unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV Delaying surgical intervention for chronic OCD does not appear to alter results of later surgery. [ 2 ] Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. 6,51 This cartilage is cultured to grow chondrocytes, which can be viable for longer than 1 year. - James Stone, MD, Evolving Technique: The Role Of Osteotomy For The Treatment Of Osteochondral Lesions Of The Talar Dome - Listen Up!- Phinit Phisitkul, MD, MACI & Newer Techniques: I Told You This Before: Wake Up Everyone! Limited by the amount of donor tissue that can be harvested, Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect. Osteochondral lesions of the talus and the role of ankle arthroscopy. It can occur in all age groups. Osteochondral lesion (OCL) is a term used to describe an injury or abnormality of the articular … The mean time of follow-up was 36 months (range, 25-49). In the ankle OCD can occur anterolateral or posteriomedial. The average age at surgery was 22.7 years (range, 19-34). Osteochondritis dissecans can be classified at surgery into 4 stages: stage I. stable; lesion in continuity with the host bone; covered by intact cartilage; stage II. • Complete fragment detachment but not displaced. INTRODUCTION. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain Read More, Copyright ©2007 Lippincott Williams & Wilkins, > Table of Contents > Osteochondral Defect of the Talus. Radiography cannot directly depict the cartilage surface (3). Make sure the patient does not have other. Osteochondral lesions of the talus. OCD of the talus usually occurs in patients aged between 10 and 40 years, and it peaks in the second decade of life. 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. 1) and anterolateral (46%) talar dome (1). The authors of this study have since published the clinical outcome of one case with good improvement in functional scores and return to sports after one year. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. For patients with CAI accompanied by talus … Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): Osteochondritis dissecans(OCD) is a problem that causes pain and stiffness of the ankle joint. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. “Osteo” means bone and “chondral” refers to cartilage. The top of the talus is dome-shaped and is completely covered with cartilage (connective tissue that allows the ankle to move smoothly). Brostrum), medial malleolar osteotomy for medial and posterior lesions, longitudinal incision centered over medial malleolus, flexor retinaculum released posteriorly; PTT retracted posteriorly, osteotomy guided based of 2 parallelly placed K-wires, with goal to enter plafond at lateral extent of OLT, prior to osteotomy, 2 drill holes placed to aid in reduction following procedure, sagittal saw and osteotome used to complete osteotomy, care taken not to cause thermal necrosis to bone or damage cartilage, lateral malleolar osteotomy or ATFL/CFL release for lateral lesions, longitudinal incision centered over lateral malleolus, oblique osteotomy planned, with predrilling of small fragment screws holes to aid in reduction following procedure, alternatively, if lateral ligament reconstruction is planned, extensor retinaculum may be released, peroneal tendons retracted posteriorly and ATFL and CFL released, ankle inverted and plantarflexed to expose talar dome, OLT debrided and measured using sizing guide, appropriately sized autograft may be harvested from knee and placed into OLT, impacted gently into defect, OATs harvested from the knee have a cartilage thickness less than the native talus, this will cause immediate post-operative xrays to show a prominent graft despite the cartilage surface being flush, do not release deltoid ligament as may jeopardize deltoid artery blood supply, ankle impingement if graft plug left proud, small percentage of patients do not achieve pain relief regardless of treatment, Posterior Tibial Tendon Insufficiency (PTTI), lesions may progress to involve entire ankle joint, mechanical symptoms such as catching or locking, arthroscopic harvest of chondrocytes (from ankle or alternatively from knee) are sent for cultured growth, open approach via osteotomy for implantation, debridement of lesion to create stable cartilage rim, subchondral bone exposed, bone graft may be placed if underlying cyst and bone loss, periosteum from tibia taken and fitted to defect, this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect, water-tight seal confirmed, cultured chondrocytes placed under flap and suture placed, fibrin glue placed over defect, newer technique of matrix-based chondrocyte implantation (MACI) shown equivalent outcomes to ACI and may obviate need for osteotomy. The lateral injuries to the Talus (ankle bone) are usually shallow and cup shaped. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. The coronal plane of the MRI demonstrates anteromedial lesions of OLT, Hepple stage 1 and 2A in figure 2A, and 2B (arrow), respectively. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment Traumatic chondral defects, on the other hand, are often related to shear. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. Fig. What would be the next most appropriate step for treatment? Stage 1 • Cystic lesion within dome of talus with an intact roof on all view: Stage 2a • Cystic lesion communication to talar dome surface: Stage 2b • Open articular surface lesion with the overlying nondisplaced fragment. Loomer R, Fisher C, Lloyd-Smith R, et al. Osteochondritis dissecans (OCD) of the talus is a disea-se affecting the subchondral bone and secondarily the articular cartilage. KEY FACTS • The natural history of osteochondral lesions of the talus appears to be fairly benign, especially as it relates to the risk of the development of arthritis. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). The most common sites are the posteromedial (53%) ( Fig. Tested Concept, Increased incidence of traumatic etiology, (OBQ06.213) We'll assume you're ok with this, but you can opt-out if you wish. The average age at surgery was 22.7 years (range, 19-34). Osteochondral defect (OCD) or lesion of the talus can accompany chronic lateral ankle instability (CAI). Physical therapy and NSAID's have not alleviated the symptoms. Physical examination elicits pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal. The ankle is the third most frequently affected site, after the knee and elbow, and it accounts for 4% of all OCD cases (1, 2). Die Osteochondrosis dissecans (kurz OCD bzw. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). Sie kann die meisten Gelenke des menschlichen Körpers betreffen, sie tritt aber vor besonders häufig im oberen Sprunggelenk … Osteochondral lesions of the talus. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Procedures that transfer hyaline cartilage to the defect: OATS/mosaicplasty, allograft transfer, Generally recommended for large lesions or lesions that fail other forms of treatment. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Stage 2 - partially attached osteochondral fragment / flap . When compared to medial talar OCDs, which of the following statements is true regarding lateral talar OCDs? All Rights Reserved. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. 3rd-generation techniques rely on a 3D bioscaffold to contain the cells instead of a periosteal flap (, Short-term clinical results generally are. Letts M, Davidson D, Ahmer A. Osteochondritis dissecans of the talus in children. Es verbleibt dann ein Gelenkflächendefekt (Mausbett). 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). Table 3. If a lesion is seen on plain radiographs, Best method for accurately characterizing the size and extent of a defect, Tends to overestimate the size of a lesion because of bone marrow edema. Giannini S, Buda R, Grigolo B, et al. It is uncertain whether these OLT or conventional OCD (best studied in the knee) represent differ-ent manifestations of a common pathologic process or sepa-rate pathologies. With proper treatment, the prognosis generally is good. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of … © 2020 - TeachMe Orthopedics. A 30-year-old professional ballet dancer presents with persistant ankle pain after an ankle sprain 6 months ago. Examine for crepitus or mechanical signs with ankle ROM. The area where OCD occurs is located at the top of the talus. He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. The most common sites are the posteromedial (53%) (, Most classification systems are based on lesion descriptions by Berndt and Harty (, Stage 2: Partially detached osteochondral fragment, Stage 3: Detached but stable/nondisplaced osteochondral fragment, Stage 5: Subchondral cyst (added by Loomer et al.) Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. These lesions are of high clinical relevance as they are commonly missed … ACI is a 2-stage procedure in which hyaline cartilage is harvested from the anterior aspect of the talus or a nonweightbearing portion of the knee in the first stage. Bony fragment may - revascularise & unite - undergo AVN & not unite . Any procedure that requires an osteotomy necessitates nonweightbearing until the osteotomy heals (4–8 weeks). Complications include malunion or nonunion of an osteotomy, persistent pain, stiffness, and arthritis. 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