Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. Fibrocartilage is the natural repair and physiologic alternative. Native articular cartilage consists of hyaline cartilage. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. 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. Frequently these lesions are traumatic in origin, most commonly occurring after an acute ankle sprain; however, atraumatic mechanisms have been described. MRI has gained popularity in its ability to delineate both the cartilage and bone extent of the lesion in addition to associated soft tissue pathology. Foot Ankle Orthop. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. Once the unhealthy tissue is found, it is removed with a large drill to leave healthy bone underneath. %%EOF MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. The loose cartilage is removed along with any damaged bone or cyst. 2018;3: 247301141877955 [Google Scholar] Chao J, Pao A. Restorative tissue … Treatments for lesions in the knee are more challenging, but also have promising outcomes. They will act as an irritant in the joint space, promoting synovial inflammation and subsequent symptoms. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. Advertisement . Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. The deep radial layer is the largest layer distributing force and resisting compression. Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. For small sized defects if the overlying cartilage is intact, then retrograde drilling of the defect is done and the space is filled with bone cement. The pathophysiology of OCLs must be appreciated to fully understand why the various treatment modalities are effective and when to use them. Arthroscopic Treatment of Ankle Osteochondral Lesions, Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,*, a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA, b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester Road South West G-10, Seattle, WA 98166, USA, c Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics and Podiatric Surgery, Kaiser Permanente, 280 West MacArthur Boulevard, Oakland, CA 94611, USA. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. Ferkel and colleagues. G"��թH���⩄4Q,R-���4Jj+R#T��H��aV�ߝ��I��Bk��Q$t"1[$��ơ��N 捴�%&��?��}3"N�,��(�Xa��N/~�����_\cC������Ct�L��(�\�z���]��D�;�ؠ�rR�;�3h�����0ic�&�/F�����)�i6�꼜Р(h�_�C�7�n�5s�~�/$�N=���{GuV���E�Ѿ��E��~�mf����lxX��ɢa;���3?��TR5͆�������˫�������5�Y���7���x������Oh��rDU�UW����TN����S��P�1ƇI'9�e�O��4�Mڢmڡ]ڣ7����o�����N���G:�O���6NO3:�!���%]QN��oTИ&TҔ�ӌ*�iN��'��-�E~2b���E�k�K8{�~��S��9��~R+me�7�u�$)���絊%��eŁ+mBbs��9}-&��I8�5B<9��yၖB��C6�t������A��}���כe1��:+��`rYx�Q��o�牐:n��iإY>��}�. Pritsch14 introduced a three-stage system in 1986 describing the cartilage as intact, soft, or frayed. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Theoretically, medial lesions with their larger osseous component have a better chance of consolidating with the underlying bone and its blood supply with proper treatment, which may range from immobilization to microfracture or open reduction and internal fixation. Surgical treatment of talar OLTs includes: Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. Therefore, if painful lesions are assumed to be painful because of instability, these MRI findings are consistent with both. In their landmark paper, Berndt and Harty1 delineated both a classification system and a clarification of the behavior of these injuries, focusing on mechanism and location of the lesion. 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 . 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: 1. Non-Invasive ankle distractor to distract the joint space, promoting synovial inflammation and symptoms! 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