant improvement in all
clinical parameters over the time period examined, and also
the size of the lesion reduced significantly by the 24-month
follow-up. The most interesting findings concerning the OG
was the significant difference between the measurements
obtained with CT and those with MRI at each time point.
On the other hand, in HG, the difference was only noted at
T0 and at T1. Moreover, the size of the lesion measured with
MRI at T0 was greater in the OG. We hypothesized that
weight plays a key role in the edema surrounding the

Foot & Ankle International 38(6)

Figure 3. Magnetic resonance imaging of a patient from
the Overweight Group (body mass index at surgery 27.5):
right ankle, sagittal view. The image on the left examination
performed at T0 shows osteochondral lesion of the medial
talar dome, with depression of the cortical bone and alteration
signal for edema of the adjacent cancellous bone. In the central
image examination performed at T2, there are minimum repair
processes, with thickened cartilage that covers the lesion and
mild edema of the surrounding bone. The right examination
performed at T3 shows good healing of the lesion, filled with
new tissue and discreet covering of the articular surface.

Figure 4. Computed tomographic scan of a patient from
the Overweight Group (body mass index at surgery 27.5):
right ankle, coronal view. The image on the left examination
performed at T0 shows presence of the osteochondral
lesion at the medial shoulder of the talus characterized by a
lenticular morphology with sclerotic edges. In the central image
examination performed at T2, there is slight improvement of
the osteochondral defect. The right examination performed at
T3 shows good reconstruction of the neocartilage with partial
coverage of the bone gap.

osteochondral lesion, increasing significantly the size of the
lesion measured with MRI. In fact, in the group of patients
with BMI t25 we noted a bigger-sized lesion measured
with MRI but not with CT in respect to the HG. Based on
the findings of our study, we believe that the association
between edema and BMI should be the subject of further
studies.
Bone marrow edema can be defined as an area of altered
signal on MRI that shows an intermediate or low signal
intensity on T1-weighted images and a high signal intensity on fat-suppressed, T2-weighted, and short tau inversion recovery sequences in comparison with the normal

Table of Contents for the Digital Edition of Foot & Ankle International - June 2017