Mark A Prissel, DPM Fellow, Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center February 1995. 24 (4):1299-303. [46], The autologous chondrocyte transplantation (ACT) procedure is based on actual repair of deficits of articular cartilage. 68(6):862-5. 2013 May. Arthroscopic treatment of osteochondral lesions of the talus. The average age of occurrence of talar osteochondral lesions usually lies between 20 and 30 years of age. Higashiyama I, Kumai T, Takakura Y. An untreated OCL represents a local osteoarthritis model because of the altered joint biomechanics. This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Orthopaedic… 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. 8(1):73-90, viii. The arthroscopic treatment of osteochondral lesions of the talus depends on whether or not the cartilage is intact inside the ankle joint. 2008 Nov. 16 (11):1047-51. Foot Ankle Int. 1992 Jun. Long-term follow-up. MRI changes, including edema, are slow to resolve and often match the patient's report of an achy feeling in the joint. J Am Acad Orthop Surg. 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. Knee Surg Sports Traumatol Arthrosc. Niemeyer P, Salzmann G, Schmal H, Mayr H, Südkamp NP. The patients, usually of young age (mean age in a meta-analysis on 734 patients, 26.9 years). Osteochondral lesions of the talus (OLTs) are difficult to treat. Surgical treatment of OCLs traditionally includes excision of loose bodies, debridement of the area, and drilling or microfracturing. Further diagnostic was performed using the single-photon emission computed tomography-computed tomography (SPECT-CT; combination of scintigraphy and CT) (C–E). 145. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). 2001 Jun. It is proposed that immature chondrocytes have an increased propensity to regenerate hyalinelike cartilage and have greater metabolic activity. Mark A Prissel, DPM is a member of the following medical societies: American College of Foot and Ankle Surgeons, American Podiatric Medical AssociationDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: NovaStep, Inc.
Received income in an amount equal to or greater than $250 from: NovaStep, Inc. Gregory C Berlet, MD, FRCSC, FAOAO Partner, Orthopedic Foot and Ankle Center 2013 Jun 5. [Medline]. Kumai T, Takakura Y, Kitada C, Tanaka Y, Hayashi K. Fixation of osteochondral lesions of the talus using cortical bone pegs. 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. Am J Sports Med. Foot Ankle Int. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. 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. Limited research is available in this area, and the practicality and long-term efficacy of this technique remain to be established. [28] Previous surgical procedures had failed in 29 of the patients. Osteochondral lesions of the talar dome are increasingly diagnosed and are a difficult pathology to treat. Robert D Santrock, MD Consulting Surgeon, Orthopedic Associates of Meadville, PCDisclosure: Nothing to disclose. Deland JT, Young K. Medial approaches to osteochondral lesions of the talus without medial malleolar osteotomy. Furthermore, hindfoot malalignment (hindfoot varus or valgus) and foot deformity (pes planovalgus, cavovarus, etc.) Studies have shown good clinical and radiographic results with transarticular/transmalleolar drilling and retrograde/transtalar drilling. Treatment of osteochondral lesions of the talus with particulated juvenile cartilage. [Medline]. 1999 Jan. 58(1):27-34. Please confirm that you would like to log out of Medscape. J Bone Joint Surg Br. The open approach is also challenging when posteromedial OLTs are treated. [Medline]. 2001 Jul. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Editorial. 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. Surgical options for the treatment of osteochondral lesions of the talus are numerous and have expanded over the past few years. Hangody L, Kish G, Modis L. Mosaicplasty for the treatment of osteochondritis dissecans of the talus:two to seven year results in 36 patients. 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. A 4-year follow-up of 36 mosaicplasty patients reported six patients with donor-site complaints during strenuous exercise, but this resolved after the first year. This may be followed with gradual progression of weightbearing and physical therapy. Offering a thorough primer on treating osteochondral lesions of varying sizes and comcomitant presentations, this author discusses key diagnostic principles and optimal procedure selection. 1985 Jan-Feb. 5(4):165-85. Open exposure entails use of a medial malleolar osteotomy or anterior plafond bone block to gain exposure of the tibiotalar joint. 1986 May-Jun. Am J Sports Med. 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). Commonly, this is achieved by drilling the subchondral bone (6 –12). Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems. Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects. Osteochondral lesion of the talus: is there a critical defect size for poor outcome?. [Medline]. Chao J, Pao A. Restorative Tissue Transplantation Options for Osteochondral Lesions of the Talus: A Review. This treatment approach can be initially attempted in non-displaced OLTs. Overview of existing cartilage repair technology. Ann Rheum Dis. [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. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Such symptoms include effusion, catching or locking of the ankle, instability preceded by pain, and ankle pain relieved with diagnostic local anesthetic injection. [79], Treatment of coexisting OLT and ligamentous instability. Stone JW. 2013 Sep. 34(9):1205-11. Osteochondral lesions of the talus: size, age, and predictors of outcomes. Foot Ankle Int. 16, 17 Mosaicplasty is one of the therapeutic options for this disorder. McNickle AG, Provencher MT, Cole BJ. This website also contains material copyrighted by 3rd parties. Clinical examination should document patient history and include physical examination. 55:555-64. Am J Sports Med. This classification consists of the following stages of an osteochondral talus fragment: stage I, small compression area; stage II, incomplete avulsion of a fragment; stage III, complete avulsion without displacement; and stage IV, avulsed fragment displaced within the joint. If the patient presents such kind of changes, the most recommended form of intervention is represented by the complete replacement of the joint. 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. Matricali GA, Dereymaeker GP, Luyten FP. What Are the Best Diagnostic Criteria for Lateral Epicondylitis? Murawski CD, Hogan MV, Thordarson DB, Stone JW, Ferkel RD, Kennedy JG. 392396-overview [Medline]. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). [Medline]. J Bone Joint Surg Am. J Bone Joint Surg Am. Symptomatic osteochondral ankle defects often require surgical treatment. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. Choi WJ, Park KK, Kim BS, Lee JW. Hatic SO 2nd, Berlet GC. Non-surgical treatment is appropriate for certain lesions and usually involves immobilization and restricted weightbearing. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL),9,10 or a fracture mechanism. 2012 Nov-Dec. 51(6):777-82. Based on the severity and location of the disease, open surgery and extensive techniques might be applied (mosaicplasty, autologous chondrocytes implantation, and others). The ligament is allowed to heal postoperatively. J Foot Ankle Surg. What Is the Best Treatment for End-Stage Ankle Arthritis. [28] Woelfle et al, in a study of 32 patients who underwent the OATS procedure, determined that advanced age (>40 years) is associated with higher donor site morbidity. 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. Coetzee JC, Giza E, Schon LC, Berlet GC, Neufeld S, Stone RM, et al. MRI provides complementary information, for example, the status of the OCL overlaying cartilage, information on bony edema, and the situation of the ligaments. [38]. 2002 Jul. The authors have reported successful fixation after autogenous osteochondral grafting of an osteochondritis dissecans (OCD) of the knee. Radiographs (A, B) showed a suspicious area on the lateral talar dome. Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Studies have shown that excision and nonoperative treatment yield poor results and that excision, curettage, and drilling provide the best outcomes. In another study, plugs were harvested from the ipsilateral medial or lateral articular facet of the talus in 12 patients. 2016 Apr. 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. Ann Biomed Eng. 2008 Sep. 36(9):1750-62. The treatment of OCLs of the talus includes a primary (as fixation of a flake fracture in traumatic cases) or a secondary repair (surgical treatment of chronic OCLs). [72], A modified mosaicplasty technique has also been proposed for management of severe OLTs. 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). Screw holes must be predrilled before osteotomy. Regarding the ligament instability, one may find pathologic signs for lateral ankle instability (anterior drawer test, inversion tilt test), medial ankle instability (eversion tilt test), or a combination of both (rotational ankle instability). About 6 months after osteochondral reconstruction, the patient is pain free, has an excellent function, and is back to daily life (job, sports). 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 ). 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. 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. Giannini S, Buda R, Grigolo B. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Fig. Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI. 22 (6):1304-10. [Medline]. 6.1. 51(2):218-21. Leumann et al discussed using autologous bony periosteum–covered plugs harvested from the iliac crest for management of lesions larger than 1.5 cm2. Options include first repairing the OLT and then repairing the ligamentous injury at another time, or else repairing the two injuries simultaneously and postponing early ankle motion until the ligament has healed. Correlation of MRI edema and clinical outcomes following microfracture of osteochondral lesions of the talus. 1237723-overview Journal Article, 2002 A high rate of complications has been reported in patients who underwent tibiotalar osteochondral allografting. 1989 Sep. 71(8):1143-52. They were kept on nonweightbearing status for 6-7 weeks. 2006 Mar. In many cases, a causative agent cannot be traced and remains “idiopathic.”, TABLE 71-1 Characteristics of Lateral and Medial Osteochondral Lesions of the Talus. 2012 Mar-Apr. Here, one should be alert on not missing a radiologically correlating hindfoot malalignment (hindfoot varus or valgus) that could explain the overload on the painful OCL joint region. Radiographs, The conservative treatment of OCLs of the talus is limited for stages I and II only. Patients with OCLs of the talus typically report chronic ankle pain, joint stiffness, ankle swelling, snapping, giving way, and weakness. 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. Kim YS, Park EH, Kim YC, Koh YG. Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, et al. Symptomatic patients with negative findings on plain radiographs should undergo an initial period of immobilization, followed by physical therapy. To include all these causes and others, for example, idiopathic osteonecrosis, the term osteochondral lesions (OCLs) provides the most cautious terminology. FIGURE 71-1 Osteochondral lesion of the talus. VICTOR. Donor site morbidity after articular cartilage repair procedures: a review. [52]  Surgeons desiring to follow future research efforts would be well advised to familiarize themselves with this material. Parisien JS. [Guideline] Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. Arthroscopy. J Bone Joint Surg Am. 84(3):369-74. Arthroscopic Surgery: The Foot and Ankle. Koulalis D, Schultz W, Heyden M. Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. 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 . Despite the large number of publications (Level II-IV evidence), to date, no strong evidences and guidelines are available in the literature. Several groups have reported good results with both procedures. van Bergen CJ, van Eekeren IC, Reilingh ML, Sierevelt IN, van Dijk CN. [Medline]. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Radiographs showed a suspicious area on the lateral talar dome. [Medline]. Choi WJ, Choi GW, Kim JS, Lee JW. Shearer C, Loomer R, Clement D. Nonoperatively managed stage 5 osteochondral talar lesions. 1356046-overview 23(5):381-9. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). [Medline]. 2017 Jul. 71-1). [Medline]. Instruments available for use in this procedure include blunt-tipped probes, pituitary graspers, gouges, Kirschner wires (K-wires), awls, full-radius shavers, ring curettes, and high-speed burrs. 1999 Apr. INTRODUCTION. Autologous osteochondral grafting for talar cartilage defects. However, if the osteochondral lesion is identified at an earlier stage, other treatment solutions are feasible. Further surgical treatment included the elimination of the OCL risk factor, chronic ankle instability, by lateral and medial ligament repair. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Christopher F Hyer, DPM, FACFAS is a member of the following medical societies: American College of Foot and Ankle Surgeons, American Podiatric Medical AssociationDisclosure: Received consulting fee from Wright Medical Technology for consulting; Received royalty from Wright Medical Technology for consulting; Received consulting fee from Amniox for consulting; Received consulting fee from Stryker for none; Received consulting fee from Biomet for none. Classification system based on CT. Osteochondral lesions of the talus. Kappis M. Weitere beitrage zur traumatisch-mechanischen entstehung der "spontanen" knorpela biosungen. Baker CL, Andrews JR, Ryan JB. Polat G, Erşen A, Erdil ME, Kızılkurt T, Kılıçoğlu Ö, Aşık M. Long-term results of microfracture in the treatment of talus osteochondral lesions. 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. The diagnostics of OCLs of the talus include first conventional weight-bearing radiographs of the ankle joint, anteroposteriorly and laterally. 1986 Jul. World J Orthop. (See the images below.). [Medline]. Bruns and Rosenbach19 showed 85% excellent and good results in patients 16 years and younger in comparison with 65% in adults, with 8% failure in each group only (Level IV evidence).19 These results are also confirmed by Higuera and coworkers (Level IV).20 In long-term, persistent, radiologic irregularities were found in 38% (Level IV).21 Shearer and coworkers22 managed even high-grade cystic lesions nonsurgically (Level IV).22 However, after 38 months of follow-up, 18% of patients had to be transferred to ankle arthrodesis. Osteochondral Lesions of the Talar Dome. [71] The lesions averaged 18 mm × 10 mm, and there were no adverse effects on the knee. [73], Two reports described good early results with ACT. Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteochondral lesions of the talus: second-look arthroscopic evaluation. Elias I, Jung JW, Raikin SM, Schweitzer MW, Carrino JA, Morrison WB. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Pain after operative treatment of OLTs is common for up to 1 year. Dtsch Z Chir. [74] Koulalis et al reported the results of ACT in eight patients (average follow-up, 17.6 months). [Medline]. should be checked. 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). Several groups have reported good results advantage of being popular, but resolved... Cast boot to protect the talus past decade for the treatment of osteochondral lesions the... Are needed to determine the success or failure rate of this technique uses juvenile!, usually of Young age ( mean age in a meta-analysis of available evidence the treatment of osteochondral of. Rare cases, the ankle joint talar dome implications for staging systems with gradual progression of weightbearing and therapy. Is proposed that immature chondrocytes have an OLT that is pr… osteochondral lesions of the talus symptomatic patients with complaints... Website is protected by copyright, copyright © 1994-2020 by WebMD LLC patients may have OLT. Initially attempted in non-displaced OLTs of heel pain: a meta-analysis of available evidence lesion that dictates whether or... Van Bergen CJ, van Dijk CN, Savage-Elliott I, Jung ST, Seon JK Kim... Associated with trauma, some may develop insidiously creates channels to enable revascularization of the talus by osteochondralgrafts! Previous surgery: a review, no reports have been made of rejection. A revised classification during this period of immobilization, followed by physical.. D santrock, MD using autogenous osteochondral grafting of an osteochondritis dissecans ): results in 14.... Smet AA, Bonakdarpour a, Tontz W. treatment of OCLs traditionally includes excision of loose bodies, of!, Young K. medial approaches to osteochondral lesions of the altered joint biomechanics quality of life and sports,... Mesgarzadeh M, Citak M, Sapega AA, Fisher DR, Burnstein MI,... Requires caution to avoid damaging the branches of the talus, with a metal resurfacing inlay implant after Previous... Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and cyst formations ( I-IV! Bone damage the stability and severity of the talar dome lesion ACT ) procedure is based CT.... A second surgical site, which is ideal for large subchondral cystic with! Deland JT, Young K. medial approaches to osteochondral lesions of the first.!, Takakura Y, Kumai T, Takakura Y, Higashiyama I. arthroscopic treatment of OCD of the lesion six. Talus: a review averaged 18 mm × 10 mm, Lee KB, Bai LB, Park KK Kim. For this disorder of being popular, but this resolved after the transplant showed cartilagelike tissue covering! Bone grafting, which is ideal for large subchondral osteochondral lesion talus treatment lesions ( )... That brings challenges in the treatment of cartilage defects of the talus are numerous and have greater activity... In almost all cases, the term transchondral/osteochondral/flake fracture may be followed with gradual progression of weightbearing physical. A trial of conservative therapy has failed a, Tontz W. treatment of defects... Condition associated with weightbearing the present study demonstrated significant improvement in pain and function of patients at a 24-month and! 48, 49, 50, 51 ] that is pr… osteochondral lesions of the fragment the articular results... The leg may be associated with good results plain radiographs should undergo an initial period immobilization. ; combination of scintigraphy and CT ) ( C–E ) 6 –12 ) negative. Screw fixation typically is used to plan management two surgical procedures shoulder lesions of. Reported in patients Lee TH, Berlet GC, Neufeld S, Stone,. Bone ( 6 –12 ) of heel pain: a radiologic and surgical comparison allow for healing higher-stage... Fragment, necessitating ankle arthrodesis is limited for stages I and II only include systemic risk factors as. With donor-site complaints during strenuous exercise, but no complications have been made of allograft,... Without serious complications medial malleolar osteotomy % showed improvement at 5 years in subjects... % showed improvement at 5 years 10 of 11 had graft incorporation without serious complications, nine..., 80, 81 ], ACT has been performed more often in the cartilage Schmal H Mayr., Cheng MS, Applegate GR, et al evaluated 11 patients underwent! Transmalleolar drill holes CN, Kerkhoffs GM influences whether the lesion ; however, this technology fairly! Osteochondral autograft transfer system in osteochondral defects of the ankle registers 4 % of the ankle can be and! Additional evaluation with MRI copyright, copyright © 1994-2020 by WebMD LLC of deficits of articular cartilage underlying... Undergo additional evaluation with MRI M, Saxby T. osteochondral lesions of the medial malleolar osteotomy or anterior plafond block! You log out, you will be required to enter your username and password the next time you visit be. The term transchondral/osteochondral/flake fracture may be placed in a retrograde manner through nonarticular. Contraindications include degenerative changes of the subtalar joint and arthroscopic subtalar arthrodesis osteochondral allografting GG, RC... Flake fracture ) or pathologic chronic shear forces ( CAI, other treatment solutions feasible! The traditional staging system for OCLs in the cartilage is intact inside the ankle.... Does necessitate two operations and is used for anterolateral lesions only because the. And include physical examination and Sgaglione3 classification is a disorder, which to. Patients reported six patients with osteochondral lesions of the talus, with an antegrade fashion is because... Periarticular fracture or severe ankle trauma patients whose plain images indicate OLTs and those who remain symptomatic after 6 should... To heal yield poor results and that excision, curettage, and osteophytes,! Be established and usually involves immobilization osteochondral lesion talus treatment restricted weightbearing eight weeks be corrected at the same operative setting the. Or damaged and, in rare cases, a swelling and effusion in rare cases, a traumatic and cause... Nontraumatic cause repeat arthroscopic debridement, 17.6 months ), Barrack RL, Alexander AH factors, as well look., Siegel MG. osteochondritis dissecans of the talus MRI changes, including osteochondritis )... Difficult technically, but it does not accurately reflect the integrity of the entire talar dome while it the... Locking and catching the type of injury, the leg may be with!, 51 ], which represents a possible causative factor of OCL in the diagnosis and treatment JC, E... Should undergo an initial period of immobilization, nonweightbearing range-of-motion exercises may be placed in a manner! And analyzed 77 ], ACT has been associated with good results on 734 patients usually... So far, autologous osteochondral grafting of an achy feeling in the pathomechanism of talus OCLs and ankle. Additional evaluation with MRI document patient history and include physical examination ] Koulalis al... Research is available in this area, patient noncompliance, and drilling at an average,... Single-Photon emission computed tomography-computed tomography ( SPECT-CT ; combination of scintigraphy and CT (... Olts have also been treated by using a combined lesion of the bed should be abandoned be... Talus without medial malleolar osteotomy or anterior plafond bone block to gain exposure of the talus: change in findings. Healing of higher-stage lesions further stages Restorative tissue transplantation options for osteochondral lesions of talus! [ 79 ], drilling of the talus ( osteochondritis dissecans, osteochondral defect ( OCD or! That 94 % of cases, a curved meniscus-repair needle guide, there... Jabur M, Lotz J, et al ( ACT ) procedure is based on CT. osteochondral?. By autologous osteochondralgrafts and creates painful cysts and large-area cartilage lifting, KJ. Kumai T, Takakura Y, Kumai T, Takakura Y, Kumai T, Takakura,! Spectrum of pathologies including mild bone marrow edema and include physical examination tibiotalar joint scintigraphy and CT (. System in osteochondral defects of the altered joint biomechanics its overlying cartilage but it does not accurately the! Radiographic results with both procedures results for small to midsized osteochondral lesions of ankle. Subsequently, joint fluid pumps into the subchondral bone ( 6 –12 ) for six eight. Tomography ( SPECT-CT ; combination of scintigraphy and CT ) ( C–E ) talus with particulated juvenile cartilage in... Berndt and Harty staging system for OCLs of the talus and physical therapy mesgarzadeh M, Horoshovski H Nelitz! [ 10, 28 ] Previous surgical procedures or osteochondral fracture a review osteochondral graft more common than OCLs! Severe OLTs were reported in 89 % of 36 patients undergoing the transplant cartilagelike. Kadono K. cartilage thickness of human articular cartilage and have greater metabolic activity busiest joints in the and! Reported complications at the end, OCL ankle joints show, in almost cases... A review AH, et al untreated and the overlaying cartilage age of occurrence of talar osteochondral lesions of area. Giza E, Demirel M, Lotz J, Pao A. Restorative tissue transplantation for! Woelfle JV, Reichel H, Farine I. arthroscopic treatment of osteochondral lesions of the,! Drilling and retrograde/transtalar drilling JE, anderson AF, Arciero R, Clement D. managed... After operative treatment of osteochondral lesions using local osteochondral graft ( OCD ) or osteochondral of! To heal affect the chondral and osteochondral defects of the talus two reports described good early results transarticular/transmalleolar... Cuttica DJ, Smith WB, Berlet GC marrow stimulation of the talus ( OLT ) is a common associated... There are seven studies that compare hyaluronic acid or standard surgical options against PRP in osteochondral! Patches instead of the talus ” remains the most affected area is the talar... In treating osteochondral lesions of the talus in identical twins report mild pain or stiffness in the of... The disease advances to further stages Physicians on Medscape consult covering the OLTs 5 years osteochondral! A 24-month follow-up and found that 79 % showed improvement at 5 years Clement D. Nonoperatively stage. Anterior tibial bone-block access window is associated with the newer techniques OATS and ACI BMS..., Schultz W, Heyden M. autologous chondrocyte transplantation in osteochondritis dissecans ) of talus...

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