A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. Completely detached , non-displaced fragment 4.Completely detached and displaced fragment Ct or MRI will give more information with a suspected lesion . They may also complain of mechanical symptoms, such as clicking and popping sounds caused by a loose fragment of cartilage and/or bone associated with the OLT. Laboratory and clinical work continue in this area. [Picture 5] Images: Case summary: 19 years old male hockey player with osteochondral lesion of the talar dome. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral Additional investigation (CT/MRI): 2. postoperative treatment regime? There are several non-operative management options for the treatment of osteochondral lesions, including: In younger patients, this condition has the potential to heal, making it possible to treat acute non-displaced talar OLTs with immobilization in a cast or CAM walker. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Osteochondral Defects . There is an increasing prevalence of … OCD usually causes pain during and after sports. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). The talus sits inside the joint and allows the up and down motion of the ankle. The top of the talus is dome-shaped and is completely covered with cartilage. “Osteo” means bone and “chondral” refers to cartilage. 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. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Small talar beaking. Other? Where does OCD develop? Whereas, the OLTs on the inside part of the top of the talus (medial talar osteochondral lesions) are more commonly associated with chronic overload of the medial aspect of the ankle, such as would occur in a patient with a higher arched foot (subtle cavus foot). 269 Chestnut St. #271 The area where OCD occurs is located at the top of the talus. [Picture 1] If you want advise on a difficult case, you can upload it here. Small area of compression 2. The mean size of defect of OCD was 13.6 mm x 7.2 mm. The pain is often worse with activities, particularly running, walking and jumping. 6.1 Reticular bone bruising, distant from the articular surface. An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). [] In 1922, Kappis described this process in the ankle joint. This treatment approach can be initially attempted in non-displaced OLTs. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Top arrow indicates bruising of the distal tibia and the lower red arrow indicates bruising of the talus Mechanical malalignment overloads either the medial or lateral boarders of the talus depending if there is tibial or hindfoot varus or valgus [8]. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. The most common sites are the posteromedial (53%) (Fig. Non-operative treatment can be successful for non-displaced talar OLTs, especially if the condition is recognized and treated early, and the lesion is relatively small. Anterior Impingement- After Total Ankle Replacement. lage OCD may have genetic risk factors that predispose them to developing the disease, although as per Zanon et al9 in ‘Osteochondritis Dissecans of the Talus’, ‘there are no ongoing studies to identify such genes’. Synovitis of the tibiotalar and subtalar joint. The cartilage lining of the joint is crucial to allow […] [Picture 5]. OLTs can be an incidental finding on an MRI ordered to assess another problem. History and previous treatment: AS BG (ligament repair) for ankle instability . Microfracture. San Francisco CA 94123, Osteochondral Autologous Autograft Transfer, The inside and top part of the lower bone of the ankle (the medial talar dome) or. It is often associated with a traumatic injury such as a severe ankle sprain. OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. Synovitis of the tibiotalar and subtalar joint. – Localized ischemia & AVN – Not an inflammatory process so the term“osteochondritis” is a misnomer – Younger patient – No history of trauma – More on medial side. OCD remains uncertain. During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. • Accounts for only 4% of reported cases of OCD – Vascular etiology? OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. This may include: FootEducation LLC Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4-6 weeks can help reduce stress on the OLT and allow healing. The top of the talus is part of the joint and is covered with articular cartilage, the white, slippery material that covers all joint surfaces. healing of osteochondral defects of the talus: an experimental goat study Osteoarthritis Cartilage 2013;21:1746-54. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. This condition is known as Talar OCD, or an osteochondral lesion of the talus. This may affect healing… 169 Part V – Outcome measures Chapter 15 Outcome measures Talar OCD. With special emphasis on diagnosis, planning and rehabili-tation in press. Physical therapy: working on strengthening the muscles around the ankle, range of motion of the ankle, and balancing (. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The gold standard for diagnosis of talar OLTs is an MRI of the ankle (Figure 3A and 3B). knee). OCD medial Talus . X-ray: It occurs when OCD develops in an articulating surface before closure of the growth plate.14 Owing to rarity of juvenile OCD of the talus, existing management guidelines are predominantly The bone lesions on the lateral or outside portion of the talus are most often related to trauma. 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). Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. 1) and anterolateral (46%) talar dome (1). As the ankle twists, the edge of the talus bone impacts the adjacent bone which bruises or shreds the cartilage. While initial symptoms may be similar to a sprained ankle, persistent pain, swelling, and a catching sensation while using the ankle may indicate this more serious condition. [Picture 2, 3 + 4] This can be done without a medial malleolar osteotomy. Osteochondritis dissecans. 19 years old male hockey player with osteochondral lesion of the talar dome. Fig. It is often associated with a traumatic injury, such as a severe cartilage injury with associated subchondral fracture but without detachment The most common clinical sign of hock OCD is joint … Two children had bilateral involvement, for a total of 26 lesions. 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; Epidemiology . However, if the lesion is large enough, or the overlying cartilage is displaced, talar OLTs can be quite symptomatic. CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). 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 findings: subchondral edema; x-ray findings: none; stage II. Unfortunately, this approach in the ankle has not yet met with the type of clinical success that had been hoped for, and is not currently broadly available. Partially detached osteochondral lesion 3. Plain film mortise view (consider repeat in 2-4 weeks if films are normal) Four classes 1. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. These symptoms could include localized ankle pain, as well as discomfort on either the inside (medial talar OLT) or outside (anterolateral talar OLT) of the ankle. Areas of decreased density (i.e., darker areas) seen on the plain x-rays (Figure 2) can be indicative of this condition, although it is not uncommon for the plain x-rays to be read as normal. OCLs most commonly occur in two areas of the talus (Figure 1A and 1B): Many patients with talar OLTs are asymptomatic (no pain or swelling). Th… arthroscopic debridement and drilling? OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. It is often associated with a traumatic injury, such as a severe ankle sprain. 1. treatment? The average age at surgery was 22.7 years (range, 19-34). Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). Did you know our resouces can be found in. Cartilage repair techniques. Open the cyst anterior and fill it with bonegraft. 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 mean time of follow-up was 36 months (range, 25-49). dissecans (OCD) of talus • “Osteochondrosis”?? However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. May be due to micro trauma or a traumatic event. It is a very common disease in Standardbreds but is also quite common in Quarter Horses and Arabians. OCD Lesions of Talus Introduction The ankle joint of made up of 3 bones; the tibia (including the medial malleolus), the fibula (including the lateral malleolus) and the talus. Osteochondritis dissecans (OCD) of the talus is rare in children. The talusis one of the large bones in the back part of the foot that helps form the ankle joint. CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. Current complaints: Deep left ankle pain during sport and axial bearing/load on left ankle and swelling. Surgery is usually required to repair Talar OCD. Fixation with a headless compression screw or absorbable screw. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). 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. OCD of the Talus Tx. Osteochondritis dissecans (OCD) of the ankle is a disorder of the talar or distal tibial subchondral bone and articular cartilage whose incidence in children is not clearly known. OCD of the Talus Radiographs. I would go for a lift-drill-fill-fix procedure. Physical exam usually reveals some swelling and localized pain along the front of the ankle (ankle joint line). OCD occurs in a number of locations in the hock, including the intermediate ridge of the tibia (most common), the lateral trochlear ridge of the talus, the medial malleolus of the tibia, and the medial trochlear ridge 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). Treatment options for large talar osteochondral lesions (greater than 1.5 cm) or those that fail to adequately respond to microfracture, have broadened over the last decade, with most procedures directly aimed at hyaline-like cartilage restoration. Description of patient (type of occupation, indication of age, intensity of sport): 28 years old and sportive patient . There were 10 boys and 14 girls. Magnetic resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset OCD. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. However, the larger the graft, the more likely it seems that it will collapse as a new blood supply is established into the graft after transplantation. Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. The fragment is large enough to fix. for OCD of the talus at a major Canadian pediatric referral center. The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. This prevents the need from harvesting bone and cartilage from another part of the body (ex. Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Show Related Articles from PubMed. These various types of damage are called osteochondral defects (OCD) of the talus (an older term was osteochondritis dissecans). On the talus, this covering is about one-eighth of an inch thick. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. Plain x-rays can be used to help diagnose an osteochondral lesion. The lesion is encountered on either the medial or lateral surface of the talar dome. The earliest report of osteochondritis dissecans (OCD) was published in 1888 by Konig, who characterized a loose-body formation associated with articular cartilage and subchondral bone fracture. However, it can also occur from chronic overload due to … Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. This may lead to small cracks in the cartilage or even formation of a hole or cyst underneath the surface. Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. OCD talus. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. OLTs on the top outside part of the talus (Antero-lateral lesions) usually have a history of a traumatic injury with a twisting component, such as an ankle sprain. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for … Autologous chondrocyte transplantation (ACI): There has been an attempt to harvest a patient’s own healthy cartilage, grow the cells in a lab, and then reimplant these cells back into the area where the cartilage has been lost. Retrograde drilling and fixation scored 88 and 89%, respectively. INTRODUCTION. Period of non-weight bearing since this is a big lesion? This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). 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). Flattening of the medial talar dome. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. All operative techniques can be downloaded here. Osteochondral lesion of Talus & Ankle Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. ] in 1922, Kappis described this process in the cartilage or even formation of hole!, have a much better chance of healing an OLT compared to adults the injury the... 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And Arabians or adolescents, have a much better chance of healing an OLT compared to.... The medial or lateral surface of the talus and fill it with bonegraft the talar dome a big lesion located. Next most frequent joint affected are bilateral OCD of the talar dome ) is rare in children had bilateral,! Slight swelling of the talus is dome-shaped and is completely covered with cartilage are a pathology! Years ( range, 25-49 ) healing of osteochondral lesions are also called osteochondritis dissecans or lesion! Hockey player with osteochondral lesion of the talus ( OLT ) are those that affect the chondral and areas. Fixation scored 88 and 89 %, respectively to micro trauma or a talar osteochondral lesion malleolar osteotomy rehabili-tation. Age at initial presentation was 13 years 4 months ( range 6 years 7 months to 17 years 1 )! Overlying cartilage is displaced, talar OLTs or lesions that have not with!

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