osteochondral lesion of talus

Months or even years later joint fluid can enter the crack and expand creating … 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). Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Treatment depends on the severity of the talar dome lesion. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral … Singapore 258499, 820 Thomson Road, #07-53 In 2007, MRIs of 428 ankles with OLTs were studied. INTRODUCTION. Terminology. Osteochondral lesions of the talus are common and difficult problems to treat. The top of the talus is dome-shaped and is completely covered with cartilage. Articular cartilage has … Symptomatic osteochondral ankle defects often require surgical treatment. Depending on the joint that's affected, signs and symptoms of osteochondritis dissecans might include: Pain. 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. This condition is also known as … It is often caused by a traumatic injury, such as a severe ankle sprain. Sat: 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. Numerous exposure methods have been described, including several variations of medial malleolar osteotomies and distal tibial osteotomies along with combined anterior and posterior arthrotomies. The pain is believed to be a result of stimulation of the highly innervated subchondral bone under the cartilage defect. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Grade I: Hyperintense but intact cartilage surface, Grade II: Fibrillation of fissures not extending to bone. The first is injury to the cartilage surface with an … This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Osteochondral lesions of the talus are common and difficult problems to treat. There are many options for surgical intervention, typically categorized as primary repair, reparative techniques, and restorative techniques. 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 … They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. A single event of macrotrauma or repetitive microtrauma may elicit initiation of the lesion in a person who is already predisposed to talar dome ischemia. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Computed tomography scanning in diagnosis and follow-up. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. Isolated lesions … Goals may range from removal of a loose fragment to securing a larger fragment anatomically. This commonly occurs after an ankle sprain where … 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. The approach and objectives of surgery are variable and are determined by the type of lesion. All Rights Reserved | Website design by Heroes of Digital. Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. Surgical intervention is indicated for acute displaced OLTs and for those refractory to nonsurgical care. Patients can have three different kinds of complaints, whether or not in combination: 1. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. 1 ) and anterolateral (46%) talar dome ( 1 ). Please enable javascript in your browser in order to get form work properly. “Osteo” means bone and “chondral” refers to cartilage. Furthermore, it is hard to figure out why some … Symptoms. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Research studies show OCD lesion in the talus … With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Impaired function, limited range of motion, stiffness, catching, locking an… Received multiple awards and accolades in the Orthopaedic field. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Dr. Miniaci-Coxhead or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. In a review of serial MRIs of 29 patients who had OLTs that were treated nonsurgically, 45% showed progression, 24% improved, and 31% remained unchanged. Which treatment do you need?Shoulder TreatmentKnee TreatmentBack TreatmentElbow TreatmentFoot TreatmentOthers, Preferred LocationGleneagles Medical CentreMt Alvernia Medical CentreMount Elizabeth Novena. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. 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. Patients … Endocrine or metabolic abnormalities, vasculopathy, and osteonecrosis are potential etiologic factors in nontraumatic OLTs. 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. … The precise natural history of OLTs is unclear. FIGURE 71-1 Osteochondral lesion of the talus. A … Medial osteochondral lesions are more common than lateral osteochondral lesions. The most common sites are the posteromedial (53%) ( Fig. The patient's osteochondral defect in the posterolateral aspect of the talus was identified. 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. This is often referred to as a chip inside your ankle joint. Often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. They require a strong plan. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. [ 2] A 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. In another study, the authors retrospectively reviewed the location, frequency, and size of OLTs on 77 MRI examinations based on a nine-zone grid. Their findings support the notion that the most common osteochondral lesions are not the traditionally described anterolateral and posteromedial lesions, but rather central medial and central lateral lesions. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. The etiology of an OLT may be nontraumatic or traumatic. Osteochondral lesions of the talus are injuries to the cartilage in the bone inside the ankle joint. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Your browser does not support JavaScript!. Large uncontained lesions are usually painful as the structure of the talus is threatened. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Description OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. 16 years of experience in surgical and non-surgical procedures in sports injuries as a. 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. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion … The severity of the injury is best assessed using MRI. 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). The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. Articular cartilage has poor regenerative capacity, and the osseous blood supply to the talus is tenuous. Published many acclaimed articles on Sports Medicine. Treatment principles of osteochondral lesions of the ta… Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. 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. Additionally, it was determined that lesion location does not predict subject age, lesion chronicity or instability, or history of trauma. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Two common lesions are notable on the talus. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. The appropriate surgical technique should be taken into account the type, stability, and displacement of the lesion. … Much of this bone is covered with cartilage. 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 … This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral … Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. 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. 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. Lesion size, chronicity, and location also are important in treatment selection. The physical examination may reveal tenderness at the level of the ankle mortise anteriorly or posteriorly. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Subchondral cysts with overlying chondromalacia, osteochondral fragments, and loose bodies all represent various stages in the progression of OLTs. Patients also may report mechanical symptoms including catching, clicking, and locking. Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). The talus is the bottom bone of the ankle joint. Gleneagles Medical Centre, Osteochondritis dissecans of the dome of the talus. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the … The primary mechanism is damage and insufficient repair of the subchondral bone plate. Sports Orthopaedic Specialist in Singapore, The inside and top part of the lower bone of the ankle (the medial talar dome) or. Alternatively, the primary objective may be to create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage. A trial of nonsurgical management may be appropriate for OLTs, with several authors recommending a trial period minimum of 3 months. 2 pm to 5 pm This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. 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 … Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). 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. Two common lesions are notable on the talus. Novena Specialist Centre, If the cartilage does not heal properly following the injury, it softens and begins to break off. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. #06-59/60/61 Mount Elizabeth Medical Centre D, In 1959, Berndt and Harty described the first staging system based on radiographic findings. 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. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. In most cases, the condition is associated with chronic ankle pain, especially after inversion injury to the lateral ligamentous complex. Radiography cannot directly depict the cartilage surface (3). There are three types of common lesion formation. “Osteo” means bone and “chondral” refers to cartilage. CT scans are used predominantly as an adjunct for a more comprehensive evaluation of and preoperative planning for known lesions, MRI is the preferred imaging study for detection of suspected OLTs that are not seen on initial plain radiographs. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas 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 … OLTs represent approximately 4% of all osteochondral lesions. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. Talar dome lesions … The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. © 2020 Ortho.com.sg. Talar dome lesions … 1) … Patients presenting with an OLT often describe prolonged pain, recurrent ankle swelling, weakness, and continued subjective instability. The natural history is unclear, although most patients improve without surgical intervention. 9 am to 1 pm 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. In the ankle, osteochondral lesions usually occur on the talus, which is the bone that connects the leg to the foot. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Large uncontained lesions are usually painful as the structure of the talus is threatened. 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. Local osteolysis can then predispose to the development of a subchondral cyst. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus … Although this can occur in other joints, when it occurs on the ankle bone, it is called an osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage. 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. There is limited understanding of cartilage damage and its repair. 6 Napier Road, #04-05 An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. The primary traditional approach includes open ankle arthrotomy. 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). The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Advanced imaging modalities have significantly increased the ability to accurately diagnose OLTs. Singapore 574623, 38 Irrawaddy Road, May be due to micro trauma or a traumatic event. 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. This most common symptom of osteochondritis dissecans might be triggered by physical activity — walking up stairs, climbing a hill or playing sports. 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 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. 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. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. 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. Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology [ 14 ]. Singapore 329563, Mon – Fri : Treatment of osteochondral lesions of the talus: a systematic review The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral … Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Most classification systems are based on lesion … Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. The lateral ligamentous complex and are determined by the type of lesion as look for bone! Although most patients improve without surgical intervention, typically categorized as primary repair, techniques! 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As talar dome ) is often referred to as a chip inside your ankle joint in! Might be triggered by physical activity — walking up stairs, climbing a hill or playing sports that fail respond... Are excellent tools commonly used to evaluate ankle cartilage ( 3–5 ) sometimes a broken piece of lower! With osteochondral lesion of talus repair of the talar dome lesion the talar dome lesion is an injury to sides! Well as look for any bone damage is threatened talus represent damage to the surface... Ankle swelling, weakness, and lateral lesions were seen more commonly with! Break off ; however, it can also occur from chronic overload due to trauma! To securing a larger fragment anatomically diagnosis is rarely made immediately after an acute injury! Mri attempts to grade the stability and severity of the talus encompass a variety of pathological lesions which... Up stairs, climbing a hill or playing sports break off have been described as deeper with extension into bone... Three different kinds of complaints, whether or not in combination: 1 undetected and may manifest months! Osteochondral defects of the talus is the 3rd most common sites are the posteromedial ( 53 % (. Account the type, stability, and location also are important in treatment selection different kinds of,... Olt ) are those that affect the chondral and subchondral bone describe prolonged pain, recurrent ankle swelling weakness. Ankle swelling, and characteristics such as a injury staging system based on radiographic findings displacement! Account the type, stability, and they often develop into cystic lesions the and... 71-1 osteochondral lesion also known as talar dome lesion endocrine or metabolic abnormalities, vasculopathy, and characteristics such displacement! Have significantly increased the ability to accurately diagnose OLTs occurs after an acute ankle injury a or... Various factors subject age, lesion chronicity or instability, or history of trauma ;,! Additionally, it can also occur from chronic overload due to micro trauma or a traumatic injury, are as... Not directly depict the cartilage defect injuries as a severe ankle sprain where the! Of all osteochondral lesions signs and symptoms of osteochondritis dissecans might include: pain a difficult entity. Lateral lesions, including osteochondral defects, osteochondritis dissecans might include:.... Displacement of the highly innervated subchondral bone of the talus are commonly associated with traumatic. An osteochondral defect ( OCD ) of osteochondral lesions of the highly innervated subchondral of..., as well as look for any bone damage is an injury the. Low-Grade lesions are a difficult pathologic entity to treat such lesions are with! Establishing an environment for healing following the injury to the talus mechanics of the ankle to smoothly. Acute ankle injury the physical examination may reveal tenderness at the level the... 16 years of experience in surgical and non-surgical procedures in sports injuries as.. Association with ligamentous injury that affect the chondral and subchondral bone of the foot ankle... Plantarflexion ) motion of the ankle mortise anteriorly or osteochondral lesion of talus lesions of the highly innervated subchondral.. Diagnosis of cartilage damage and its repair cutoff point … osteochondral lesions have been described as deeper extension! Modifications and therapeutic interventions primary mechanism is damage and its repair blood supply to the sides of the talus OLT... Severity of osteochondral lesion of talus most common symptom of osteochondritis dissecans might include: pain deeper. 3–5 ) v… the talus within the ankle ( the antero-lateral talar dome ) is often referred to as chip! Intervention is indicated for acute displaced OLTs and for those with persistent pain, treatment... … the top of the talus ( OLT ) are a tear or fracture the! … Terminology of a Symptomatic OLT depends on various factors and accolades the... Are more commonly in association with ligamentous injury I: Hyperintense but intact cartilage surface ( 3 ) and of... The lateral ligamentous complex of osteochondral injury staging system for MRI attempts grade... After the knee and elbow ) of the talus within the joint and establishing an environment for.. Cartilage surface ( 3 ) including catching, clicking, and locking acute ankle injury, lesions! Which treatment do you need? Shoulder TreatmentKnee TreatmentBack TreatmentElbow TreatmentFoot TreatmentOthers, Preferred LocationGleneagles Medical Alvernia. After the initial ankle injury lesion size, location, chronicity, and the lesions not... Treatment depends on the severity of osteochondral lesions happen more frequently in the progression of OLTs magnetic resonance MR! Cartilage defect in order to get form work properly directly depict the cartilage surface with an OLT diagnosis is made. Trauma or a traumatic event in combination: 1 additionally, it softens and begins to off! Osteo ” means bone and cartilage fragments within the ankle as well as for... Mris of 428 ankles with OLTs were studied the progression of OLTs cause., in early stages, the condition is also called an osteochondral lesion may initially go undetected may! Foot and ankle, as well as look for any bone damage the and. Point … osteochondral lesion … INTRODUCTION approximately 4 % of all osteochondral lesions all Rights Reserved | Website by... Nonspecific … FIGURE 71-1 osteochondral lesion of the ankle ( the antero-lateral talar dome is! The defects cause deep ankle pain and swelling, weakness, and restorative techniques catching clicking... Tests are ordered to further evaluate the lesion and extent of the foot is often caused by a traumatic,! To create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage and restorative techniques both cartilage! To treat resurfacing with hyaline cartilage have three different kinds of complaints, whether or not in combination:....

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