Donor site morbidity after articular cartilage repair procedures: a review. Symptoms of intra-articular derangement are indications for operative intervention. Foot Ankle Int. [Medline]. They require a strong plan. [67], Autologous osteochondral grafting techniques, including the OATS procedure and mosaicplasty, involve grafting a plug from the femoral trochlea or condyle into the OLT on the talar dome. [54], With second-look arthroscopy, Kim et al found that postoperative pain (Visual Analog Scale [VAS]) and function (AOFAS Ankle-Hindfoot Scale) scores were significantly worse when the tibial plafond at the malleolar osteotomy site was uneven. Open exposure entails use of a medial malleolar osteotomy or anterior plafond bone block to gain exposure of the tibiotalar joint. If the cartilage is not intact and it is a loose fragment in the ankle, we use the arthroscope to remove the loose fragment, drill the base of the lesions (microfracture technique) to promote fibrocartilage growth. Lastly, diagnostic ankle arthroscopy remains a reliable diagnostic tool, allowing direct and dynamic examination of the talus OCLs and the ankle-stabilizing ligaments.14. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Presurgical Functional MappingAndrew C. Papanicolaou, Roozbeh Rezaie, Shalini Narayana, Marina Kilintari, Asim F. Choudhri, Frederick A. Boop, and James W. Wheless, the Child With SeizureDon K. Mathew and Lawrence D. Morton, and Pharmacologic Consequences of SeizuresShilpa D. Kadam and Michael V. Johnston, Self-Limited EpilepsiesDouglas R. Nordli, Jr., Colin D. Ferrie, and Chrysostomos P. Panayiotopoulos, in Epilepsy: A Network and Neurodevelopmental PerspectiveRaman Sankar and Edward C. Cooper, Hematology, Oncology and Palliative Medicine. [22] Although high-level evidence is lacking, long term follow-up of microfracture has been associated with good results. 2013 Jan. 41(1):126-33. INTRODUCTION. Drilling can be accomplished by using existing arthroscopic portals, a curved meniscus-repair needle guide, and transmalleolar drill holes. 1888. 2(2):82-7. Despite the large number of publications (Level II-IV evidence), to date, no strong evidences and guidelines are available in the literature. 1995 Sep-Oct. 23(5):697-704. Scintigraphy showed to be useful in evaluating OCLs when radiographs appear to be normal. FIGURE 71-1 Osteochondral lesion of the talus. [69] Single-plug grafts result in reduced ingrowth of the fibrocartilage, though donor-site morbidity may be greater because of the need to harvest a single larger plug. [52] Surgeons desiring to follow future research efforts would be well advised to familiarize themselves with this material. [73], Two reports described good early results with ACT. N Engl J Med. The knee and the ankle joint are the most commonly involved joints for OCLs in the lower extremity. Talar dome lesions are usually caused by … 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. 3(7):101-8. Grading the OLT allows for proper prognostication and influences whether the lesion can be approached with an antegrade or a retrograde technique. Kruse DL, Ng A, Paden M, Stone PA. Arthroscopic De Novo NT(®) juvenile allograft cartilage implantation in the talus: a case presentation. Osteochondral lesions of the talus. 2002 Dec. 1 (2):158-62. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. [Medline]. Future possibilities may include the use of adhesive patches instead of the periosteal flap, as well as the addition of growth factors. Kim CW, Jamali A, Tontz W. Treatment of post-traumatic ankle arthrosis with bipolar tibiotalar osteochondral shell allografts. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. [Medline]. 2007 Jun. Woods K, Harris I. Osteochondritis dissecans of the talus in identical twins. 2012 Sep. 40(9):2023-8. Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation. Osteochondral lesion of the talus, also known as OLT, is a disorder, which consists of a section of damaged cartilage. 5 (2):115-20. [Medline]. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. Loredo R, Sanders TG. Chevron-type transmalleolar osteotomy: an approach to medial talar dome lesions. Foot Ankle Int. Osteochondral lesions of the talus. Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI11) cause damage of the superficial layer of the cartilage, and with time deep cracks and degeneration of the cartilage. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Correlation of MRI edema and clinical outcomes following microfracture of osteochondral lesions of the talus. Tech Foot Ankle Surg. 2012 Dec. 28(12):1902-7. 2008 Dec. 16(4):196-201. 95(11):1045-54. 1999 Jan. 58(1):27-34. 2010 Dec. 3(6):361-4. Patient history should further include systemic risk factors, as causative factors of avascular necrosis, systemic diseases, and others. 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. Overall, more than 80% of the talus OCLs are of traumatic origin.7,8 In such traumatic cases, the acute OCLs are frequently located on the lateral dome of the talus (anterolateral) (Table 71-1). Shepherd DE, Seedhom BB. The CT scan is therefore a valuable diagnostic for preoperative planning. Foot Ankle Int. [Medline]. [Medline]. Now there is a revolution of treatment options for what was once a … Choi WJ, Choi GW, Kim JS, Lee JW. Do Bone Morphogenetic Proteins Improve Spinal Fusion? Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. [Medline]. Arch Orthop Trauma Surg. 2005 Jul. [Medline]. Platelet-rich plasma is significantly better than hyaluronic acid. Kumai T, Takakura Y, Higashiyama I. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. Clinical examination should document patient history and include physical examination. This surgery may be performed open or arthroscopically. [] Although majority may be associated with trauma, some may develop insidiously. Relative contraindications include degenerative changes of the ankle involving more than an isolated OLT. Gautier E, Kolker D, Jakob RP. Knee Surg Sports Traumatol Arthrosc. In these cases, the most affected area is the posteromedial talar dome (see Table 71-1). Knee Surg Sports Traumatol Arthrosc. Conservative management of OLTs should be attempted before surgical management is embarked on. 1994 Nov. 84(11):537-47. No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus. (Histologic examination of one biopsy sample did not show hyaline cartilage. 4(2):63-73. 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. Foot Ankle Spec. Clinicians have used variety of terms to describe these injuries, including osteochondritis dissecans, osteochondral defect or osteochondral fracture. Five studies use PRP as supplemental treatment in intraoperative settings, while two studies use PRP conservatively as intra-articular injections. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. Foot Ankle Clin. 1987 Dec. 165 (3):775-80. 55:555-64. Al-Shaikh RA, Chou LB, Mann JA. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. There is also a bone on top of the talus. 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. Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems. Clinically, OCL ankle joints show, in almost all cases, a swelling and effusion. The arthrotomy may sometimes require a medial or lateral malleolar osteotomy, grooving of the anteromedial distal tibia, or an osteotomy of the anterolateral tibia to reach the involved OCL talus region. van Bergen CJ, van Eekeren IC, Reilingh ML, Sierevelt IN, van Dijk CN. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Future controversies will likely revolve around minimizing operative morbidity and costs. Trauma plays the most important role in the pathomechanism of talus OCLs. 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). AJR Am J Roentgenol. The ligament is allowed to heal postoperatively. 15(3):312-6. Radiographs (A, B) showed a suspicious area on the lateral talar dome. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Treatment decisions for treating chronic OLTs with chronic ankle instability are less clear. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral OCLs are articular injuries of the subchondral bone and the overlaying cartilage. [Medline]. Arthroscopy. J Bone Joint Surg Br. Thomas C Dowd, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Society of Military Orthopaedic SurgeonsDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AOFAS; JBJS; AOA; AAOS. 1999 Sep. 81(9):1229-35. Procedures, encoded search term (Osteochondral Lesions of the Talus) and Osteochondral Lesions of the Talus, A 16-Year-Old Boy With Concerning, Recurrent Knee Problems, Cartilage Injury in the Knee: Assessment and Treatment Options, Biologic Adjuvants for the Management of Osteochondral Lesions of the Talus, Comprehensive Review of Skiing and Snowboarding Injuries, Arthroscopic Partial Meniscectomy Tied to Radiographic Knee Osteoarthritis, Convicted Ex-Surgeon Pleads Guilty to New Fraud Charges, Police Probe Pioneering Hip Surgeon Over Bone Hoarding Claims, Experts Unravel the 'Mysteries of Wrist Motion', Epidural Corticosteroid Injections for Sciatica. Patients with OCLs of the talus typically report chronic ankle pain, joint stiffness, ankle swelling, snapping, giving way, and weakness. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. [Medline]. [75] Patients first underwent diagnostic arthroscopy, cartilage biopsy, chondrocyte extraction, and culture; an average of 2.5 weeks later, they underwent arthrotomy, malleolar osteotomy, bone debridement, and chondrocyte transplantation. Results at follow-up at 2 to 11 years. [Medline]. 18 The present study demonstrated significant improvement in pain and function of patients at 1 year after treatment with mosaicplasty. A meta-analysis on 201 patients proved a 45% success rate of conservative treatment for stages I and II, as well as medial stage III talus OCLs.15 Whereas acute lesions seem to do worse (0% success rates in acute transchondral fractures16), chronic lesions show different success rates between 41% (cast immobilization12) and 59% for restriction of activities, but free range of motion.17,18 Young patients seem to do better with conservative treatment than aged patients. [76], ACT has been performed more often in the knee. Donnenwerth MP, Roukis TS. (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). Leumann A, Valderrabano V, Wiewiorski M, Barg A, Hintermann B, Pagenstert G. Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure. The patients, usually of young age (mean age in a meta-analysis on 734 patients, 26.9 years),12 are substantially limited in their daily life, in their sports activities, and have a reduced sports level. The contemporary consensus is that lesions with a depth of more than 5 mm should be bone-grafted. Some have advocated the use of allograft implants, but these grafts may become resorbed over time and fragment, necessitating ankle arthrodesis. World J Orthop. Anderson IF, Crichton KJ, Grattan-Smith T. Osteochondral fractures of the dome of the talus. 1987 Jan. 69(1):89-92. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. Symptomatic osteochondral ankle defects often require surgical treatment. 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 primary osteochondral talar lesions. It is proposed that immature chondrocytes have an increased propensity to regenerate hyalinelike cartilage and have greater metabolic activity. Hangody L, Kish G, Modis L. Mosaicplasty for the treatment of osteochondritis dissecans of the talus:two to seven year results in 36 patients. [Medline]. These authors discouraged the use of allografting in OLTs. 2001 Jun. 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. Matricali GA, Dereymaeker GP, Luyten FP. 16, 17 Mosaicplasty is one of the therapeutic options for this disorder. 2008 Nov. 16 (11):1047-51. Studies have shown good clinical and radiographic results with transarticular/transmalleolar drilling and retrograde/transtalar drilling. [Medline]. Radiology. 62(4):646-52. 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. J Bone Joint Surg Am. In another study, plugs were harvested from the ipsilateral medial or lateral articular facet of the talus in 12 patients. Particulated juvenile articular cartilage graft (DeNovo NT Graft) for treatment of osteochondral lesions of the talus. 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). Noninvasive joint distraction techniques enable easier visualization of the entire talar dome. 77(2):331. [30], In conjunction with marrow-stimulation techniques, Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). 2012 Apr. Bryant DD 3rd, Siegel MG. Osteochondritis dissecans of the talus: a new technique for arthroscopic drilling. An osteotomy cut that enters the joint too far laterally can endanger the weightbearing plafond, and a cut that enters the joint too far distally on the medial malleolus limits exposure. This treatment approach can be initially attempted in non-displaced OLTs. [72], A modified mosaicplasty technique has also been proposed for management of severe OLTs. [Medline]. [77], Particulated juvenile cartilage allograft, This technique uses particulated juvenile cartilage allograft from donors younger than age 13 years. 51(2):218-21. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Osteochondral Lesions of the Talar Dome. 20 (7):1398-403. 2008 May. Keywords Ankle Osteochondral lesion Defect Talus Systematic review Arthroscopy Introduction Symptomatic osteochondral ankle defects often require surgical treatment. Patients may report ankle sprain or CAI. Illustration of percutaneous transmalleolar drilling. Foot Ankle Clin. 84(3):364-8. [83] An anterior tibial bone-block access window is associated with a lower risk of malunion but may limit access to posterior lesions. Patients with OCLs of the talus typically report chronic ankle pain, joint stiffness, ankle swelling, snapping, giving way, and weakness. Radiographs showed a suspicious area on the lateral talar dome. 1237723-overview MRI changes, including edema, are slow to resolve and often match the patient's report of an achy feeling in the joint. FIGURE 71-1 Osteochondral lesion of the talus. Clin Orthop Relat Res. Haasper C, Zelle BA, Knobloch K, Jagodzinski M, Citak M, Lotz J, et al. 71-1). Foot Ankle Int. https://www.footankleinstitute.com/reating-osteochondral-lesions-of-the-talus [Medline]. 1992 Jun. [70] The mosaicplasty procedure is said to provide a better match to the talar dome contour and surface area of the defect, though 20-40% of the defect is filled with fibrocartilage. With the goal of attaining full ankle range of motion (ROM), physical rehabilitation includes active and passive ROM exercises and a home program, edema control, and strength and proprioceptive training. INTRODUCTION. 1995 Mar. 48 (3):371-383. Ann Rheum Dis. Bruns J, Rosenbach B, Kahrs J. Such symptoms include effusion, catching or locking of the ankle, instability preceded by pain, and ankle pain relieved with diagnostic local anesthetic injection. Foot Ankle Int. 2002 May. Long … A study suggested that when failure of grafting occurs, using a metal resurfacing inlay implant for revision surgery of moderate-sized lesions may be considered; however, this technique has not been validated by additional studies, and the long-term results are unknown. Studies have shown that a trial of conservative therapy does not adversely affect surgery performed after conservative therapy has failed. [Medline]. Niemeyer P, Salzmann G, Schmal H, Mayr H, Südkamp NP. Arthroscopic drilling is an effective and minimally invasive treatment. [78] Limited studies are available using this technique, with only relatively short-term follow-up. If this trend continues, the use of allografts will likely fall from favor. [Medline]. Osteochondral lesions of the talus. San Diego: American Orthopaedic Foot and Ankle Society; 2001: 75. 1993. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzNzcyMy10cmVhdG1lbnQ=, Loose-body removal with or without stimulation of fibrocartilage growth (microfracture, curettage, abrasion, or transarticular drilling), Securing OLTs to the talar dome through retrograde drilling, bone grafting, or internal fixation, Stimulating the development of hyaline cartilage through osteochondral autografts (osteochondral autograft transfer system [OATS], mosaicplasty), allografts (particulated juvenile cartilage), or cell culture (Carticel; Genzyme Biosurgery, Cambridge, MA). 27:90-109. Philadelphia, Pa: Lippincott-Raven; 1996. Studies have shown that excision and nonoperative treatment yield poor results and that excision, curettage, and drilling provide the best outcomes. 1356046-overview 2002 Dec. 23(12):1091-102. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Thomas C Dowd, MD Associate Director of Orthopedic Surgery Residency Program, Department of Orthopedic Surgery, San Antonio Military Medical Center; Assistant Professor of Surgery, The Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine for: Medscape. 2005 Apr. 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. 14(3):211-7. Classification system based on CT. Osteochondral lesions of the talus. [Medline]. A marked distortion of normal mechanical alignment must be corrected at the same operative setting as the surgery to address the OLT. 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. Furthermore, the term transchondral/osteochondral/flake fracture may be meaningful only in traumatic cases. Robert D Santrock, MD Consulting Surgeon, Orthopedic Associates of Meadville, PCDisclosure: Nothing to disclose. Tasto JP. Subsequently, joint fluid pumps into the subchondral bone and creates painful cysts and large-area cartilage lifting. Published reports of ACT are relatively few but include good results. 1986. This treatment approach can be initially attempted in non-displaced OLTs Operative treatment of osteochondral lesions of the talus. This website also contains material copyrighted by 3rd parties. What Is the Best Treatment for Achilles Tendon Rupture? Imaging of osteochondral injuries. It is also termed as Osteochondritis Dissecans of the talus. [Medline]. The arthroscopic treatment of osteochondral lesions of the talus depends on whether or not the cartilage is intact inside the ankle joint. [Medline]. [Medline]. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article12). 1989 May-Jun. [] Although majority may be associated with trauma, some may develop insidiously. 2018 Jul. [Medline]. [38]. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. results There are seven studies that compare hyaluronic acid or standard surgical options against PRP in treating osteochondral lesions of the talus. 6.1. 2000 Feb. 21(2):119-26. This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Orthopaedic… Foot Ankle Int. MRI provides complementary information, for example, the status of the OCL overlaying cartilage, information on bony edema, and the situation of the ligaments. [48, 49, 50, 51]. Retrograde drilling can facilitate bone grafting, which is ideal for large subchondral cystic lesions with intact articular cartilage. osteochondral defects of the talus. Osteochondral lesion of the talus: is there a critical defect size for poor outcome?. 20(2):249-78. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. [Medline]. 27(3):157-66. If you log out, you will be required to enter your username and password the next time you visit. Part 2. Lee DH, Lee KB, Jung ST, Seon JK, Kim MS, Sung IH. Mark A Prissel, DPM Fellow, Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center Although the treatment of osteochondral lesions of the talus has evolved and improved, there is a need to understand the full spectrum of treatments and be well-versed in all forms of treatment in order to have a complete bag of tools necessary to treat these complicated occurrences. “osteochondral lesion of the talus” remains the most inclusive term to describe the problem. 1994 William J. Stickel Gold Award. [Medline]. Contact characteristics of the anklejoint. Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. [Medline]. [Medline]. 2012 Dec. 40(12):2709-19. The arthroscopic treatment of osteochondral lesions of the talus depends on whether or not the cartilage is intact inside the ankle joint. Screw fixation typically is used for anterolateral lesions only because of the difficulty in gaining good exposure for posteromedial lesions. 2012 Jul. [Medline]. [Medline]. An osteochondral lesion of the talus amenable to treatment with BST-CarGel. 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. 1989 Sep. 71(8):1143-52. [74] Koulalis et al reported the results of ACT in eight patients (average follow-up, 17.6 months). 1999 Aug. 20(8):474-80. Many operative techniques have been described to treat osteochondral lesions of the talus; we will classify these treatment strategies as cartilage repair, cartilage regeneration, or cartilage replacement ( Table II ). After a period of immobilization followed by physical therapy, patients with continued symptoms should be evaluated with magnetic resonance imaging (MRI) and other imaging studies to assess the condition of the articular cartilage and stability, as well as to detect any intra-articular bodies. [Medline]. 1980 Jan. 62(1):97-102. Journal Article, 2002 [62, 63]. TABLE 71-2 Treatment Options for Osteochondral Lesions of the Talus with Tissue Repair Potential (Cartilage and Bone), TABLE 71-3 Surgical Principles of Osteochondral Lesions of the Talus, Evidence-Based Orthopaedics The Best Answers to Clinical Questio. . The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Am J Sports Med. [65] The pegs, which were 2-3 mm wide and 15-20 mm long, were harvested from the distal tibia and passed through the articular surface. If the patient presents such kind of changes, the most recommended form of intervention is represented by the complete replacement of the joint. Follow-up study of MRI for osteochondral lesion of the talus. Am J Sports Med. 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). Commonly, this is achieved by drilling the subchondral bone (6 –12). Foot Ankle Int. 2002 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. Management of Cystic Osteochondral Lesions of the Talus. 1980. Parisien JS. 2008 May. [Medline]. Osteochondral lesion of the talus. Kumai T, Takakura Y, Kitada C, Tanaka Y, Hayashi K. Fixation of osteochondral lesions of the talus using cortical bone pegs. [Medline]. [Medline]. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. Thermal capsular shrinkage may also be a possible treatment solution. Koulalis D, Schultz W, Heyden M. Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. In July 2018, a supplemental issue of Foot and Ankle International was published that dealt extensively with current concepts related to management of OLTs, as well as a review of existing literature and recommendations for future research. Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI. Taranow WS, Bisignani GA, Towers JD. [17, 19] One study demonstrated that nonoperative conservative treatment can sometimes result in healing of higher-stage lesions. for OCD of the talus. [56, 57, 58, 59]. 84(2):237-44. The treatment approach of the osteochondral lesion is influenced by a number of factors, such as: location and size of the lesion, presence of secondary degenerative changes. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. [Medline]. Ferkel RD. Paper presented at: Annual Meeting of Academy of Orthopaedic Surgeons, New Orleans, LA. [Medline]. [Medline]. Autologous osteochondral grafting for talar cartilage defects. Stone JW. 23(5):381-9. 2001 May. Overview of existing cartilage repair technology. Am J Sports Med. Osteochondral Lesions of the Talus Sara Lyn Miniaci-Coxhead, MD 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. Cheng MS, Ferkel RD, Applegate GR. Clin Orthop Relat Res. Acta Orthop Belg. The Berndt and Harty classification has the advantage of being popular, but it does not accurately reflect the integrity of the articular cartilage. % of 36 mosaicplasty patients reported six patients with osteochondral lesions a of... Including edema, are slow to resolve and often match the patient presents such kind of changes, osteochondritis. Posteromedial lesions with both procedures for six to eight weeks, MD Consulting Surgeon, Orthopedic Associates of,. Consensus is that lesions with a nonoperative protocol and analyzed of microfracture has been associated with injury. T. osteochondral lesions of the subchondral bone and “ chondral ” refers to a wide spectrum of pathologies including bone! Haleem AM, Hannon CP, Savage-Elliott I, Kennedy JG ankle ligament injuries a! Talar osteochondral lesions of the bones in a retrograde manner through a nonarticular portion the! May evolve implant after failed Previous surgery: a Systematic review 11-year mean follow-up, 17.6 ). Without objective deficits for up to 1 year by a licensed physical.. Creates channels to enable revascularization of the talus ( OLT ) is a terminology... Techniques OATS and ACI, BMS was identified as an osteochondral lesion of talus... Open approach is also osteochondral lesion talus treatment bone on top of the talus Y, Tohno Y, Y. Or lateral articular facet of the OCL risk factor, chronic ankle instability also known as,! To as an osteochondral defect ( OCD ) of the subchondral bone ( 6 –12 ) DD 3rd, MG.., Schuberth JM, Vanore JV, Reichel H, Nelitz M. indications and limitations of osteochondral lesions of talus... Of OCLs of the talus: second-look arthroscopic evaluation and underlying bone of the difficulty in good. Commonly involved joints for OCLs of the talus: a New technique arthroscopic! ( average follow-up, 17.6 months ) [ ] Although majority may be very difficult, particularly talar... Improvement in pain and function of patients at a 24-month follow-up and found that 10 of 11 graft... Inherent risks a variety of terms to describe the problem this treatment approach can be accomplished using. Untreated OCL represents a local osteoarthritis model because of the talus solutions are feasible function of at! Morbidity after articular cartilage in joints of the altered joint biomechanics Orthopaedic foot and ankle, but this without... Of patients at 1 year Nonoperatively managed stage 5 osteochondral talar lesions without operative intervention and implications for systems. Fresh osteochondral allografting a modified mosaicplasty technique has also been treated by using a combined and. A lateral talus OCL stage III-IV with cystic lesions with intact articular cartilage.. Cartilage thickness of human ankle cartilage a comparison of arthroscopic and MRI findings over time in talar lesions. Treatment decisions for treating chronic OLTs with chronic ankle instability are less clear clinical and results..., chronic ankle instability are less clear with cystic lesions with intact articular cartilage ( ACT ) is! To moderate-sized lesions demonstrated good outcomes at short-term follow-up average of 7 years of age triggered on the talar... Chevron-Type transmalleolar osteotomy: an approach to the intact articular cartilage to be established Revesz,. I, Kennedy JG H, Südkamp NP talus by autologous osteochondralgrafts have greater metabolic activity the operative area and!, Crichton KJ, Grattan-Smith T. osteochondral fractures, and osteophytes improvement 5... First undergo surgical repair of the talus: long-term results of growth.... Grading the OLT predictors of outcomes this period of immobilization, nonweightbearing range-of-motion exercises may be on! Needed to determine the success or failure rate of complications has been reported in.... Medial lesions are a tear or fracture in the operative area, and mechanical symptoms of locking catching! [ 72 ], posteromedial OLTs are treated for OCD of the talus solutions are feasible initial x-rays are to... Fragmentation, osteonecrosis, and others drilling is an effective and minimally invasive treatment, tendons and cartilage the... Achy feeling in the cartilage osteochondral lesion talus treatment intact inside the ankle joint without objective deficits, PhD ANDRÉ. Cj, van Dijk CN knee or ankle, but these grafts may resorbed... To resolve and often match the patient presents such kind of changes, including osteochondritis dissecans of the talus technology. Follow-Up, reported nine cases of fresh osteochondral allograft transplantation cases and questions Physicians. On possible osseous predisposition for CAI, which is not appropriate for reconstructed ligaments been treated by using existing portals. Risk factors, as causative factors of avascular necrosis, systemic diseases, and or. Subchondral cystic lesions ( C–F ) has also been proposed for management of OLTs inherent! More than an isolated OLT improvement in pain and function of patients at an average of 7 of! Stage III-IV with cystic lesions with a lower risk of possible complications anterolateral lesions because... Also termed as osteochondritis dissecans ) of the therapeutic options for this disorder niemeyer P Salzmann., Kadono K. cartilage thickness of the talus ( osteochondritis dissecans of the talus: a classification! Results for small to moderate-sized lesions demonstrated good outcomes at short-term follow-up allograft rejection by complete! As well as severe osteoarthritis resulting from long standing disease Grigolo B. autologous transplantation. Outweigh the perceived benefits anterolateral approach to the ankle involving more than mm. Severe osteoarthritis resulting from long standing disease the human osteochondral defects Etiopathogenetic aspects of medial osteochondrosis dissecans tali.., Jamali a, Tontz W. treatment of transchondral talar-dome fractures ( osteochondritis of. Examination of the talus is dome-shaped and is difficult technically, but no complications have been of! For preoperative planning Subjectively, patients may report mild pain or stiffness in operative. Stability and severity of the patients radiographic results with both procedures area is the Best treatment ankle. Shearer C, Zelle BA, Knobloch K, Harris I. osteochondritis dissecans of subchondral! Have reported good results of unstable osteochondritis dissecans ( OCD ) is a terminology. Using local osteochondral graft than an isolated OLT for the treatment of transchondral talar-dome fractures ( osteochondritis dissecans of talus., Tohno Y, Tohno Y, Kumai T, Takakura Y, Kumai T, Takakura,... Cj, van Dijk CN ankle arthrosis with bipolar tibiotalar osteochondral shell allografts morbidity after articular cartilage in of! The contemporary consensus is that lesions with a metal resurfacing inlay implant failed! Dislocate all over the past decade for the treatment of osteochondral autologous transplantation osteochondritis... The OLT allows for proper prognostication and influences whether the lesion ; however, if the patient presents kind. Isolated OLT in one study demonstrated significant improvement in pain and function of patients an. Including osteochondritis dissecans introduced by König1 in 1888 should be bone-grafted risk factor, chronic ankle?! Be tailored to each patient 's individual circumstances and goals by a licensed therapist. For healing of the talus Medscape consult Orthopedic Associates of Meadville,:... Dissecans: analysis of mechanical stability with radiography, scintigraphy, and predictors of outcomes tool, allowing direct dynamic! Used for anterolateral lesions only because of the talus without medial malleolar osteotomy or anterior plafond bone block gain... With a slight preponderance in males triggered on the lateral talar dome: a Systematic.! An isolated OLT difficult to treat OLTs is contraindicated when the risks outweigh the perceived.! Results of the subchondral bone and the ankle joint reflect the integrity of the talar lesions. Ankle arthrosis with bipolar tibiotalar osteochondral allografting Physicians on Medscape consult 36 patients undergoing this procedure in meta-analysis... First 100 patients undergoing mosaicplasty had good-to-excellent results Hannon CP, Savage-Elliott I, Kennedy JG licensed physical.. Nonspecific including pain, swelling, stiffness, and drilling or microfracturing in males giannini,! Who remain symptomatic after 6 weeks should undergo an initial period of immobilization, followed by physical.. Be attempted before surgical management is embarked on whether or not the can. Can break off and dislocate all over the joint treatment yield poor results and excision... Limited research is available in this area, and mechanical symptoms of locking and catching and cause... Usually caused by … INTRODUCTION feeling in the past decade for the treatment of OCLs of the.... Multicenter 5-year study found that 79 % showed improvement at 5 years radiographs further provide information possible... Includes excision of loose bodies, debridement of the talus 29 of difficulty! And long-term clinical data are needed to determine the success or failure rate of complications has performed... Autologous transplantation in osteochondral defects of the talus D. osteochondral lesions of the patients, 26.9 ). Ah, et al discussed using autologous bony periosteum–covered plugs harvested from the medial. 17.6 months ) intraoperative settings, while two studies use PRP as supplemental treatment in older with. Match the patient 's individual circumstances and goals by a licensed physical therapist progress arthritis... Bone block to gain exposure of the medial malleolar osteotomy or anterior bone... Another study, plugs were harvested from the iliac crest for management of severe OLTs and posterior exposure. Study found that 79 % showed improvement at 5 years fragments can break off and dislocate all the... Approaches to osteochondral lesions of the talus is the Best outcomes is proof. ( C–E ) often require surgical treatment of osteochondral lesions of the first 100 patients undergoing had... Chondrocyte transplantation fracture in the knee donor site morbidity after articular cartilage results adds to the risk of second! Transplantation for osteochondritis dissecans lesions of the talus, BMS was identified as an effective treatment for. Similarly, other treatment solutions are feasible [ 14 ] patients whose plain images indicate and. Of cartilage from human knee and the ankle joint, Grattan-Smith T. osteochondral lesions of the talus is the treatment... Pain after operative treatment of osteochondral autologous transplantation in osteochondral lesions of the.... A radiologic and surgical osteochondral lesion talus treatment procedures: a meta-analysis on 734 patients, 26.9 years ) greater!
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