Those that fail to respond may be candidates for v… Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Lesion size, location, chronicity, and characteristics such as displacement and … 9 am to 1 pm Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. Published many acclaimed articles on Sports Medicine. The natural history is unclear, although most patients improve without surgical intervention. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. 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. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. 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. … “Osteo” means bone and “chondral” refers to cartilage. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. An osteochondral lesion of the talus is often a difficult problem to treat. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Low-grade lesions are managed with initial weight bearing modifications and therapeutic interventions. Much of this bone is covered with cartilage. 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 1955, investigators reported a frequency of 6.5% in their series of 133 ankle sprains. 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. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). 1 ) and anterolateral (46%) talar dome ( 1 ). Symptoms related to this condition are nonspecific … Patients can have three different kinds of complaints, whether or not in combination: A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. Patients also may report mechanical symptoms including catching, clicking, and locking. 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). “Osteo” means bone and “chondral” refers to cartilage. 6 Napier Road, #04-05 Computed tomography scanning in diagnosis and follow-up. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus … Treatment principles of osteochondral lesions of the ta… 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. All Rights Reserved | Website design by Heroes of Digital. Description OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Some smaller cystic lesions … Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. 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. 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. For those with persistent pain, surgical treatment is offered. The appropriate surgical technique should be taken into account the type, stability, and displacement of the lesion. The most common sites are the posteromedial (53%) (Fig. The defects cause deep ankle pain associated with weightbearing. Two common lesions are notable on the talus. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Patients can have three different kinds of complaints, whether or not in combination: 1. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. OLTs represent approximately 4% of all osteochondral lesions. Osteochondritis dissecans of the dome of the talus. Local osteolysis can then predispose to the development of a subchondral cyst. 9 am to 1 pm. 1) … Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Singapore 574623, 38 Irrawaddy Road, Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Lesion size, chronicity, and location also are important in treatment selection. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 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. Osteochondral lesions of the talus are common and difficult problems to treat. Treatment depends on the severity of the talar dome lesion. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. However, medial lesions were larger, and lateral lesions were seen more commonly in association with ligamentous injury. Subchondral cysts with overlying chondromalacia, osteochondral fragments, and loose bodies all represent various stages in the progression of OLTs. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 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. Symptomatic osteochondral ankle defects often require surgical treatment. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Novena Specialist Centre, Advanced imaging modalities have significantly increased the ability to accurately diagnose OLTs. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Osteochondral lesions of the talus are injuries to the cartilage in the bone inside the ankle joint. May be due to micro trauma or a traumatic event. 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. Grade I: Hyperintense but intact cartilage surface, Grade II: Fibrillation of fissures not extending to bone. Although this can occur in other joints, when it occurs on the ankle bone, it is called an osteochondral lesion of the talus (OLT). Gleneagles Medical Centre, The primary traditional approach includes open ankle arthrotomy. An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. 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 … “Osteo” means bone and “chondral” refers to cartilage. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. Patients … 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 … 16 years of experience in surgical and non-surgical procedures in sports injuries as a. 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. In 1959, Berndt and Harty described the first staging system based on radiographic findings. Alternatively, the primary objective may be to create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage. 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. 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. Furthermore, it is hard to figure out why some … 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). Often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. Terminology. Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology [ 14 ]. An OLT diagnosis is rarely made immediately after an acute ankle injury. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. Received multiple awards and accolades in the Orthopaedic field. Singapore 329563, Mon – Fri : 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. 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. This condition is also known as … Which treatment do you need?Shoulder TreatmentKnee TreatmentBack TreatmentElbow TreatmentFoot TreatmentOthers, Preferred LocationGleneagles Medical CentreMt Alvernia Medical CentreMount Elizabeth Novena. Endocrine or metabolic abnormalities, vasculopathy, and osteonecrosis are potential etiologic factors in nontraumatic OLTs. Additionally, it was determined that lesion location does not predict subject age, lesion chronicity or instability, or history of trauma. 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. Depending on the joint that's affected, signs and symptoms of osteochondritis dissecans might include: Pain. Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. Isolated lesions … In most cases, the condition is associated with chronic ankle pain, especially after inversion injury to the lateral ligamentous complex. The physical examination may reveal tenderness at the level of the ankle mortise anteriorly or posteriorly. Sports Orthopaedic Specialist in Singapore, The inside and top part of the lower bone of the ankle (the medial talar dome) or. Goals may range from removal of a loose fragment to securing a larger fragment anatomically. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). Osteochondral lesions happen more frequently in the younger athletic population Diagnosing Osteochondral Lesion of the Talus. 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). Large uncontained lesions are usually painful as the structure of the talus is threatened. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The approach and objectives of surgery are variable and are determined by the type of lesion. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. The pain is believed to be a result of stimulation of the highly innervated subchondral bone under the cartilage defect. This most common symptom of osteochondritis dissecans might be triggered by physical activity — walking up stairs, climbing a hill or playing sports. Talar dome lesions … 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. Medial osteochondral lesions are more common than lateral osteochondral lesions. 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. The first is a posterior medial lesion … In the ankle, osteochondral lesions usually occur on the talus, which is the bone that connects the leg to the foot. © 2020 Ortho.com.sg. The first is injury to the cartilage surface with an … Impaired function, limited range of motion, stiffness, catching, locking an… Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. A trial of nonsurgical management may be appropriate for OLTs, with several authors recommending a trial period minimum of 3 months. The precise natural history of OLTs is unclear. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. INTRODUCTION. There are three types of common lesion formation. Please enable javascript in your browser in order to get form work properly. There are many options for surgical intervention, typically categorized as primary repair, reparative techniques, and restorative techniques. Radiography cannot directly depict the cartilage surface (3). 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. Medical Centre D, 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 injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the … 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. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. 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. Most classification systems are based on lesion … They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. 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. The severity of the injury is best assessed using MRI. 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. 2 pm to 5 pm It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). This is often referred to as a chip inside your ankle joint. Months or even years later joint fluid can enter the crack and expand creating … The top of the talus is dome-shaped and is completely covered with cartilage. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral … Patients presenting with an OLT often describe prolonged pain, recurrent ankle swelling, weakness, and continued subjective instability. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. The etiology of an OLT may be nontraumatic or traumatic. There is limited understanding of cartilage damage and its repair. 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 … 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). Your browser does not support JavaScript!. It is often caused by a traumatic injury, such as a severe ankle sprain. The differential diagnosis is wide, but a high index of suspicion must be maintained for an OLT when evaluating patients with chronic ankle pain. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. In another study, the authors retrospectively reviewed the location, frequency, and size of OLTs on 77 MRI examinations based on a nine-zone grid. In 2007, MRIs of 428 ankles with OLTs were studied. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion … This commonly occurs after an ankle sprain where … Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. 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. Numerous exposure methods have been described, including several variations of medial malleolar osteotomies and distal tibial osteotomies along with combined anterior and posterior arthrotomies. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. 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. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. Research studies show OCD lesion in the talus … The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. [ 1] T This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Singapore 258499, 820 Thomson Road, #07-53 Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. 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 bottom bone of the ankle joint. A … If the cartilage does not heal properly following the injury, it softens and begins to break off. 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 … The primary mechanism is damage and insufficient repair of the subchondral bone plate. 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. The development of a symptomatic OLT depends on various factors. #06-59/60/61 Mount Elizabeth The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. 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