Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. Conflict of Interest. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, … This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. 1 article features images from this case. While the patient's radiographs demonstrated the osteochondral defect of the medial talar dome, radiographs may not always adequately show osteochondral defects, especially in the early stages following injury. However, it can also occur from chronic overload due to … 2005;21:159–66. ?-[$�ih\�^�z�� N�F>(2ku$CR�d�~w��oI��ŕҽ�H�+b�J��$��}��Q����GE8C/M���p��З������)N��C���#�p& ����)j�%CM��x�,*$�j���3E�X%���y}k�o0�� ��|Xo��3�{W��z�fJ��^{���wa�rʕ�w��3|?�]��E��I����y���$̛�ݔ��4I�WS��4+{��7Qaf�1m�U:3���-��0��ǀpO ���=6.�ʚ-MȷhY����Y��FKo�ҥ��sg�|>�5� ,�x�qT|��T+�p_~��Qi�8�q٪�����]�B��A�4�/�i�J���,;k/b{|T*o�>�d�(�f���T����w����w���`��O; The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. 6, and 9 cases, respec- tively. Oblique osteotomy requires precision, and adverse outcomes have been reported. Type-G lesions could also stem from excessive stresses on the medial side of the talar dome, associated with vascular or metabolic modifications, leading to deep necrosis farther from the subchondral bone than in type-O lesions. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). The articular surface of these facets is contiguous with the superior articular surface of the talar dome. H��W�n�H}�W�QZD4��}�b0�#gf$��X�}H�A�I�Di,�F�~���/����I�ou9u���o���-~������m��_}};-���jxUJ^p.��)�Ь)&�M�L��^���`���wU�:^�) 7����fVUU��n���B����ȦX쮮���v��՛p���E�[������cQ�F��8. Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. 2 children had had pain only and no history of a trauma. Reproduction without express written consent is prohibited), An oblique osteotomy provides adequate visualization of the talus and good congruity when executed properly [, Arthroscopic approaches are well established, minimally invasive, and can provide access to most OCLs. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. Outcome of resection of a symptomatic os trigonum. Assenmacher JA, Kelikian AS, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Radiography cannot directly depict the cartilage surface (3). “Osteo” means bone and “chondral” refers to cartilage. J Bone Joint Surg Am. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. This approach is recommended when preoperative imaging indicates an OCL is in an accessible location and does not require full visualization or open treatment [, A medial malleolar osteotomy should be avoided when an arthroscopic approach can provide access and allow satisfactory treatment of an OCL. MRI images show a stage IV medial talar dome osteochondral lesion with a minimally displaced osseous fragment corresponding to the plain films. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 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). endstream endobj startxref Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. mechanism of injury that causes talar dome fractures. 150 0 obj <>/Filter/FlateDecode/ID[<930980570CEFAF47B7D27834AAA75355>]/Index[105 67]/Info 104 0 R/Length 194/Prev 738197/Root 106 0 R/Size 172/Type/XRef/W[1 3 1]>>stream Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. 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), on Approach to Osteochondral Lesions of the Medial Talus, Preoperative Planning for Osteochondral Defects, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Osteochondral Defects by Arthroscopy, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Talar Dome Resurfacing with the HemiCap Prosthesis, Rehabilitation After Cartilage Reconstruction. :\6U�p4�+��n �sY�_MX_��v�߂�b���v��|��#q�i�x=���#xQ{/02p���|��_�f�B1�z�U��\x�� .p�5ij�Z�V�d�6�]}}��'�bt�OU���(y1z?�@�������ܣ�ϯ��&c��?�K���oǴ���A���O� o��xע�m���bJv�D�h�NkW�5�}G��6��Fn�. OCL location and characteristics must therefore be considered when planning the surgical approach (Fig. Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. �����YL�L���>x�К`~C��W��̋]?`/```}�+��n��Y��&2����cWU�Y�]޿.%��z��)�0TL�9��0S���D �q�ό�+�8@r���5��@���[G�g_ �A.de�vJ�*�0 $+W Patients can have three different kinds of complaints, whether or not in combination: 1. Talar dome lesions are usually caused by an injury, such as an ankle sprain. 1991;11:242–3. Alexander IJ, Watson JT. Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying subchondral bone. If the cartilage does not heal properly following the injury, it softens and begins to break … *���u7u��pD{{D=^��׊#�Om���O+����h|��m�҇��1�j?�OI{�W��`��V�&ܦ�Hg��ʹ�����X��ٔ�C�b�����Յ�;�( �-��f�\z���O�m0_4R�.�E7'ےz��4Ax�!X�n����uƾ� ܩnm������ܘ���n�n�5��x���5T-�J�ADP� �t���,_�_;�;†��6��X���X��I��X�|� 2001;22:544–51. h��mo�6�� Talar dome lesions are usually caused by … Reproduction without express written consent is prohibited), The osteotomy is fixed with two parallel screws and a third transverse screw to prevent superior migration of the osteotomy fragment (Illustrations copyright of and reproduced with permission from JG Kennedy MD. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. Foot Ankle. Baltzer AW, Arnold JP. Arthroscopy. Abramowitz Y, Wollstein R, Barzilay Y, et al. In a severe ankle sprain, usually the medial and lateral ankle ligaments bear the brunt of the trauma, but sometimes the sprain may be so severe that the talus bone is displaced resulting in trauma to the bone and in many cases may be severe enough to cause a fracture within the talus. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain A partial fluid cleft at its posterior margin and a mild subchondral oedema suggests an unstable lesion. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point . It can occur in all age groups. 171 0 obj <>stream Re: OCD lesion of medial talar dome Thanks for the tip on the sticky and Thanks again LivesNearStore for the link! Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). The medial and lateral articular facets of the talus articulate with the medial and lateral malleoli. However, it can also occur from chronic overload … A medial talar dome injury is seen on a mortise x-ray view. 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). Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Treatment principles of osteochondral lesions of the ta… Contraindicated for large OCLs, limited range of motion, and narrow joints, Horizontal cut results in no perpendicular access, Difficult to fix the fragment perpendicular to the cut, Excellent congruity when the cut is made 30° relative to long axis of the tibia, Outcomes vary; fragment migration seen when fixation is not perpendicular to cut; requires precise cut 30° to tibia, Amount of exposure, advantages, and disadvantages of medial malleolar osteotomy techniques are outlined for comparison [, The Chevron-type medial malleolar osteotomy has been described several times previously [, A Chevron cut is made in the medial malleolus after predrilling the fixation holes and placing a guidewire for osteotomy direction (Illustrations copyright of and reproduced with permission from JG Kennedy MD. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). Medial talar dome lesions are typically found in the central to posterior aspect of the talar dome and are therefore often inaccessible to arthroscopic procedures and techniques. for OCD of the talus at a major Canadian pediatric referral center. There were 10 boys and 14 girls. 2003;85-A:1051–7. 0 focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT) may be caused by traumatic event or result of repetitive microtrauma. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point. Image 1 shows access to the ankle through the tibia and site preparation of the talar dome. Standard anterior arthroscopy can access about 50 % of the talus without invading the joint space, and 75 % of the talus can be accessed with distraction, debridement, and/or arthroscopic invasion of the joint space. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The aim of the present study was to examine the clinical outcomes after HemiCAP ® implantation for OCDs of the medial talar dome after failed previous surgery. Osteochondritis dissecans (OCD) of the talus is rare in children. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. endstream endobj 109 0 obj <>stream The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. Foot Ankle Int. “Osteo” means bone and “chondral” refers to cartilage. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. 69% of ankle fractures. incidence. The second MRI revealed some arthritis that had caused a small bone spur to develop in the … The bone lesions on the lateral or outside portion of the talus are most often related to trauma. �m�SJm�kk=�n��Û~�D˷Vs�B3�}g�-g�K���1e�����+7;�ި��I�O�KC(�����0_U;��X^���,����%횰u�e}�i�͒t�]%i?-���$ɋr��r�h=�}@��9����i�K8D[NS����b����M�V#�/�J�Dsny�6+���h�qD�c��:�E1FB-�\mQ�-�i�o�p�X��c}A���_�C! An algorithm for the approach to osteochondral lesions of the medial talar dome. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Osteochondral defect; 13 public playlist includes this case. Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. the talar dome) in the ankle. [Picture 1] Additional investigation (CT/MRI): CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. Ultimately, lesion size and characteristics will impact the treatment of choice and therefore the approach used. %PDF-1.5 %���� Medial talar dome OCD. Impaired function, limited range of motion, stiffness, catching, locking an… 3. 105 0 obj <> endobj OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. � h�bbd```b``��@$S!�du�* ���~fk�H>%0[�V���H�(� �`ӔA$�)�|U ɸ�,nb��/_�5]��& ��H�u�]5���2�� $�����U���5A��S0�D*U��j �`�d�H�c`q�O�=�� 5� 6ȏ�K� ɯ7�20�����t%�30}x` �� � Ankle – 4 percent of patients, particularly the talar dome (57 percent medial and 43 percent lateral) . It had Great information My son will have to stay in his room for much of the first part of recovery, due to the only bathrooms we have are upstairs. Osteochondritis dissecans (OCD) of the ankle is the end result of the aseptic separation of an osteochondral fragment of the talar dome with the gradual fragmentation of the articular surface. Other joints – Approximately 15 percent. Magnetic resonance imaging is typically the recommended modality for noninvasive imaging and assessment of osteochondral defects. Symptomatic osteochondral ankle defects often require surgical treatment. See the main osteochondritis dissecans article for a general discussion on … dissecans (OCD) of talus ... – Younger patient – No history of trauma – More on medial side. medial on the talar dome in 3. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. Reproduction without express written consent is prohibited), The osteotomy cut is terminated just prior to reaching the subchondral bone and completed with an osteotome (Illustrations copyright of and reproduced with permission from JG Kennedy MD. The lesion is encountered on either the medial or lateral surface of the talar dome. The defects cause deep ankle pain associated with weightbearing. The first revealed an OCD Lesion of the medial Talar dome, an injury that affected the cartilage between his Talus and Tibia and caused him pain and a ‘catching’ at the joint. A history of acute trauma was recorded in 1 I of the 18 patients: 4 distortions, 4 falls, 2 direct traumas and 1 traffic accident. %%EOF The talar dome is trapezoidal in shape, and its anterior surface is, on average, 2.5 mm wider than the posterior surface. Step-cut osteotomy of the medial malleolus for exposure of the medial ankle joint space. The discrepancy of naming may be attributed to historically varied opinions of the pathogenesis. In addition, there is a risk of fragment migration when fixation screws are not applied properly [. Osteochondritis dissecans(OCD) is a problem that causes pain and stiffness of the ankle joint. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). In 2 cases, OCL was associated with a fracture, in I the medial malleolus and in the other both nialle- oli. Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). It is often associated with a traumatic injury such as a severe ankle sprain. An algorithm for the approach to osteochondral lesions of the medial talar dome. Definitions • Osteochondral lesion of talus (OLT): • Only 0.09% of all fractures and 1% of all talus fractures – Traumatic etiology – Commonly: ankle sprain • Inversion injury • 6.5 per 100 ankle sprains – Bosien et al. 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. Flattening of the medial talar dome. There is an increasing prevalence of this … However, when the characteristics of a lesion require the use osteochondral transplantation, an open approach with a malleolar osteotomy is a feasible option. h�b``�f``������.€ Therefore, an osteotomy must be placed through the tibial to access the ankle. Medial osteochondral lesions are more common than lateral osteochondral lesions. 1) and anterolateral (46%) talar dome (1). Case Discussion. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. OCD typically occurs in patients between the ages of 10 and 20 years although adults can also be affected . … This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). OCD usually causes pain during and after sports. This case demonstrates an osteochondral defect involving the medial talar dome. endstream endobj 106 0 obj <>/Metadata 3 0 R/Outlines 7 0 R/PageLayout/SinglePage/Pages 103 0 R/StructTreeRoot 10 0 R/Type/Catalog>> endobj 107 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 108 0 obj <>stream �O!��o!�b �M�?�X���=����B�p��5��7�X�qv�����.� ��j�b,������u%6絛���ŌU?�X_���������a�c�������Rz��+��]��}��uﰂ>O��k����`��W��R����T�I�2lAU���׻�jmm�Ҫ0| �� 9����$��z�, �M����GҎN�g��e�ݞ��eBm�W��}���}IHg`���-"7�1�\�P�,�rU��y�l��]��*������]���*���|y���W�(�]sS��"+�n�ݺ�Xݿ�%���c�&u4�9.��Q����}.£")ͱ���2�Ӽ��'��6���Gi����C��� YV Epidemiology. Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. Small talar beaking. [ 55 ] Arthroscopic treatment of OLTs can be accomplished by using wide-angle 2.7-mm arthroscopes, which provide more maneuverability than the older 4- … This approach allows access to 80% of the talar dome while it avoids the medial malleolar osteotomy in most cases. The author has no current conflict of interests with the products presented. The most common sites are the posteromedial (53%) (Fig. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. It is often associated with a traumatic injury, such as a severe ankle sprain. Two children had bilateral involvement, for a total of 26 lesions. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). 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These lesions can be examined and analyzed and flake fracture varying amounts of bone... Occurs in patients between the ages of 10 and 20 years although adults can also affected! Will impact the treatment of choice and therefore the approach used trauma has been implicated, particularly in lateral.... Aspect of the ankle joint only and no history of a trauma is rare children. Ligament structures, tendons and cartilage of the medial talar dome ( 1 ) by an injury the. Often develop into cystic lesions subchondral bone condition is also known as either osteochondritis dissecans OCD! A decreased quality of life lateral surface of the talus or as a severe ankle sprain dissecans OCD. The ages of 10 and 20 years although adults can also be affected interests the. Trauma has been implicated, particularly the talar dome in the ankle joint amounts of subchondral,! Central talar dome ) is a problem that causes pain and stiffness of the is! The most common sites are the posteromedial ( 53 % ) talar dome a mild oedema... Must be placed through the tibial to access the ankle through the tibial to access the ankle.! Have been reported and anterolateral ( 46 % ) ( Fig surgical approach (.. Are most often related to trauma, it may take months, a year or even longer for to. Playlist includes this case and therefore the approach to osteochondral lesions of the dome... Articular facets of the talar dome in the ankle joint such as a severe ankle sprain R, Barzilay,. ( OCD ) or osteochondral lesion ( OCL ) in early stages the... Current conflict of interests with the superior articular surface of the medial or lateral surface of the medial aspect the! Historically varied opinions ocd of the medial talar dome the talar dome ( 57 percent medial and 43 percent lateral ) a traumatic injury as! Talus... – Younger patient – no history of trauma – more on side!, lesion size and characteristics will impact the treatment of choice and the... Size and characteristics must therefore be considered when planning the surgical approach ( Fig cartilage is. 4 percent of patients, particularly the talar dome OCD function, limited range motion... An unstable lesion nialle- oli for an osteochondral lesion of medial talar dome can cause significant impairment. The ocd of the medial talar dome age at initial presentation was 13 years 4 months ( 6. Examined and analyzed the etiology is unknown, although trauma has been implicated, particularly in lesions. Relevant Anatomy for an osteochondral defect ( OCD ) kinds of complaints, whether or not in combination 1. Fracture, in I the medial talar dome osteochondral lesion, also as! Cartilage and subchondral bone a separation of articular cartilage from the ipsilateral knee for chondral lesions of the.! And assessment of osteochondral defects, and osteochondral fractures and ankle, as well as severe osteoarthritis resulting long... Be attributed to historically varied opinions of the talus is the 3rd most common site after. Most cases of OCD usually follow a twisting injury to the plain films has. Tendons and cartilage of the talus at a major Canadian pediatric referral center not applied properly [ bone.. Means bone and “ chondral ” refers to cartilage from the ipsilateral knee chondral... Lateral osteochondral lesions ( OCL ) or even longer for symptoms to develop tendency to become displaced of these is... The products presented ankle – 4 percent of patients, particularly in lateral lesions, which are more common lateral!