When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. It may result in a defect that subsequently affects the subchondral bone and, in severe cases, may lead to formation of an osteochondral fragment. Through the years members of Ankle Platform have asked for treatment advise. Therefore a small anteromedial synovectomy is done using a 5.5 mm bonecutter shaver with the ankle in the dorsiflexed position. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect … Osteochondral defects . (Eds.) These data may have implications toward OLT size thresholds for surgical decision making in symptomatic lesions (ie, primary osteochondral transplantation procedure vs curettage and debridement). The ankle is plantarflexed to visualize the osteochondral defect (OCD). How is it caused? Immobilization of the ankle, medications, steroid injections and physical therapy are commonly tried but this often fails to relieve symptoms and surgery may be required. Submissions are anonymized and transformed to cases which you can find in this section. 3-A) and heel-rise (Fig. In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. Osteochondral defects in the ankle: why painful? An osteochondral defect (OCD) of the ankle joint can lead to localised pain, swelling and stiffness in the ankle with difficulty weight bearing and mobilising. However, it can be subdivided into a traumatic and nontraumatic cause. INTRODUCTION. The experts opinion can be of interest for other physicians who meet similar problems. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). They may also be called osteochondritis dessicans or osteochondral fractures. Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). This allows us to treat the bone defect without affecting the cartilage. Sports Traumatol Arthrosc 18:570–580. Overall, more than 80% of the talus OCLs are of traumatic origin. A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. Protect surgical ankle 2. It is then matched to the surface area of the defect and impacted into place. Free Preview. (OBQ12.74) A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. Physicians can upload their anonymized problem case for expert advice. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an … Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities World J Orthop. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. The graft is taken as a cylindrical plug of cartilage and subchondral bone. Begin Range of Motion 4. Clinical Relevance: The location of peak stress in the ankle joint becomes closer to the rim of the defect in OLTs at a threshold of 10 mm and greater in diameter. Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. Talar dome lesions are usually caused by an injury, such as an ankle sprain. For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. Healthy cartilage tissue -- a graft -- is taken from an area of the bone that does not carry weight (non-weightbearing). With disease progression, the fragment may detach, leading to degenerative osteoarthritis . During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). Many synonyms for OCLs of the ankle have been used, such as osteocartilaginous bodies, joint mice, intra-articular fragmentary fractures, transchondral fractures, and osteochondral defects, with the acronym OCD being used interchangeably to refer to osteochondral defect or osteochondritis dissecans. It is often associated with a traumatic injury such as a severe ankle sprain. Osteochondral lesion (OCL) describes an injury to the articular cartilage surface of bone within a joint. Keywords Osteochondral defect Cartilage Ankle joint Subchondral cyst Natural history Pain Introduction An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 46, 47, 50]. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Non-operative measures such as mobilisation, a heel lift and steroid injections are reasonable non-operative techniques to try before surgical referral, but pain from mechanical symptoms is often resistant to non-operative measures. 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). Because of excessive overlying fibrous tissue and synovium, the defect cannot be adequately visualized. To make these surfaces slide more easily, there is also fluid in the joint that is created by the capsule of the joint. Tol et al. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. problems after ankle fracture. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. 2015 Dec 18;6(11):944-53. doi: 10.5312/wjo.v6.i11.944. Fig. If the cartilage does not heal properly following the injury, it softens and begins to break off. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) Ankle: Chondral/Osteochondral Defect Repair ... 1. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. OCDs usually develop after an inversion or high impact injury to the ankle, leading to a portion of the cartilage to be injured. Joint preservation is challenging in cases with large osteochondral defects (OCDs) of the tibia plafond after trauma or septic arthritis of the ankle joint (1,2), and it is particularly necessary among young individuals or athletes.Several treatment strategies—namely, arthrodesis, osteochondral allograft, and total ankle replacement (TAR)—have been described for large OCDs of the ankle (). Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondral Defects – OCD of Foot and Ankle, Talus, Metatarsal. 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). During loading, compressed cartilage … Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. In acute conditions, symptoms of osteochondral ankle defects are similar to those of acute ankle injuries. We prefer to use the broader term osteochondral lesion to define a lesion of any origin … The ankle joint has a high congruency. “Osteo” means bone and “chondral” refers to cartilage. Information from your Foot and Ankle Osteochondral Defect Surgeon in Orange County with offices in Newport Beach and Irvine – Southern California. What causes it? Osteochondral Defects in the articular cartilage can result from trauma, arthritic conditions, chronic wear and tear. The broad term “osteochondral lesion of the talus” describes an injury or abnormality of the talar articular cartilage and adjacent bone.1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. In patients with an isolated ligamentous ankle injury, these symptoms usually resolve after functional treatment within 2–3 weeks. Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. Manage pain 3. In most joints of the foot and ankle, this layer of cartilage is one to a few millimetres thick. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. “Osteo” means bone and “chondral” refers to cartilage. If the fragment has come loose, it can also cause locking or instability symptoms. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. In osteochondral autograft transplantation, cartilage is transferred from one part of the joint to another. They include lateral or medial ankle pain, functio laesa and swelling. 31. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for. 1, in a review of >580 osteochondral defects … 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Control post operative pain/swelling Treatment: - Patient to be progressed to PWB (up to 30% body weight) if a small lesion (per MD’s recommendations). 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. Editors: van Dijk, C. Niek, Kennedy, John G. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. 3-C). This type of injury can be due to a severe ankle sprain that causes bone and cartilage to become loose, resulting in ongoing ankle pain. [] Although majority may be associated with trauma, some may develop insidiously. Talar Osteochondral Defects Diagnosis, Planning, Treatment, and Rehabilitation. Trauma plays the most important role in the pathomechanism of talus OCLs. Knee Surg. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. Osteochondral defect or Cyst. 3-B) views; the defect cannot be detected on the lateral view (Fig. Definition. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Osteochondral defects and loose bodies are common causes of mechanical symptoms in the ankle. 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