Talus Osteokondral Lezyonlarının Epidemiyolojisi: 490 Hastada MRG İncelemesi

Year 2026, Volume: 7 Issue: 1, 179 - 188, 31.01.2026

Fırat Doğruöz , Murat Yüncü , Mehmet Barış Ertan , Koray Kaya Kiliç , Aliekber Yapar , Özkan Köse

https://doi.org/10.47482/acmr.1719683

Abstract

Amaç: Talus osteokondral lezyonları (TOL), kronik ayak bileği ağrısı ve fonksiyon kaybının önemli nedenlerindendir. Ancak bu lezyonların yaygınlığı, anatomik dağılımı ve morfolojik özelliklerine dair, özellikle cinsiyete dayalı farklılıkları içeren veriler sınırlıdır. Bu çalışmada, geniş bir hasta grubunda MRG temelli değerlendirme ile TOL’lerin dağılımı ve karakteristik özellikleri analiz edilmiştir.
Yöntem: 2018–2022 yılları arasında ayak bileği ağrısı nedeniyle MRG çekilen 5.356 hasta geriye dönük olarak incelenmiş, TOL tanısı doğrulanan 490 erişkin hasta (283 kadın, 207 erkek) çalışmaya dahil edilmiştir. Lezyonlar, dokuz bölgeli anatomik grid sistemi ile lokalize edilmiş, Bristol/Hepple sınıflamasına göre derecelendirilmiş ve ROI yöntemiyle boyutları hesaplanmıştır. Gözlemciler arası uyum, ICC ve Cohen’s kappa ile değerlendirilmiştir.
Bulgular: TOL prevalansı %9,1 olarak saptanmıştır (kadınlarda %9,0; erkeklerde %9,3). Ortalama hasta yaşı 46,2±14,3 yıldır. Lezyonlar en sık 4. (%33,7) ve 7. (%33,5) bölgelerde görülmüştür. Ortalama lezyon alanı 78,2±61,9 mm² olup, en büyük lezyonlar 4. bölgededir. En sık karşılaşılan evreler Grade 1 (%26,2) ve Grade 5 (%20,7) olmuştur. Erkek hastalar, kadınlara göre anlamlı olarak daha genç yaşta ve daha büyük lezyonlarla başvurmuştur (p<0,01). Kadınlarda ise bilateral tutulum ve medial yerleşim daha yaygın bulunmuştur (p<0,05).
Sonuç: Bu çalışma, TOL’lerin bölgesel dağılımı ve cinsiyete özgü morfolojik farklılıklarını bir arada sunan, MRG temelli en kapsamlı serilerden biridir. Bulgular, medial talar kubbenin biyomekanik olarak daha savunmasız olduğunu ve cinsiyet temelli farklılıkların lezyon karakteristiklerini etkilediğini göstermektedir. Bu veriler, erken tanı, risk değerlendirmesi ve bireyselleştirilmiş tedavi planlaması açısından klinik uygulamalara katkı sağlayabilir.

Keywords

talus osteokondral lezyonları , insidans , epidemiyoloji , osteokondritis dissekans , Hepple sınıflandırması.

Epidemiology of the talus osteochondral lesions: an MRI survey in 490 patients

Abstract

Background: Osteochondral lesions of the talus (TOLs) are a frequent cause of chronic ankle pain and functional limitation. Despite their clinical significance, data on their prevalence, anatomical distribution, and morphological features remain limited, particularly concerning sex-based differences.
Methods: This retrospective study reviewed 5,356 ankle MRI scans performed over five years to identify patients with TOLs. 490 skeletally mature patients (283 females, 207 males) were included. Lesions were evaluated based on anatomical localization using a standardized nine-zone grid, graded according to the Bristol/Hepple classification, and measured using region of interest (ROI) tools. Inter- and intra-observer reliability was assessed using ICC and Cohen’s kappa statistics.
Results: The overall prevalence of TOLs was 9.1%, with similar rates in males (9.3%) and females (9.0%). The mean age was 46.2±14.3 years. Lesions were most commonly located in Zones 4 (33.7%) and 7 (33.5%). The mean lesion area was 78.2±61.9 mm², with the largest lesions in Zone 4. Grade 1 (26.2%) and Grade 5 (20.70%) were the most frequent lesion grades. Male patients were significantly younger(42,2) and had larger lesions (p<0.01), whereas bilateral involvement and medial localization were more common in females (p<0.05).
Conclusion: This study provides the first large-scale MRI-based analysis integrating zonal lesion mapping with sex-specific morphological characteristics of TOLs. The findings highlight medial talar dome vulnerability and reveal sex-related differences in lesion presentation, suggesting distinct pathomechanical pathways. These results may aid in early diagnosis and guide personalized management strategies for TOLs.

Keywords

talus osteochondral lesions , incidence , epidemiology , osteochondritis dissecans , Hepple classification.

Ethical Statement

Antalya Training and Research Hospital institutional review board approved the study protocol (01/16, 06.01.2022).

Supporting Institution

No funds have been received for this study.

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