Valderrabano V, Leumann A, Rasch H, Egelhof T, intermann B, agenstert G Knee-to-ankle mosaicplasty for treatment of osteochondral lesions of the ankle joint. Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans Overall, more than 80% of the talus OCLs are of traumatic origin.7,8 In such traumatic cases, the acute OCLs are frequently located on the lateral dome of the talus (anterolateral) (Table 71-1). Surgical treatment of OCLs traditionally includes excision of loose bodies, debridement of the area, and drilling or microfracturing. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. At the initial physical evaluation following injury, the dorsolateral aspect of the talus should be examined for tenderness. As an alternative or as an addition to the open technique, ankle arthroscopy allows, beside a good diagnostic visualization of the OCLs, a minimal invasive therapy avoiding the high morbidity of an extensive arthrotomy or malleolar osteotomy. Patients with OCLs of the talus typically report chronic ankle pain, joint stiffness, ankle swelling, snapping, giving way, and weakness. Anterolateral lesions: Tenderness may occur when the ankle is palpated laterally with a plantar flexion. Further inversion ruptures the lateral ligament and may cause avulsion at its attachment (stage II), which may become completely detached, but remain in place (stage III) or be displaced by further inversion (stage IV). Surgical treatment of OCLs traditionally includes excision of loose bodies, debridement of the area, and drilling or microfracturing. Osteochondral injuries commonly affect the ankle joint and involve the dome of the talus. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. 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. 23. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Woo Jin Choi, Kwan Kyu Park, Bom Soo Kim and Jin Woo Lee; Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, 120-752, South Korea (e-mail: Choi W, Park K, Kim B and Lee J, Osteochondral Lesion of the Talus: Is There a Critical Defect Size for Poor Outcome? If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Patient history should further include systemic risk factors, as causative factors of avascular necrosis, systemic diseases, and others. 1173185, Durur-Subasi B, Durur-Karakaya A, Yildirim O S; Osteochondral Lesions of Major Joints Eurasian J Med 2015; 47: 138-44, Osteochondral Lesions of Major Joints Durur-Subasi B, Durur-Karakaya A, Yildirim O S; Eurasian J Med 2015; 47: 138-44, Patrick J. McGahan, MD and Stephen J. Pinney, MD, Current Concept Review: Osteochondral Lesions of the Talus , FRCS(C) Sacramento, CA; Foot & Ankle International/Vol. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. The therapist would probably focus on the quadriceps (a thigh muscle) and especially on the vastus medial;is (part of the quadriceps). However, it can be subdivided into a traumatic and nontraumatic cause. The various treatment options currently available are briefly reviewed. Foot Ankle Int. Osteochondral cylinders are harvested from lesser marginal weight-bearing areas of the knee joint and press-fitted into the prepared defect. MRI is also necessary to rule out differential diagnosis'. A non-weight bearing cast is attached for 6 weeks and is then followed by a gradual return to weight bearing and athletic activity. With CT, the stages described by Berndt and Harty can be better defined, OCL cysts and fragments better visualized, and the integrity of the subchondral bone better analyzed. It can be done with an arthroscope. This is because the healthy graft tissue can only be taken from a limited area of the same joint. Commonly, multiple cylinders have to be transplanted to fill larger defects. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. The traditional staging system for OCLs of the talus is the Berndt and Harty2 classification based on radiographic findings. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. Hale S, Hertel J, Reliability and Sensitivity of the Foot and Ankle Disability Index in Subjects With Chronic Ankle Instability, J Athl Train. Chapter 71 What Is the Best Treatment for Ankle Osteochondral Lesions? Slight increase in degenerative changes of the ankle with limited cartilage damage of anterior distal tibia. OCLs are articular injuries of the subchondral bone and the overlaying cartilage. Physiotherapy treatment is vital for all patients with an osteochondral lesion of the talar dome to maximise the healing process, ensuring an optimal outcome and to reduce the likelihood of recurrence. Surgical Treatment for Osteochondral Defect. Rehabilitation Exercises – to be done every 2 hours. If OLT is diagnoses immediately after the injury, immobilization of the foot and ankle for a period of time usually resolves the problem. 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), Presurgical Functional MappingAndrew C. Papanicolaou, Roozbeh Rezaie, Shalini Narayana, Marina Kilintari, Asim F. Choudhri, Frederick A. Boop, and James W. Wheless, the Child With SeizureDon K. Mathew and Lawrence D. Morton, and Pharmacologic Consequences of SeizuresShilpa D. Kadam and Michael V. Johnston, Self-Limited EpilepsiesDouglas R. Nordli, Jr., Colin D. Ferrie, and Chrysostomos P. Panayiotopoulos, in Epilepsy: A Network and Neurodevelopmental PerspectiveRaman Sankar and Edward C. Cooper, Hematology, Oncology and Palliative Medicine. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. This is called an osteochondritis dissecans (OCD). A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Foot Ankle Int. The medial anterior aspect of the talar dome is the area most injured. The arthrotomy may sometimes require a medial or lateral malleolar osteotomy, grooving of the anteromedial distal tibia, or an osteotomy of the anterolateral tibia to reach the involved OCL talus region. Trauma plays the most important role in the pathomechanism of talus OCLs. Do Bone Morphogenetic Proteins Improve Spinal Fusion? Berndt and Harty2 reported in 1959 that nonoperatively treated patients obtained poor results, and that good results were registered in 84% of the cases after surgical treatment (Level IV). The knee and the ankle joint are the most commonly involved joints for OCLs in the lower extremity. If your symptoms are not relieved with non-surgical treatment options, you might need surgery. MRI is the gold standard for OCL diagnosis, providing information about bone bruise, cartilage status and soft tissues. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. The talus is a bone in the foot that helps form the ankle joint. 24. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an … Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities World J Orthop. can best be initially accessed with our initial visualiza-tion and working portals. Radiographs provide information on the OCL location and stage only if the x-rays hit the OCL perpendicular, that is, if the OCL lies on the highest point of the talar dome. Because of the still unclear natural history of OCLs, several terms can be found for this entity to date in the literature, for example, The traditional staging system for OCLs of the talus is the. References 6 The cause of OCLs of the talus has multiple facets. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article, In most of the conservatively treated OCL cases, the pain remains untreated and the disease advances to further stages. AANA Advanced Arthroscopy: the Foot and Ankle; 1st ed, Amendola N, Stone J; Saunders, July 2010, p.99. The therapist would probably focus on the quadriceps (a thigh muscle) and especially on the vastus medial;is (part of the quadriceps). Osteochondral defect or Cyst. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Overall, more than 80% of the talus OCLs are of traumatic origin. What Is the Best Treatment for End-Stage Ankle Arthritis. Characteristics of Lateral and Medial Osteochondral Lesions of the Talus, An untreated OCL represents a local osteoarthritis model because of the altered joint biomechanics. 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