Treatment depends on the severity of the talar dome lesion. Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. For those with persistent pain, surgical treatment is offered. Authors of a 2010 study theorized that water from compressed cartilage is forced into the microfractured subchondral bone during loading, which subsequently leads to localized increased fluid pressure within the subchondral bone. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. Two common lesions are notable on the talus. A variety of surgical techniques is available to accomplish this: Orthopaedics is the medical specialty that focuses on injuries and diseases of your body’s musculoskeletal system. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Plain x-rays can be used to help diagnose an osteochondral lesion although it is not uncommon for the plain x-rays to be read as normal. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. Most classification systems are based on lesion … The differential diagnosis is wide, but a high index of suspicion must be maintained for an OLT when evaluating patients with chronic ankle pain. Treatment principles of osteochondral lesions of the ta… Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Osteochondritis dissecans of the dome of the talus. Goals may range from removal of a loose fragment to securing a larger fragment anatomically. The primary mechanism is damage and insufficient repair of the subchondral bone plate. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. However, medial lesions were larger, and lateral lesions were seen more commonly in association with ligamentous injury. Osteochondral lesions of the talus are injuries to the cartilage in the bone inside the ankle joint. Most authors believe that trauma has an integral role in the pathogenesis of most OLTs and that OLTs most likely represent the chronic phase of a compressed talar dome fracture. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. The patient's osteochondral defect in the posterolateral aspect of the talus was identified. He is a USA Sports Medicine Fellowship trained Orthopaedic Surgeon and is a member of the Arthroscopy Association of North America as well as the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. The etiology of an OLT may be nontraumatic or traumatic. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. Purpose: The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation (OAT) in patients with osteochondral lesions of the talus … However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. The first is injury to the cartilage surface with an … Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus … Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. “Osteo” means bone and “chondral” refers to cartilage. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. The physical examination may reveal tenderness at the level of the ankle mortise anteriorly or posteriorly. The unstable cartilaginous edges were removed with curved curet to stable borders, and then an angled pick was used to perform a microfracture procedure, essentially a drilling microfracture procedure of the osteochondral defect. The approach and objectives of surgery are variable and are determined by the type of lesion. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Osteochondral Defects of the Talus Ankle injuries are one of the most common musculoskeletal conditions. Advanced imaging modalities have significantly increased the ability to accurately diagnose OLTs. Lesion size, location, chronicity, and characteristics such as displacement and … Novena Specialist Centre, [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral … Symptomatic osteochondral ankle defects often require surgical treatment. OLTs represent approximately 4% of all osteochondral lesions. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Months or even years later joint fluid can enter the crack and expand creating … “Osteo” means bone and “chondral” refers to cartilage. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. To diagnose this injury, the surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking or limited motion within that joint. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. They require a strong plan. FIGURE 71-1 Osteochondral lesion of the talus. Some smaller cystic lesions … Osteochondritis dissecans was originally described in 1888 as a process of loose body formation associated with articular cartilage and subchondral bone fracture in the hip and knee. Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology [ 14 ]. Lesion size, chronicity, and location also are important in treatment selection. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. In 1955, investigators reported a frequency of 6.5% in their series of 133 ankle sprains. “Osteo” means bone and “chondral” refers to cartilage. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. If the cartilage does not heal properly following the injury, it softens and begins to break off. Additionally, it was determined that lesion location does not predict subject age, lesion chronicity or instability, or history of trauma. The talus is the bottom bone of the ankle joint. Radiography cannot directly depict the cartilage surface (3). Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). It includes your bones, joints, ligaments, tendons, muscles and even your nerves: basically all the essential parts of your body for you to move, work and enjoy your life. Those that fail to respond may be candidates for v… Research studies show OCD lesion in the talus … Articular cartilage has … The appropriate surgical technique should be taken into account the type, stability, and displacement of the lesion. INTRODUCTION. Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the … The pain is believed to be a result of stimulation of the highly innervated subchondral bone under the cartilage defect. Medial osteochondral lesions are more common than lateral osteochondral lesions. Published many acclaimed articles on Sports Medicine. Purpose: (1) To determine the rate of return to play following autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and (2) report subsequent rehabilitation protocols. The first is a posterior medial lesion … Patients also may report mechanical symptoms including catching, clicking, and locking. OCLs most commonly occur in two areas of the talus: Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. A … Singapore 258499, 820 Thomson Road, #07-53 Depending on the joint that's affected, signs and symptoms of osteochondritis dissecans might include: Pain. The natural history is unclear, although most patients improve without surgical intervention. Articular cartilage has poor regenerative capacity, and the osseous blood supply to the talus is tenuous. Orthopaedic Knowledge Update: Foot and Ankle 5, Orthopaedic Knowledge Update Foot and Ankle 4, TABLE 1 Mintz and Associates’ MRI Classification Compared With Cheng’s Arthroscopic Staging System for Osteochondral Lesions of the Talus, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Sports-Related Injuries of the Foot and Ankle, Forefoot, Sesamoid, and Turf Toe Injuries, Orthopaedic Knowledge Update: Foot and Ankle 6. Description OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion … If you are experiencing one or more of the symptoms mentioned above, it is important to get a prompt and accurate diagnosis to determine the severity of your injury and get proper treatment immediately. Computed tomography scanning in diagnosis and follow-up. There is limited understanding of cartilage damage and its repair. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Singapore 329563, Mon – Fri : © 2020 Ortho.com.sg. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. A cutoff point … A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the pediatric population. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. The precise natural history of OLTs is unclear. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral … Furthermore, it is hard to figure out why some … Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. This is often referred to as a chip inside your ankle joint. Numerous exposure methods have been described, including several variations of medial malleolar osteotomies and distal tibial osteotomies along with combined anterior and posterior arthrotomies. [ 1] T This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. Much of this bone is covered with cartilage. Most ankle sprains occur when the foot is pointed downwards, and the ankle “rolls over” the foot, causing the talus (ankle bone) to push into the tibia. Talar dome lesions … An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI … Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Symptoms. In the ankle, osteochondral lesions usually occur on the talus, which is the bone that connects the leg to the foot. Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. The top of the talus is dome-shaped and is completely covered with cartilage. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. 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