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. X-ray, CT scan, MRI or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition.  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. 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. Berndt and Harty, that nonoperatively treated patients obtained poor results, and that good results were registered in 84% of the cases after surgical treatment (Level IV). 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. Osteochondral injuries are a possible cause of continued ankle pain after a sprain. On images it is easy to see the extent of damage to the surface of the cartilage. Commonly, multiple cylinders have to be transplanted to fill larger defects. This is a main cause of ankle morbidity. 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. 2013;37:1697-1706. What Is the Best Treatment for Pilon Fractures? 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 “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. What Is the Best Treatment for End-Stage Hallux Rigidus? Osteochondral Defects in the articular cartilage can result from trauma, arthritic conditions, chronic wear and tear. Mei-Dan O, Michael R. Carmont, Laver L, Mann G, Maffulli N, Meir Nyska, Platelet-Rich Plasma or hyaluronate in the Management of Osteochondral Lesions of the Talus, Clinical Sports Medicine: Medical management and Rehabilitation; Walter R. Frontera; p467 level of evidence : 2A, Jung, HG, Foot and Ankle Disorders: An Illustrated Reference; 2016, Springer Berlin Heidelberg; p.129. Triple Flexion/Extension (hip, knee, ankle) Bring knee toward chest bringing foot and ankle up Straighten leg, pointing toes Repeat 30 times. What Is the Best Treatment for Recurrent Ankle Instability? This classification consists of the following stages of an osteochondral talus fragment: stage I, small compression area; stage II, incomplete avulsion of a fragment; stage III, complete avulsion without displacement; and stage IV, avulsed fragment displaced within the joint. Medial lesions may need to be visualized in the anterolateral portal while working through the anteromedial portal. Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome What Is the Best Treatment for End-Stage Ankle Arthritis. Wear appropriate shoes when playing sports or working with heavy machinery, and always exercise caution. Symptomatic osteochondral ankle defects often require surgical treatment. Furthermore, the term transchondral/osteochondral/flake fracture may be meaningful only in traumatic cases. 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. http://www.ankle-arthroscopy.co.uk/ Osteochondral Defects New and improved video with voice-overs from Consultant Orthopedic surgeons Mr. Simon Moyes and Mr. Omar Haddo. How Can I Prevent Osteochondritis Dissecans? The ankle joint is composed of the bottom of the tibia bone (shin) and the top of the talus bone (ankle). The various treatment options currently available are briefly reviewed. VICTOR.  Younger people have a higher incidence of trauma history and the lesion size is usually larger as they are exposed to more diverse sporting activities. Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI. 22(7):544– 51, 2001. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. osteochondral defects of the ankle ML Reilingh, MD CJA van Bergen, MD CN van Dijk, MD, PhD Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Corresponding address: Academic Medical Centre University of Amsterdam Department of Orthopaedic Surgery Prof Dr C Niek van Dijk PO Box 22660 1100 DD Amsterdam, The Netherlands … At the end, OCL fragments can break off and dislocate all over the joint. Osteochondral injuries commonly affect the ankle joint and involve the dome of the talus. Anterolateral lesions: Tenderness may occur when the ankle is palpated laterally with a plantar flexion. Foot Ankle Int. It is relatively prevalent and are an important cause of ankle morbidity. How is it caused? 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. Osteochondral cylinders are harvested from lesser marginal weight-bearing areas of the knee joint and press-fitted into the prepared defect. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL),9,10 or a fracture mechanism. 71-1). Surgical Treatment for Osteochondral Defect. Osteochondral injuries occur more often than thought and result in significant disability and pain. , An osteochondral lesion is rarely diagnosed via a physical exam without further testing. Because currently there is no proof for an underlying inflammation, the traditional term osteochondritis dissecans introduced by König1 in 1888 should be abandoned. The therapist would probably focus on the quadriceps (a thigh muscle) and especially on the vastus medial;is (part of the quadriceps). Ankle sprains are exceedingly common, with >2 million such injuries diagnosed in the United States each year 2. As the foot is inverted on the leg, the lateral border of the talar dome is compressed against the face of the fibula (stage I), while the collateral ligament remains intact. This article describes the etiology and pathogenesis of these injuries. Osteochondral Defect (OCD) Rehabilitation Protocol . The defects cause deep ankle pain associated with weightbearing. 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). 1/January 2010, 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. Osteochondral lesions may also involve the talar dome, most frequently the medial aspect. Finally, although no accepted definition of lesion size exists, OLTs can generally be considered as either small or large based on their cross-sectional area or greatest diameter (area greater than or less than 1.5 cm² or diameter greater than or less than 15 mm).. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Anderson and colleagues4 described an MRI-based classification including the bone marrow edema. This surgery may be performed open or arthroscopically. What Is the Best Treatment for Achilles Tendon Rupture? Slight increase in degenerative changes of the ankle with limited cartilage damage of anterior distal tibia. Because of the still unclear natural history of OCLs, several terms can be found for this entity to date in the literature, for example, osteochondritis dissecans, osteochondral fracture, flake fracture, and others. 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). 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. Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle. osteochondral defects of the talar dome. Strengthening and range-of-motion exercises can help once your injury has healed adequately and can reduce swelling and pain. The SPECT-CT and diagnostic arthroscopy confirmed a lateral talus OCL stage III-IV with cystic lesions (C–F). 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. AANA Advanced Arthroscopy: the Foot and Ankle; 1st ed, Amendola N, Stone J; Saunders, July 2010, p.99. The results of a physical examination can vary as there is no specific test to diagnose an osteochondral lesion. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. In many cases, a causative agent cannot be traced and remains “idiopathic.”, TABLE 71-1 Characteristics of Lateral and Medial Osteochondral Lesions of the Talus. The treatment of OCLs of the talus includes a primary (as fixation of a flake fracture in traumatic cases) or a secondary repair (surgical treatment of chronic OCLs). The knee and the ankle joint are the most commonly involved joints for OCLs in the lower extremity. Other predisposing factors may be a periarticular fracture or severe ankle trauma. These findings are nonspecific because the tenderness could likely be related to joint synovitis instead of an osteochondral lesion. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Perform knee cartilage damage exercises. Many of them lose their sports career or even jobs by disability. Several factors may also slow the healing process and increase the likelihood of a poor outcome in patients with this condition. If you experience episodes of minor swelling or pain while exercising, have your physician examine your ankle. A portion of the talar margin can be sheared off from the main body of the talus, causing lateral OLT. Total lesion size unchanged. Original Editors - Lore Aerts as part of the Vrije Universiteit Brussel Evidence-Based Practice Project, Top Contributors - Allan D'Hose, Lore Aerts, Scott Cornish, Rachael Lowe and Kim Jackson. Patients may report ankle sprain or CAI. Osteochondral Defects – OCD of Foot and Ankle, Talus, Metatarsal. The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). An osteochondral injury to the talar dome produces pain at the ankle and you will find walking and other weight bearing activities difficult. Jun 17, 2019 Posted by admin Uncategorized 0 comments. “Osteo” means bone and “chondral” refers to cartilage. Am J Sports Med 37 (2009) 105- 111. Other diagnoses sharing similar symptoms: , The location of the lesion, lesion size, containment, number of lesions, and combined intra-articular lesions can be identified through a preoperative MRI and are finally determined by arthroscopic surgery. Tenderness may be triggered on the affected ankle side (lateral, medial) or periarticular. The top of the talus is dome-shaped and is completely covered with cartilage. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 2001, 22(7):544– 51. Choi WJ, Youn HK, Choi GW, Park YJ, Lee JW, Osteochondral Lesions of the Talus; Are There Any Differences Between Osteochondral and Chondral Types? Osteochondral Defects of the Talus. The recovery period after an osteochondral lesion usually lasts six months to a year. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). (C–F, if in color, the SPECT-CT would have a red spot over the OCL) Therapy consisted of debridement, microfracturing (G), autologous bone transplantation (H), and treatment by “autologous matrix-induced chondrogenesis” (AMIC; bilayer collagen membrane; Geistlich Pharma AG, Wolhusen, Switzerland) (I, J). should be checked. About 6 months after osteochondral reconstruction, the patient is pain free, has an excellent function, and is back to daily life (job, sports). Their clinical presentation is described and advice is given on how to diagnose and investigate suspected osteochondral injuries. 2013 Dec; 8(6): 838–848.  Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). If your symptoms are not relieved with non-surgical treatment options, you might need surgery. If a cartilage defect is too large for an autograft, an allograft may be considered. Damage to your cartilage, the padding between the bones in your knee joints, can lead to pain and difficulty moving. 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. Regarding the ligament instability, one may find pathologic signs for lateral ankle instability (anterior drawer test, inversion tilt test), medial ankle instability (eversion tilt test), or a combination of both (rotational ankle instability). FIGURE 71-1 Osteochondral lesion of the talus. The defect is what’s called an osteochondral lesion, and it can cause pain and swelling in the joint and ultimately could develop into osteoarthritis. 10. The ankle may demonstrate acute injury with swelling and ecchymosis or it may appear completely normal, as is often the case with delayed presentations. Currently, six characteristics are used to categorise a particular lesion. 6 The cause of OCLs of the talus has multiple facets. Definition. MRI is the gold standard for OCL diagnosis, providing information about bone bruise, cartilage status and soft tissues. A high level of suspicion is needed with continued pain and disability. 31, No. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. The different options for secondary repairs depend on whether the OCL is predominantly a problem of the chondral layer, the osseous part, or a combination of both, on the age of the patient and the size of the OCL (, Treatment Options for Osteochondral Lesions of the Talus with Tissue Repair Potential (Cartilage and Bone), Surgical Principles of Osteochondral Lesions of the Talus, Chondral reconstruction (ACI, MACI, AMIC), Chondral and osseous reconstruction (ACI, MACI, or AMIC with or without microfracturing or bone grafting). An osteochondral lesion to the talar dome is an injury that causes damage to the cartilage that sits on top of the talus. 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. In the ankle joint, OCLs are mostly seen in the talus, at the posteromedial and anterolateral talar dome, closely related to the top of the curvature. 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. The talar dome has no direct muscle attachments(2); during norm… Osteochondral lesions (OCLs) are focal articular injuries of the subchondral bone and the cartilage with a multifaceted cause (trauma, ligament instability, ischemic necrosis, malalignment, endocrine diseases, and others). However, it can be subdivided into a traumatic and nontraumatic cause. 6. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJA. http://www.ankle-arthroscopy.co.uk/ Osteochondral Defects New and improved video with voice-overs from Consultant Orthopedic surgeons Mr. Simon Moyes and Mr. Omar Haddo. Typically, you progress from range-of-motion exercises to light cardiovascular exercise and then strengthening exercises. Last, a commonly used arthroscopic classification is the OCL classification of the International Cartilage Repair Society.5, Epidemiologically, the ankle registers 4% of all the human osteochondral defects.6 The cause of OCLs of the talus has multiple facets. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. In recent years, diagnosis of OCL increased substantially with the widespread use of modern diagnostic tools, such as computed tomography (CT), arthrocomputer tomography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT)-CT, and other tools. Clinically, OCL ankle joints show, in almost all cases, a swelling and effusion. Scintigraphy showed to be useful in evaluating OCLs when radiographs appear to be normal. Further diagnostic was performed using the single-photon emission computed tomography-computed tomography (SPECT-CT; combination of scintigraphy and CT) (C–E). The various treatment options currently available are briefly reviewed. Specific changes in the program will be made by the physician as appropriate for the individual patient. The best way to prevent osteochondral lesions is to avoid sustaining serious ankle injuries. The Berndt and Harty classification has the advantage of being popular, but it does not accurately reflect the integrity of the articular cartilage. Foot Ankle Clin 8:233–242 PubMed CrossRef Google Scholar. Buy Membership for Orthopaedics Category to continue reading. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. & Lee, KB; Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture , Knee Surg Sports Traumatol Arthrosc (2015) 23: 860. Lateral ligamentous stability should also be examined. If osteochondral lesions on the ankle are not diagnosed early the bone fragment is not likely to heal and can continue to cause problems. Osteochondral defect or Cyst. , Non-surgical: Osteochondral lesions of the ankle can be treated with injections of Platelet-rich plasma and hyaluronic acid, which results in a decrease in pain scores and an increase in function for at least 6 months. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. When you get an injury to the underlying bone of your talus and the cartilage within the ankle joint it is referred to as a talar dome lesion injury or an osteochondral defect (OCD). Patients with OCLs of the talus typically report chronic ankle pain, joint stiffness, ankle swelling, snapping, giving way, and weakness. Verhagen RA, Struijs PA, Bossuyt PM et al (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. Osteochondral lesion of the talus. Surgical treatment of OCLs traditionally includes excision of loose bodies, debridement of the area, and drilling or microfracturing. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. It can be done with an arthroscope. The therapist would probably focus on the quadriceps (a thigh muscle) and especially on the vastus medial;is (part of the quadriceps). The University Foot and Ankle Institute is one of the top foot and ankle centers in the world. Here, one should be alert on not missing a radiologically correlating hindfoot malalignment (hindfoot varus or valgus) that could explain the overload on the painful OCL joint region. 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