When planning the treatment of osteochondral lesions of the talus, it is important to evaluate the articular cartilage to distinguish between stable and unstable lesions (1,2). Cartilage damage was noted in 17–66% of ankles with lateral ligament injuries [ 3 , 12 , 21 , 26 ]. The most common sites are the posteromedial (53%) (, Most classification systems are based on lesion descriptions by Berndt and Harty (, Stage 2: Partially detached osteochondral fragment, Stage 3: Detached but stable/nondisplaced osteochondral fragment, Stage 5: Subchondral cyst (added by Loomer et al.) Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of … He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. Berndt & Harty Xray Classification . With proper treatment, the prognosis generally is good. During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Evaluate for tenderness over the talar dome. If the subchondral bone is not violated, no healing occurs. Stage VI: massive osteochondral defects of the talus. The mean time of follow-up was 36 months (range, 25-49). The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The diagnosis of OCD most frequently depends on obtaining an imaging study: Plain radiographs or CT, MRI, or bone scans. Subchondral bone is penetrated to allow bleeding and fibrin clot formation. Die Osteochondrosis dissecans (OCD, auch angloamerikanisch Osteochondritis dissecans) ist die umschriebene aseptische Knochennekrose unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper enden kann. Although OCD of the talus is, by definition, detachment of an osteochondral fragment of the talar dome occurring in a growing patient, symptomatic OCD is more typically observed in adults. • Cartilage injury with underlying fracture and surrounding bony edema, • Stage 2a without surrounding bone edema, often limited secondary to pain or effusion, evaluate for ligamentous laxity or insufficiency, suspicion for OLT in setting of equivocal radiographs, helpful in evaluating subchondral bone and cysts, less reliable in purely cartilaginous lesions of nondisplaced OLTs, provides fine detail of lesions for pre-operative planning, persistent pain following injury, ankle sprains that do not heal with time, variable edema patterns, may overestimate degree of injury, unstable lesions show fluid deep to subchondral bone, predicts stability of lesion with 92% sensitivity, nondisplaced fragment with incomplete fracture, size > 1 cm and displaced lesions, shoulder lesions, salvage for failed marrow stimulation or drilling, period of immobilization in cast or boot for 6 weeks, followed by progressive weight bearing with physical therapy emphasizing peroneal strengthening, range of motion, and proprioceptive training, Arthroscopy with marrow stimulation (microfracture or antegrade drilling), debridement of unstable cartilage flaps to create stable and contained defect using curettes or shaver, loose bodies and cartilage removed using shaver or grasper, microfracture awl placed perpendicular to surface and tapped into subchondral bone 2-4 mm deep, inflow stopped to allow fat or blood to emanate from holes, indicating adequate penetration, Kirschner wire can be passed using anterior portals, or transmalleolar for central or posterior lesions, talus dorsiflexed and plantar flex to necessitate only 1 transosseous passing of wire, articular cartilage delamination and graft failure, 65-90% improvement in patient reported outcomes, fibrocartilage formation at site of lesion in 60% of patients on second-look arthroscopy, no correlation noted with patient outcomes, Arthroscopy with retrograde drilling and bone grafting, evaluate cartilaginous surface for softening, dimpling with probe seen, Kirschner wire drilled from sinus tarsi into defect, fluoroscopy often helpful to confirm location, if bone grafting indicated, cannulated drill placed over K wire, Osteochondral autograft and allograft transplant, dictated by location of OLT and concomitant procedures required (i.e. Copyright © 2020 Lineage Medical, Inc. All rights reserved. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Any procedure that requires an osteotomy necessitates nonweightbearing until the osteotomy heals (4–8 weeks). Although biomechanically inferior to hyaline cartilage, fibrocartilage formation appears to be sufficient for smaller lesions. Osteochondral defect (OCD) or lesion of the talus can accompany chronic lateral ankle instability (CAI). On the lateral aspect of the ankle it most often occurs from trauma. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. Procedures that transfer hyaline cartilage to the defect: OATS/mosaicplasty, allograft transfer, Generally recommended for large lesions or lesions that fail other forms of treatment. The coronal plane of the MRI demonstrates anteromedial lesions of OLT, Hepple stage 1 and 2A in figure 2A, and 2B (arrow), respectively. • Cystic lesion within dome of talus with an intact roof on all view, • Cystic lesion communication to talar dome surface. Giannini S, Vannini F. Operative treatment of osteochondral lesions of the talar dome: current concepts review. The top of the talus is part of the joint and is covered with articular cartilage , … Read More, Copyright ©2007 Lippincott Williams & Wilkins, > Table of Contents > Osteochondral Defect of the Talus. Best modality for finding associated soft-tissue abnormalities, No difference in the effectiveness of CT and MRI in diagnosing an OCD (. Osteochondral lesions of the talus and the role of ankle arthroscopy. All Rights Reserved. We'll assume you're ok with this, but you can opt-out if you wish. • There are… Osteotomy usually is required as part of the surgical approach. Bei der Osteochondrosis dissecans stirbt ein Teil des Knochens unterhalb des Gelenkknorpels ab, sodass sich dieser ablösen kann und in der Gelenkhöhle lose vorliegt (Dissektat). The incidence of osteochondral defects (OCD) of the talus is 0.09 % in the literature with a prevalence of 0.002 per 100,0001-3. Coronal T1-weighted image of the ankle, showing a medial talar OATS. The lateral injuries to the Talus (ankle bone) are usually shallow and cup shaped. Osteochondritis dissecans (OCD) of the talus is a disea-se affecting the subchondral bone and secondarily the articular cartilage. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. The sagittal MRI demonstrates non-displaced mid-medial lesion of OLT, Hepple stage 3, in figure 2E (arrow) and displaced mid-lateral lesion of the OLT, Hepple stage 4, in (Fig. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. ROM usually is started 2–6 weeks after surgery, depending on the quality of the osteotomy fixation. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. If the subchondral bone is violated, the defect attempts to heal with fibrous tissue or fibrocartilage. Limited by the amount of donor tissue that can be harvested, Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. Pathology . Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain Osteochondral lesions of the talus. Osteochondral lesions of the talus. However, for the last six months, he has developed persistent ankle pain with intermittent swelling. In the ankle OCD can occur anterolateral or posteriomedial. Physical examination elicits pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal. Table 3. Accept 6,51 This cartilage is cultured to grow chondrocytes, which can be viable for longer than 1 year. Cyst may develop under fragment . - James Stone, MD, Evolving Technique: The Role Of Osteotomy For The Treatment Of Osteochondral Lesions Of The Talar Dome - Listen Up!- Phinit Phisitkul, MD, MACI & Newer Techniques: I Told You This Before: Wake Up Everyone! Traumatic chondral defects, on the other hand, are often related to shear. Overlying cartilage may degenerate . A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. Radiographs at the time were negative and his pain improved over the next two months. [ 2 ] The top of the talus is dome-shaped and is completely covered with cartilage (connective tissue that allows the ankle to move smoothly). MRI is less useful for determining healing of OCD lesions because clinical healing may not correlate with imaging [ 5,20 ], and, in patients with operative repair, bony edema from instrumentation interferes with identification of healing during the postoperative period [ 44 ]. [] Although majority may be associated with trauma, some may develop insidiously. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. The ankle is the third most frequently affected site, after the knee and elbow, and it accounts for 4% of all OCD cases (1, 2). 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