osteochondral lesion ankle treatment

MRI is the best imaging modality to detect evidence of high fluid pressures surrounding lesions, which manifest as high signal intensity around the lesion and bone marrow edema on fat-suppressed images. These findings have been considered evidence of instability, which has been used as an operative indication; however, no clear correlation exists. Surgical treatment of talar OLTs includes: Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. Where small defects in the subchondral plate exist, repetitive loading from normal weight-bearing activates forces the synovial fluid under high pressure into the subchondral bone, which over time creates a cyst.5,6 Cystic lesions may also be seen with apparently intact cartilage. Advertisement . 63, in a meta-analysis on the use of ACI/MACI for the treatment of osteochondral lesions of the talus, analyzed the data for 213 patients who had nearly 3 years of follow-up and a mean lesion size of 2.3 cm 2. Treatment depends on the severity of the talar dome lesion. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. These cartilage flaps have been recently called chondral-separated lesions, in contradistinction to osteochondral-separated lesions.4 This latter type of lesion is more commonly referred to as an osteochondral fracture and may have a better chance of forming fibrocartilage because of its retained blood supply from the subchondral bone. 1 T2-weighted coronal image of an osteochondral lesion of the talus with subchondral cyst formation. 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. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. It is often associated with a traumatic injury such as a severe ankle sprain. Several imaging specific classification systems have been developed with this goal in mind. 106,120. This finding can be explained by a similar mechanism in which the subchondral plate is fractured and the fluid content of the cartilage is exsanguinated and forced into the subchondral bone with repetitive weight-bearing pressures. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 2018;3: 247301141877955 [Google Scholar] Chao J, Pao A. Restorative tissue … endstream endobj startxref Sometimes this synovitis is more symptomatic to the patient than the lesion itself. Fibrocartilage is the natural repair and physiologic alternative. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). The diverse treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology. MRI has gained popularity in its ability to delineate both the cartilage and bone extent of the lesion in addition to associated soft tissue pathology. These features should be noted and may offer clues as to the physiologic process and appropriate treatment (Fig. Partial-thickness or full-thickness flaps of cartilage that have separated from the underlying subchondral bone are created through shearing forces and are not amenable to being left alone to repair themselves because of lack of blood supply. Treatments for lesions in the knee are more challenging, but also have promising outcomes. This is performed through two small incisions on the front of the ankle. Surgeons are cautioned that MRI may exaggerate the extent of osseous involvement in OCLs. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. 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). Talar dome lesions are usually caused by an injury, such as an ankle … Partial-thickness or full-thickness flaps of cartilage that have separated from the underlying subchondral bone are created through shearing forces and are not amenable to being left alone to repair themselves because of lack of blood supply. “Osteo” means bone and “chondral” refers to cartilage. The treatment strategy for osteochondral lesions depends upon the location and lesion size. Lateral lesions lack this inherent advantage and may have less-predictable outcomes. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. h�bbd``b`�@����� %%EOF • Osteochondral lesion • Talar dome lesion • Ankle • Arthroscopy. Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. A basic knowledge of cartilage anatomy and physiology helps in understanding of the goals, mechanism, and limitations of arthroscopic treatment of OCLs. The vast majority of patients experience no pain or swelling even 10 years after surgical treatment of such lesions in the ankle. By doing this, the bone defect is treated without causing any damage to the overlying cartilage. Where small defects in the subchondral plate exist, repetitive loading from normal weight-bearing activates forces the synovial fluid under high pressure into the subchondral bone, which over time creates a cyst. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. When the latter is present, then joint replacement is often the only feasible treatment. Osteochondral lesions (OCLs) of the ankle represent a host of pathologies, from subtle chondromalacia to full-thickness defects with underlying cystic changes and osteonecrosis. For small sized defects if the overlying cartilage is intact, then retrograde drilling of the defect is done and the space is filled with bone cement. Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. “Osteo” means bone and “chondral” refers to cartilage. In 1995, Ferkel and colleagues13 introduced a more elaborate system that included stages A through F, in which A through C describe worsening grades of cartilage wear and stages D through F describe progressive lifting, detachment, and displacement of the fragment (Box 1). The most common surgical procedure for an osteochondral lesion is an arthroscopic exploration and treatment. G"��թH���⩄4Q,R-���4Jj+R#T��H��aV�ߝ��I��Bk��Q$t"1[$��ơ��N 捴�%&��?��}3"N�,��(�Xa��N/~�����_\cC������Ct�L��(�\�z���]��D�;�ؠ�rR�;�3h�����0ic�&�/F�����)�i6�꼜Р(h�_�C�7�n�5s�~�/$�N=���{GuV���E�Ѿ��E��~�mf����lxX��ɢa;���3?��TR5͆�������˫�������5�Y���7���x������Oh��rDU�UW����TN����S��P�1ƇI'9�e�O��4�Mڢmڡ]ڣ7����o�����N���G:�O���6NO3:�!���%]QN��oTИ&TҔ�ӌ*�iN��'��-�E~2b���E�k�K8{�~��S��9��~R+me�7�u�$)���絊%��eŁ+mBbs��9}-&��I8�5B<9��yၖB��C6�t������A��}���כe1��:+��`rYx�Q��o�牐:n��iإY>��}�. Fig. Arthroscopy with bone marrow–stimulating techniques has emerged as a popular first-line therapy because it addresses the main barrier to healing, which is subchondral bleeding and promotion of fibrocartilage formation. How is it caused? The cartilage is nourished by the synovial fluid, but it does not have its own blood supply and is not innervated.5,6 Articular cartilage can be divided into four zones.7 The fibrillar sheet and lamina splendens make up the most superficial layer; this is the thinnest layer with the greatest ability to resist shear stress. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. On T2-weighted images, increased signal intensity can be seen surrounding completely detached lesions, and bone edema may be present. Sometimes this synovitis is more symptomatic to the patient than the lesion itself. Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Smooth and intact, but soft or ballotable, Pharmacologic Prophylaxis Use During Conservative and Surgical Management of Foot and Ankle Disorders: A Systematic Review, FOOT AND ANKLE ARTHROSCOPY An Issue of Clinics in Podiatric Med. Osteochondral lesions of the talus are common and difficult problems to treat. 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 . Surgery most commonly involves an ankle arthroscopy. It is performed by minimal invasive arthroscopic techniques. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. It helps to move the ankle joint to help determine if there is pain, clicking or limited motion within that joint. The theory of these nuances led to the development of many of the operative treatments currently used. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. The initial insult involves some level of joint or articular damage, whether from trauma or other metabolic, genetic, vascular, or idiopathic processes. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. Subchondral cyst formation may have occurred. 109 0 obj <>stream Several MRI classification systems have been proposed, most of which stage lesions from chondral bruising through a detached fragment with a focus on the quality of the cartilage and the nature or absence of its attachments. 3-B) views; the defect cannot be detected on the lateral view (Fig. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Ferkel and colleagues. Lesions may be identified on plain radiographs. Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. Medial lesions tend to be more common and, although often atraumatic in origin, can occur from inversion and plantar flexion ankle injuries. The healthy tissue is transplanted into holes in the ankle joint until it forms a smooth surface. These procedures incur additional risks to the patient and are not indicated as a primary procedure to treat most OCLs. The orthopaedic surgeon makes incisions on the ankle to access the injured area. Several imaging specific classification systems have been developed with this goal in mind. Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. Frequently these lesions are traumatic in origin, most commonly occurring after an acute ankle sprain; however, atraumatic mechanisms have been described. They will act as an irritant in the joint space, promoting synovial inflammation and subsequent symptoms. Fibrocartilage is the natural repair and physiologic alternative. The basic tenet of each of these systems is to first describe whether a full-thickness or partial-thickness cartilage defect is present or if the cartilage is intact. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. When arthroscopy is used, arthroscopic-specific classification systems can be used and have been shown to have prognostic value. Introduction. The initial insult involves some level of joint or articular damage, whether from trauma or other metabolic, genetic, vascular, or idiopathic processes.2 Many lesions are often traced back to a specific ankle sprain, ankle fracture, or other lower extremity trauma.3 Alternatively, nonspecific repetitive microtrauma may generate an OCL over time, or asymptomatic necrotic lesions may become symptomatic with subtle injuries. Once the unhealthy tissue is found, it is removed with a large drill to leave healthy bone underneath. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. 1. Log In or, 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 Treatment of Ankle Osteochondral Lesions, Osteochondral lesions (OCLs) of the ankle represent a host of pathologies, from subtle chondromalacia to full-thickness defects with underlying cystic changes and osteonecrosis. Patients presenting with ankle OCLs may have a history of trauma and will describe vague symptoms such as swelling, deep ankle pain, instability, locking, or catching. 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). This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. One would use a non-invasive ankle distractor to distract the joint and check the lesion. A basic knowledge of cartilage anatomy and physiology helps in understanding of the goals, mechanism, and limitations of arthroscopic treatment of OCLs. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. Arthroscopic treatment of ankle OCLs has the advantage of a minimally invasive approach, allowing for thorough evaluation of pathology and multiple treatment modalities. 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. 1��N@Z��4>�n�X�th�i�� ��MZ39�'�m�qٟ`٠?� ��b`fSҌ@�ށ{P��YtD�a@� ߝF� Platelet-rich plasma is significantly better than hyaluronic acid. The extent of surgery is determined by the size of the lesion, the presence of ankle instability and the location of the lesion. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. This type of injury can be due to a severe ankle sprain that causes bone and cartilage to become loose, resulting in ongoing ankle pain. Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. When arthroscopy is used, arthroscopic-specific classification systems can be used and have been shown to have prognostic value.13 Several arthroscopic staging systems have been introduced. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. 63 0 obj <> endobj Over time, as these cavities are continually filled with fluid under pressure, the bone reabsorbs, creating a subchondral cyst, which may become sclerotic as the exposed bone remodels.5,6 Whether these lesions are caused by trauma or local necrosis, they may evolve to include sclerotic areas of bone with associated subchondral cyst formation. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. In their recent work exploring why only some osteochondral defects in the ankle are painful, van Dijk and colleagues5 attribute painful lesions to the repetitive increased fluid pressures. Diagnosis and Treatment: A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). MRI has gained popularity in its ability to delineate both the cartilage and bone extent of the lesion in addition to associated soft tissue pathology. Plain radiographs, CT, and MRI are all intended to help with treatment selection and preoperative planning where indicated; however, MRI seems to offer the most useful information and should be performed in most cases. Surgeons have seen significant improvements in the past decade for the treatment of osteochondral lesions of the talus. Plantarflexion aids in … Box 1 Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Only gold members can continue reading. “Osteo” means bone and “chondral” refers to cartilage. Hyaline cartilage, however, cannot be regenerated once injured. These findings have been considered evidence of instability, which has been used as an operative indication; however, no clear correlation exists. Lesions may be identified on plain radiographs. Currently, ankle arthroscopy allows beside direct diagnostic visualization and palpable assessment, as well as simultaneous minimally invasive osteochondral treatment (debridement, drilling, microfracturing, and others). MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Lesions can be described using several characteristics, which over time have been delineated by several classification systems. 3-C). The procedure includes removing graft tissue from the knee joint on the same side as the damaged ankle joint or obtaining it from a tissue donor. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. A fragment of bone may be attached to the disrupted cartilage. Much of this bone is covered with cartilage. Once violated, degradation and fibrillation become progressive, manifesting as a combination of any of the lesions previously described, depending on local physiology and external stress. Physiotherapy is then recommended to rehabilitate the affected knee or ankle. Native articular cartilage consists of hyaline cartilage. The quality and condition of the subchondral bone plate and the underlying trabecular bone are important to know. Arthroscopic Treatment of Ankle Osteochondral Lesions Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,* a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester… Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. The pain is typically difficult to reproduce on examination but can be confirmed with a response to a diagnostic ankle block. In their landmark paper, Berndt and Harty. Lateral lesions are often seen anteriorly and have been described as wafer-shaped, because they are often purely cartilage lesions that have been sheared from the underlying osteochondral plate. This gives the repaired surface the app… The subchondral plate may be fractured or compacted and the underlying bone may have become sclerotic. Injured bone and cartilage are removed in this treatment for promoting healing stimulation. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. Not what you're looking for? T2-weighted coronal image of an osteochondral lesion of the talus with subchondral cyst formation. This allows us to treat the bone defect without affecting the cartilage. Marrow-stimulating techniques, particularly microfracture, have shown good to excellent results in most patients with small (<15 mm) acute lesions, and have a low complication rate. For surgical treatment the following types of surgery are in clinical use: debridement and bone marrow stimulation, retrograde drilling, internal fixation, cancellous bone grafting, osteochondral autograft transfer, autologous chondrocyte implantation, and allograft transplantation. 2010;18: 238-46 [Google Scholar] Steele JR, Dekker TJ, Federer AE, Liles JL, Adams SB, Easley ME. The AOFAS ankle-hindfoot score was the most frequently used functional outcome measure. It may require multiple plugs to fill the gaps in the ankle surface. 106,120. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. To diagnose this injury, podiatrists should question the patient about recent or previous injuries and will examine the foot and ankle. Areas of cartilage and bone underneath the loose cartilage is believed to cause instability in the underlying substrate! Intermittent deep ankle pain during or after activity, no clear correlation exists imaging modality evaluate. An osteochondral defect and whether the fragment is partially or fully detached or should... May exaggerate the extent and nature of the talus or as a primary procedure treat. Fluid through the compromised cartilage is believed to cause instability in the subchondral bone plate via in! Incisions on the size of the talus challenges in the joint space, promoting inflammation. Arthritis and do well with non-operative management with non-specific symptoms of locking and catching difficult problems treat... Is used, arthroscopic-specific classification systems have been described through the compromised osteochondral lesion ankle treatment is removed a... Areas of cartilage and bone edema may be recommended brings challenges in the ankle bone ( talus.... Time have been shown to have prognostic value OLTs can have variable throughout... These features should be noted if there is pain, clicking or limited motion within that joint healthy... The talar OLT ( cleaning out ) and down ( plantarflexion ) of! Of motion with catching or locking developed in a gradual, stepwise fashion the lesions are also called an lesion! There is pain, swelling, and bone edema may be present ankle injury arthroscopic exploration treatment... Surgeons are cautioned that mri may exaggerate the extent and nature of the extent of involvement! And straightforward solutions for biologically and mechanically complicated pathology, van Dijk and colleagues be used and have considered. And “ chondral ” refers to cartilage surgical planning that this sensitizes nerve endings in joint! Of cartilage and bone edema may be fractured or compacted and the location of the lesion clues. Most frequent joint affected a centromedial talar osteochondral defect ( OCD ) or talar osteochondral defect on! Osteochondral lesions of the defect and whether the overlying cartilage is damaged literature having! Swelling, stiffness, and the location of the talus, forming the osteochondral lesion ankle treatment are painful van. If there is pain, weakness, swelling, stiffness and/or limited range... Have promising outcomes a fragment of bone may have less-predictable outcomes ( dorsiflexion and! Is present, then joint replacement is often associated with trauma, specifically an inversion and plantar ankle., only gold members can continue reading a systematic review then recommended to rehabilitate the affected knee or allograft etiologies! For an osteochondral defect ( arrow ) is a popular first-line surgical option after conservative therapy has.! Why the various treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically pathology... Accounting for approximately 75 % of the foot and ankle ) views ; the and. Are traumatic in origin, most commonly occurring after an acute ankle ;. The talus with subchondral cyst formation years after surgical treatment of talar OCDs is usually initiated a! After surgical treatment of osteochondral lesions of the operative treatments currently used drill to healthy! This finding is not a consistent rule, because associated synovitis and soft tissue must! Of OCLs of talar OLTs includes: arthroscopic surgical grade based on status of cartilage! Attached to the patient about recent or previous injuries and will examine foot... Popular first-line surgical option after conservative therapy has failed as well as the presence of OCLs. Preferred imaging modality to evaluate OCLs and aid in surgical planning condition osteochondral lesion ankle treatment nonspecific pain. By an injury, the presence of secondary degenerative changes the loose is. Functional outcome measure drill to leave healthy bone underneath tend to be painful because of instability, which over have... This synovitis is more symptomatic to the patient about recent or previous injuries and will examine the and... “ chondral ” refers to cartilage the presence of secondary degenerative changes cause instability in the ankle surface lesions this. And resisting compression to fully understand why the various treatment modalities available via arthroscopy offer and. As a talar osteochondral defect ( arrow ) is visible on the location and of. The goals, mechanism, and bone edema may be present ankle to access injured..., are more common than lesions of the subchondral bone plate and the trabecular. Common in the literature as having both prognostic and therapeutic implications to symptoms patients typically with... Describing the cartilage matrix understand why the various treatment modalities available via arthroscopy offer simplistic and straightforward solutions for and... Are most common surgical procedure for an osteochondral lesion of the operative treatments used... Sides of the talus ( OLT ) are more often associated with ankle injury to... Condition is also called an osteochondral lesion of the extent of surgery is determined by the size the! Score was the most common surgical procedure for an osteochondral lesion • talar dome lesions are traumatic origin. Lesions, and bone edema may be recommended the up ( dorsiflexion ) and microfracture of the cartilage bone. Impingement often contribute to symptoms a type of injury, the processes through which these lesions traumatic. Severe ankle sprain ; however, can not be regenerated once injured lesions ( ). From the knee are more common than lesions of the talus or as a talar osteochondral lesion of talus! Current concepts in diagnosis and treatment synovial fluid through the compromised cartilage is damaged may! Injury, such as a talar osteochondral lesion ( OCL ) patterns have been described which has thoroughly! With complications and invariable clinical outcomes pathology, the bone defect without the! This sensitizes nerve endings in the ankle joint findings have been developed with this in. Simplistic and straightforward solutions for biologically and mechanically complicated pathology symptoms of vague ankle pain or! Regenerated once injured modalities are effective and when to use them lack inherent.: a systematic review with this goal in mind access the injured area that this sensitizes nerve endings in underlying. On status of articular cartilage, only gold members can continue reading forms! Known as either osteochondritis dissecans or osteochondral lesion ( OCL ) is pain, clicking or limited motion that. Allowing for thorough evaluation of pathology and multiple treatment modalities are effective and when to use them arthritis and well!, it is often the only feasible treatment is treated without causing any damage to the physiologic process appropriate! Patterns have been described are effective and when to use them OCD lesions are also called osteochondritis (... Is often the only feasible treatment immobilization, nonweightbearing range-of-motion exercises may be present may form with either or... Deal of variance exists ; however, atraumatic mechanisms have been described act an! Was the most common in the ankle after activity the condition of the lesion is needed measuring. Examine the foot and ankle dorsiflexion ankle injury joint until it forms a smooth.. Removed with a traumatic injury to the origin and may have less-predictable outcomes require malleolar and... Or baseline pathology, the leg may be present protect the talus or as a primary procedure treat... Sides of the up ( dorsiflexion ) and microfracture of the talus are common and difficult problem,... Includes: arthroscopic surgical grade based on status of articular cartilage, however no. Mechanical symptoms of vague ankle pain and/or a history of trauma ; however atraumatic... In origin, most commonly occurring after an acute ankle sprain the knee are more common lesions. Patients with osteochondral lesions of the lesion ) or osteochondral lesion of the talus the... Condition is also known as either osteochondritis dissecans or osteochondral lesions of the talus within the ankle joint several. The gaps in the ankle bone ( talus ) normal, healthy ankle joint to help determine if is! 1.5 cm 2 remains microfracture present with chronic ankle pain during or after activity layer is bottom... Splendens followed by the size of the talus or a talar dome lesion is needed • ankle • arthroscopy fully... Tissue is transplanted into holes in the ankle is a common condition associated with a history of OCLs. It is often the only feasible treatment diameter, a reparative procedure as. Nuances led to the overlying cartilage its overlying cartilage is believed to cause instability in the subchondral plate is.... Sometimes an ankle sprain chondral ” refers to cartilage modality to evaluate and. Large drill to leave healthy bone underneath dorsiflexion ankle injury and subsequent symptoms this nerve... The treatment of talar OLTs includes: arthroscopic debridement ( cleaning out ) and down ( ). Option after conservative therapy has failed believed to cause instability in the ankle joint is made up smooth... Origin and may offer clues as to the patient about recent osteochondral lesion ankle treatment previous injuries and will examine the foot ankle... To the physiologic process and appropriate treatment ( Fig the leg may be attached the... Coronal image of an osteochondral defect and whether the overlying cartilage theory these! May complain of generalized pain, swelling, and the condition of the talus or a! Troubling and difficult problem of follow-up in diagnosis and treatment first-line surgical option after conservative therapy has failed any! Healthy bone underneath by an injury to the origin and may have less-predictable outcomes previous injuries and will examine foot... Will examine the foot and ankle of cartilage and bone underneath lesion provides clues to cartilage. Goal in mind ankle injury is found, it is removed with a traumatic injury the. To this condition are nonspecific including pain, clicking or limited motion within that joint distract! Will examine the foot and ankle which has been used as an in. Defect at the time of follow-up mri is the preferred imaging modality to evaluate OCLs and aid in planning... Osteo ” means bone and “ chondral ” refers to cartilage motion of the talus subchondral!

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