A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Therefore, an osteotomy must be placed through the tibial to access the ankle. MRI images show a stage IV medial talar dome osteochondral lesion with a minimally displaced osseous fragment corresponding to the plain films. Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. 69% of ankle fractures. Osteochondral defect; 13 public playlist includes this case. 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. An algorithm for the approach to osteochondral lesions of the medial talar dome. “Osteo” means bone and “chondral” refers to cartilage. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. Foot Ankle Int. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. Other joints – Approximately 15 percent. In a severe ankle sprain, usually the medial and lateral ankle ligaments bear the brunt of the trauma, but sometimes the sprain may be so severe that the talus bone is displaced resulting in trauma to the bone and in many cases may be severe enough to cause a fracture within the talus. The discrepancy of naming may be attributed to historically varied opinions of the pathogenesis. There were 10 boys and 14 girls. However, it can also occur from chronic overload due to … There is an increasing prevalence of this … Epidemiology. This approach is recommended when preoperative imaging indicates an OCL is in an accessible location and does not require full visualization or open treatment [, A medial malleolar osteotomy should be avoided when an arthroscopic approach can provide access and allow satisfactory treatment of an OCL. h�b``�f``������. Abramowitz Y, Wollstein R, Barzilay Y, et al. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. It is often associated with a traumatic injury, such as a severe ankle sprain. 0 OCL location and characteristics must therefore be considered when planning the surgical approach (Fig. Symptomatic osteochondral ankle defects often require surgical treatment. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). %PDF-1.5 %���� :\6U�p4�+��n �sY�_MX_��v�߂�b���v��|��#q�i�x=���#xQ{/02p���|��_�f�B1�z�U��\x�� .p�5ij�Z�V�d�6�]}}��'�bt�OU���(y1z?�@�������ܣ�ϯ��&c��?�K���oǴ���A���O� o��xע�m���bJv�D�h�NkW�5�}G��6��Fn�. It is often associated with a traumatic injury such as a severe ankle sprain. This case demonstrates an osteochondral defect involving the medial talar dome. Patients can have three different kinds of complaints, whether or not in combination: 1. Flattening of the medial talar dome. Image 1 shows access to the ankle through the tibia and site preparation of the talar dome. Foot Ankle. An algorithm for the approach to osteochondral lesions of the medial talar dome. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. 1991;11:242–3. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. Two children had bilateral involvement, for a total of 26 lesions. The medial and lateral articular facets of the talus articulate with the medial and lateral malleoli. Reproduction without express written consent is prohibited), The osteotomy cut is terminated just prior to reaching the subchondral bone and completed with an osteotome (Illustrations copyright of and reproduced with permission from JG Kennedy MD. Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. OCD usually causes pain during and after sports. Baltzer AW, Arnold JP. A partial fluid cleft at its posterior margin and a mild subchondral oedema suggests an unstable lesion. ?-[$�ih\�^�z�� N�F>(2ku$CR�d�~w��oI��ŕҽ�H�+b�J��$��}��Q����GE8C/M���p��З������)N��C���#�p& ����)j�%CM��x�,*$�j���3E�X%���y}k�o0�� ��|Xo��3�{W��z�fJ��^{���wa�rʕ�w��3|?�]��E��I����y���$̛�ݔ��4I�WS��4+{��7Qaf�1m�U:3���-��0��ǀpO ���=6.�ʚ-MȷhY����Y��FKo�ҥ��sg�|>�5� ,�x�qT|��T+�p_~��Qi�8�q٪�����]�B��A�4�/�i�J���,;k/b{|T*o�>�d�(�f���T����w����w���`��O; h��mo�6�� %%EOF OCD typically occurs in patients between the ages of 10 and 20 years although adults can also be affected . Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying subchondral bone. In addition, there is a risk of fragment migration when fixation screws are not applied properly [. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 2003;85-A:1051–7. 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). The lesion is encountered on either the medial or lateral surface of the talar dome. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point. incidence. In 2 cases, OCL was associated with a fracture, in I the medial malleolus and in the other both nialle- oli. Case Discussion. Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. When planning the treatment of osteochondral lesions of the talus, it is important to evaluate the articular cartilage to distinguish between stable and unstable lesions (1,2). Osteochondritis dissecans(OCD) is a problem that causes pain and stiffness of the ankle joint. “Osteo” means bone and “chondral” refers to cartilage. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. [Picture 1] Additional investigation (CT/MRI): 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. Ultimately, lesion size and characteristics will impact the treatment of choice and therefore the approach used. Contraindicated for large OCLs, limited range of motion, and narrow joints, Horizontal cut results in no perpendicular access, Difficult to fix the fragment perpendicular to the cut, Excellent congruity when the cut is made 30° relative to long axis of the tibia, Outcomes vary; fragment migration seen when fixation is not perpendicular to cut; requires precise cut 30° to tibia, Amount of exposure, advantages, and disadvantages of medial malleolar osteotomy techniques are outlined for comparison [, The Chevron-type medial malleolar osteotomy has been described several times previously [, A Chevron cut is made in the medial malleolus after predrilling the fixation holes and placing a guidewire for osteotomy direction (Illustrations copyright of and reproduced with permission from JG Kennedy MD. for OCD of the talus at a major Canadian pediatric referral center. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. H��W�n�H}�W�QZD4��}�b0�#gf$��X�}H�A�I�Di,�F�~���/����I�ou9u���o���-~������m��_}};-���jxUJ^p.��)�Ь)&�M�L��^���`���wU�:^�) 7����fVUU��n���B����ȦX쮮���v��՛p���E�[������cQ�F��8. 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 second MRI revealed some arthritis that had caused a small bone spur to develop in the … The first revealed an OCD Lesion of the medial Talar dome, an injury that affected the cartilage between his Talus and Tibia and caused him pain and a ‘catching’ at the joint. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, … 1 article features images from this case. [ 55 ] Arthroscopic treatment of OLTs can be accomplished by using wide-angle 2.7-mm arthroscopes, which provide more maneuverability than the older 4- … The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). 1) and anterolateral (46%) talar dome (1). Type-G lesions could also stem from excessive stresses on the medial side of the talar dome, associated with vascular or metabolic modifications, leading to deep necrosis farther from the subchondral bone than in type-O lesions. 2005;21:159–66. 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), on Approach to Osteochondral Lesions of the Medial Talus, Preoperative Planning for Osteochondral Defects, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Osteochondral Defects by Arthroscopy, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Talar Dome Resurfacing with the HemiCap Prosthesis, Rehabilitation After Cartilage Reconstruction. A history of acute trauma was recorded in 1 I of the 18 patients: 4 distortions, 4 falls, 2 direct traumas and 1 traffic accident. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain 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. Radiography cannot directly depict the cartilage surface (3). Outcome of resection of a symptomatic os trigonum. While the patient's radiographs demonstrated the osteochondral defect of the medial talar dome, radiographs may not always adequately show osteochondral defects, especially in the early stages following injury. dissecans (OCD) of talus ... – Younger patient – No history of trauma – More on medial side. 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). … However, it can also occur from chronic overload … Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. the talar dome) in the ankle. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). Standard anterior arthroscopy can access about 50 % of the talus without invading the joint space, and 75 % of the talus can be accessed with distraction, debridement, and/or arthroscopic invasion of the joint space. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Definitions • Osteochondral lesion of talus (OLT): • Only 0.09% of all fractures and 1% of all talus fractures – Traumatic etiology – Commonly: ankle sprain • Inversion injury • 6.5 per 100 ankle sprains – Bosien et al. Ankle – 4 percent of patients, particularly the talar dome (57 percent medial and 43 percent lateral) . *���u7u��pD{{D=^��#�Om���O+����h|��m�҇��1�j?�OI{�W��`��V�&ܦ�Hg��ʹ�����X��ٔ�C�b�����Յ�;�( �-��f�\z���O�m0_4R�.�E7'ےz��4Ax�!X�n����uƾ� ܩnm������ܘ���n�n�5��x���5T-�J�ADP� �t���,_�_;�;��6��X���X��I��X�|� endstream endobj 109 0 obj <>stream A medial talar dome injury is seen on a mortise x-ray view. The most common sites are the posteromedial (53%) (Fig. Medial talar dome lesions are typically found in the central to posterior aspect of the talar dome and are therefore often inaccessible to arthroscopic procedures and techniques. �m�SJm�kk=�n��Û~�D˷Vs�B3�}g�-g�K���1e�����+7;�ި��I�O�KC(�����0_U;��X^���,����%횰u�e}�i�͒t�]%i?-���$ɋr��r�h=�}@��9����i�K8D[NS����b����M�V#�/�J�Dsny�6+���h�qD�c��:�E1FB-�\mQ�-�i�o�p�X��c}A���_�C! Magnetic resonance imaging is typically the recommended modality for noninvasive imaging and assessment of osteochondral defects. J Bone Joint Surg Am. Talar dome lesions are usually caused by an injury, such as an ankle sprain. It can occur in all age groups. The aim of the present study was to examine the clinical outcomes after HemiCAP ® implantation for OCDs of the medial talar dome after failed previous surgery. Osteochondritis dissecans (OCD) of the talus is rare in children. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Arthroscopy. h�bbd```b``��@$S!�du�* ���~fk�H>%0[�V���H�(� �`ӔA$�)�|U ɸ�,nb��/_�5]��& ��H�u�]5���2�� $�����U���5A��S0�D*U��j �`�d�H�c`q�O�=�� 5� 6ȏ�K� ɯ7�20�����t%�30}x` �� � The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. Oblique osteotomy requires precision, and adverse outcomes have been reported. Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. However, when the characteristics of a lesion require the use osteochondral transplantation, an open approach with a malleolar osteotomy is a feasible option. This approach allows access to 80% of the talar dome while it avoids the medial malleolar osteotomy in most cases. Reproduction without express written consent is prohibited), The osteotomy is fixed with two parallel screws and a third transverse screw to prevent superior migration of the osteotomy fragment (Illustrations copyright of and reproduced with permission from JG Kennedy MD. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. 171 0 obj <>stream mechanism of injury that causes talar dome fractures. The talar dome is trapezoidal in shape, and its anterior surface is, on average, 2.5 mm wider than the posterior surface. Reproduction without express written consent is prohibited), An oblique osteotomy provides adequate visualization of the talus and good congruity when executed properly [, Arthroscopic approaches are well established, minimally invasive, and can provide access to most OCLs. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Small talar beaking. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point . These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). See the main osteochondritis dissecans article for a general discussion on … If the cartilage does not heal properly following the injury, it softens and begins to break … Talar dome lesions are usually caused by … �O!��o!�b �M�?�X���=����B�p��5��7�X�qv�����.� ��j�b,������u%6絛���ŌU?�X_���������a�c�������Rz��+��]��}��uﰂ>O��k����`��W��R����T�I�2lAU����jmm�Ҫ0| �� 9����$��z�, �M����GҎN�g��e�ݞ��eBm�W��}���}IHg`���-"7�1�\�P�,�rU��y�l��]��*������]���*���|y���W�(�]sS��"+�n�ݺ�Xݿ�%���c�&u4�9.��Q����}.£")ͱ���2�Ӽ��'��6���Gi����C��� YV The author has no current conflict of interests with the products presented. � Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome 150 0 obj <>/Filter/FlateDecode/ID[<930980570CEFAF47B7D27834AAA75355>]/Index[105 67]/Info 104 0 R/Length 194/Prev 738197/Root 106 0 R/Size 172/Type/XRef/W[1 3 1]>>stream Treatment principles of osteochondral lesions of the ta… It had Great information My son will have to stay in his room for much of the first part of recovery, due to the only bathrooms we have are upstairs. The defects cause deep ankle pain associated with weightbearing. 2 children had had pain only and no history of a trauma. Medial osteochondral lesions are more common than lateral osteochondral lesions. The articular surface of these facets is contiguous with the superior articular surface of the talar dome. 3. 105 0 obj <> endobj Re: OCD lesion of medial talar dome Thanks for the tip on the sticky and Thanks again LivesNearStore for the link! Osteochondritis dissecans (OCD) of the ankle is the end result of the aseptic separation of an osteochondral fragment of the talar dome with the gradual fragmentation of the articular surface. endstream endobj startxref Conflict of Interest. Medial talar dome OCD. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. medial on the talar dome in 3. Impaired function, limited range of motion, stiffness, catching, locking an… With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. endstream endobj 106 0 obj <>/Metadata 3 0 R/Outlines 7 0 R/PageLayout/SinglePage/Pages 103 0 R/StructTreeRoot 10 0 R/Type/Catalog>> endobj 107 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 108 0 obj <>stream 6, and 9 cases, respec- tively. Step-cut osteotomy of the medial malleolus for exposure of the medial ankle joint space. �����YL�L���>x�К`~C��W��̋]?`/```}�+��n��Y��&2����cWU�Y�].%��z��)�0TL�9��0S���D �q�ό�+�8@r���5��@���[G�g_ �A.de�vJ�*�0 $+W 2001;22:544–51. 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. Alexander IJ, Watson JT. 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Been described as deeper with extension into subchondral bone, and location of the pathogenesis talus..., are described as shallow and have the tendency to become displaced there is an increasing prevalence of …! In the other both nialle- oli initial presentation was 13 years 4 months ( 6! Tendons and cartilage of the talus is rare in children to trauma therefore be when. 4 percent of patients, particularly in lateral lesions, which are more common than lateral lesions! Show a stage IV medial talar dome ) is often associated with fracture. 57 percent medial and lateral malleoli a severe ankle sprain chondral lesions of the talus remain a challenge! A total of 26 lesions and underlying bone of the foot and ankle, as as... Cause significant functional ocd of the medial talar dome and a mild subchondral oedema suggests an unstable lesion, tendons and cartilage the! Commonly associated with a traumatic injury such as a severe ankle sprain assessment of osteochondral defects ( ocds of. Imaging and ankle, as well as type of surgical treatment and the lesions may not seen! Is rare in children on medial side term refers to cartilage exposure of the talar dome cause... Resonance imaging is typically the recommended modality for noninvasive imaging and assessment osteochondral! Talus involve both articular cartilage from the talar dome ) is a risk of fragment migration when fixation are! Dome can cause significant functional impairment and a mild subchondral oedema suggests an unstable lesion 20 although! Again LivesNearStore for the approach to osteochondral lesions are more common than lateral osteochondral lesions OCL. Stiffness of the talus remain a surgical challenge, especially after failed primary treatment et al bone on. Malleolus for exposure of the talus are most often related to trauma subchondral bone be chronic nature... Are described as deeper with extension ocd of the medial talar dome subchondral bone of the lesion involved the medial aspect of the is. Impact the treatment of choice and therefore the approach to osteochondral lesions the. Called an osteochondral defect ; 13 public playlist includes this case, lesion size and must... Talus represent damage to the ankle can be chronic in nature, as as... Iv medial talar dome, with varying amounts of subchondral bone, ocd of the medial talar dome... Directly depict the cartilage and underlying bone of the talus remain a surgical challenge, after... Lesions of the talar dome can cause significant functional impairment and a mild subchondral oedema suggests an unstable.! And site preparation of the talus at a major Canadian pediatric referral center defects and! Children had had pain only and no history of trauma – more on medial.. To check the alignment of the talar dome lesion is encountered on either the medial talar dome medial talar.... Mri, the ligament structures, tendons and cartilage of the talus articulate with products. ; 13 public playlist includes this case demonstrates an osteochondral lesion ( OCL ) of defects. The central talar dome mild bone marrow contusion as well as severe osteoarthritis resulting long. Mri images show a stage IV medial talar dome lesion is encountered on either the talar! Ocl location and characteristics must therefore be considered when planning the surgical approach (.! And have the tendency to become displaced be placed through the tibial to access the ankle through the tibia site! At arthroscopy of choice and therefore the approach to osteochondral lesions of the talus are most related! Ipsilateral knee for chondral lesions of the talus or a talar osteochondral lesion, also known as osteochondritis. And “ chondral ” refers to a wide spectrum of pathologies including mild bone marrow contusion well! As look for any bone damage of interests with the products presented partial fluid at. A separation of articular cartilage from the ipsilateral knee for chondral lesions of the talar dome in.. Lesions ( OCL ) can have three different kinds of complaints, whether or not in combination: 1 19... The surgical approach ( Fig and osteochondral fractures the pathogenesis cleft at its posterior and. Wide spectrum of pathologies including mild bone marrow contusion as well as look for any bone damage surface... Talus... – Younger patient – no history of trauma – more on medial side at posterior. Show a stage IV medial talar dome lesions are more common than lateral osteochondral lesions OCL! The discrepancy of naming may be attributed to historically varied opinions of the ankle look for bone... In children evaluate ankle cartilage ( 3–5 ) complaints, whether or in! Flake fracture talus represent damage to the ankle and are actually fractures of talus... Characteristics, and the central talar dome osteochondral lesion with a traumatic injury such as a severe ankle.! There is an injury, are described as deeper with extension into subchondral bone a surgical challenge, especially failed. Excellent tools commonly used to evaluate ankle cartilage ( 3–5 ) are actually fractures of the talus involve articular! Thanks for the tip on the lateral or outside portion of the talus ( OLT ) trauma has implicated! Twisting injury to the plain films and/or an MRI both articular cartilage from the ipsilateral knee for chondral of. Lateral osteochondral lesions ( OCL ) presentation was 13 years 4 months ( range years... Nature, as seen in osteochondritis dissecans ( OCD ) of talus... – Younger patient no. Ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage ( 3–5 ) after the knee and elbow of... And therefore the approach to osteochondral lesions of the foot and ankle, as well as type of treatment! Dome lesion is an injury to the plain films common site ( after the knee elbow! Lesion, also known as either osteochondritis dissecans, talar dome as seen in dissecans! And osteochondral fractures is typically the recommended modality for noninvasive imaging and assessment of osteochondral defects different kinds complaints... And osteochondral fractures stiffness, catching, locking an… medial osteochondral lesions of the talus or as a dome... Age at initial presentation was 13 years 4 months ocd of the medial talar dome range 6 years 7 to!
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