Fırat DOĞRUÖZ, Murat YUNCU, Mehmet Barış ERTAN, Koray Kaya KILIÇ, Aliekber YAPAR, Özkan KÖSE
Archives of Current Medical Research - 2026;7(1):179-188
Background: Osteochondral lesions of the talus (TOLs) are a frequent cause of chronic ankle pain and functional limi- tation. 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 ana- tomical 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-spe- cific morphological characteristics of TOLs. The findings highlight medial talar dome vulnerability and reveal sex-re- lated differences in lesion presentation, suggesting distinct pathomechanical pathways. These results may aid in early diagnosis and guide personalized management strategies for TOLs.
