This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral … Patients presenting with an OLT often describe prolonged pain, recurrent ankle swelling, weakness, and continued subjective instability. Patients also may report mechanical symptoms including catching, clicking, and locking. Symptoms. Description OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. An osteochondral lesion of the talus is often a difficult problem to treat. Patients can have three different kinds of complaints, whether or not in combination: A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. Which treatment do you need?Shoulder TreatmentKnee TreatmentBack TreatmentElbow TreatmentFoot TreatmentOthers, Preferred LocationGleneagles Medical CentreMt Alvernia Medical CentreMount Elizabeth Novena. Two common lesions are notable on the talus. … Surgical intervention is indicated for acute displaced OLTs and for those refractory to nonsurgical care. Authors of a 2010 study theorized that water from compressed cartilage is forced into the microfractured subchondral bone during loading, which subsequently leads to localized increased fluid pressure within the subchondral bone. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Research studies show OCD lesion in the talus … Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology [ 14 ]. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Please enable javascript in your browser in order to get form work properly. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the … The precise natural history of OLTs is unclear. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. 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. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Endocrine or metabolic abnormalities, vasculopathy, and osteonecrosis are potential etiologic factors in nontraumatic OLTs. Impaired function, limited range of motion, stiffness, catching, locking an… Patients … Months or even years later joint fluid can enter the crack and expand creating … If you are experiencing one or more of the symptoms mentioned above, it is important to get a prompt and accurate diagnosis to determine the severity of your injury and get proper treatment immediately. 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: If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. This most common symptom of osteochondritis dissecans might be triggered by physical activity — walking up stairs, climbing a hill or playing sports. Large uncontained lesions are usually painful as the structure of the talus is threatened. Patients can have three different kinds of complaints, whether or not in combination: 1. The appropriate surgical technique should be taken into account the type, stability, and displacement of the lesion. Their findings support the notion that the most common osteochondral lesions are not the traditionally described anterolateral and posteromedial lesions, but rather central medial and central lateral lesions. 9 am to 1 pm The primary traditional approach includes open ankle arthrotomy. Lesion size, location, chronicity, and characteristics such as displacement and … “Osteo” means bone and “chondral” refers to cartilage. Novena Specialist Centre, Sat: The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. Osteochondral Defects of the Talus Ankle injuries are one of the most common musculoskeletal conditions. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. Often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. Most ankle sprains occur when the foot is pointed downwards, and the ankle “rolls over” the foot, causing the talus (ankle bone) to push into the tibia. There are many options for surgical intervention, typically categorized as primary repair, reparative techniques, and restorative techniques. The natural history is unclear, although most patients improve without surgical intervention. Dr. Miniaci-Coxhead or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. This condition is also known as … The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Some smaller cystic lesions … Computed tomography scanning in diagnosis and follow-up. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI … The development of a symptomatic OLT depends on various factors. Large uncontained lesions are usually painful as the structure of the talus is threatened. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Medial osteochondral lesions are more common than lateral osteochondral lesions. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Osteochondral lesions happen more frequently in the younger athletic population Diagnosing Osteochondral Lesion of the Talus. The most common sites are the posteromedial (53%) ( Fig. Osteochondritis dissecans of the dome of the talus. It includes your bones, joints, ligaments, tendons, muscles and even your nerves: basically all the essential parts of your body for you to move, work and enjoy your life. The first is injury to the cartilage surface with an … It is often caused by a traumatic injury, such as a severe ankle sprain. Your browser does not support JavaScript!. The unstable cartilaginous edges were removed with curved curet to stable borders, and then an angled pick was used to perform a microfracture procedure, essentially a drilling microfracture procedure of the osteochondral defect. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. Gleneagles Medical Centre, Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. The severity of the injury is best assessed using MRI. Goals may range from removal of a loose fragment to securing a larger fragment anatomically. There is limited understanding of cartilage damage and its repair. Most authors believe that trauma has an integral role in the pathogenesis of most OLTs and that OLTs most likely represent the chronic phase of a compressed talar dome fracture. [ 2] A Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. “Osteo” means bone and “chondral” refers to cartilage. An OLT diagnosis is rarely made immediately after an acute ankle injury. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. In a review of serial MRIs of 29 patients who had OLTs that were treated nonsurgically, 45% showed progression, 24% improved, and 31% remained unchanged. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. The physical examination may reveal tenderness at the level of the ankle mortise anteriorly or posteriorly. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. May be due to micro trauma or a traumatic event. Talar dome lesions … Articular cartilage has poor regenerative capacity, and the osseous blood supply to the talus is tenuous. CT scans are used predominantly as an adjunct for a more comprehensive evaluation of and preoperative planning for known lesions, MRI is the preferred imaging study for detection of suspected OLTs that are not seen on initial plain radiographs. For those with persistent pain, surgical treatment is offered. Singapore 329563, Mon – Fri : Purpose: (1) To determine the rate of return to play following autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and (2) report subsequent rehabilitation protocols. The pain is believed to be a result of stimulation of the highly innervated subchondral bone under the cartilage defect. #06-59/60/61 Mount Elizabeth There are three types of common lesion formation. The patient's osteochondral defect in the posterolateral aspect of the talus was identified. A … Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral … Numerous exposure methods have been described, including several variations of medial malleolar osteotomies and distal tibial osteotomies along with combined anterior and posterior arthrotomies. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Furthermore, it is hard to figure out why some … 16 years of experience in surgical and non-surgical procedures in sports injuries as a. This is often referred to as a chip inside your ankle joint. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion … A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Terminology. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. 1 ) and anterolateral (46%) talar dome ( 1 ). The talus is the bottom bone of the ankle joint. 6 Napier Road, #04-05 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 … This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. A single event of macrotrauma or repetitive microtrauma may elicit initiation of the lesion in a person who is already predisposed to talar dome ischemia. In 2007, MRIs of 428 ankles with OLTs were studied. Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. Depending on the joint that's affected, signs and symptoms of osteochondritis dissecans might include: Pain. OLTs represent approximately 4% of all osteochondral lesions. © 2020 Ortho.com.sg. INTRODUCTION. Medical Centre D, … The etiology of an OLT may be nontraumatic or traumatic. Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. Plain x-rays can be used to help diagnose an osteochondral lesion although it is not uncommon for the plain x-rays to be read as normal. Published many acclaimed articles on Sports Medicine. 1) … Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Osteochondral lesions of the talus are common and difficult problems to treat. Treatment principles of osteochondral lesions of the ta… Sports Orthopaedic Specialist in Singapore, The inside and top part of the lower bone of the ankle (the medial talar dome) or. Received multiple awards and accolades in the Orthopaedic field. This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Osteochondral lesions of the talus are common and difficult problems to treat. Articular cartilage has … Although this can occur in other joints, when it occurs on the ankle bone, it is called an osteochondral lesion of the talus (OLT). 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). Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. Local osteolysis can then predispose to the development of a subchondral cyst. Additionally, it was determined that lesion location does not predict subject age, lesion chronicity or instability, or history of trauma. Treatment depends on the severity of the talar dome lesion. They require a strong plan. [ 1] T This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Advanced imaging modalities have significantly increased the ability to accurately diagnose OLTs. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Singapore 258499, 820 Thomson Road, #07-53 Talar dome lesions … Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. The top of the talus is dome-shaped and is completely covered with cartilage. 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. Symptoms related to this condition are nonspecific … Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. Low-grade lesions are managed with initial weight bearing modifications and therapeutic interventions. The differential diagnosis is wide, but a high index of suspicion must be maintained for an OLT when evaluating patients with chronic ankle pain. Singapore 574623, 38 Irrawaddy Road, Grade I: Hyperintense but intact cartilage surface, Grade II: Fibrillation of fissures not extending to bone. Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. Isolated lesions … The most common sites are the posteromedial (53%) (Fig. The primary mechanism is damage and insufficient repair of the subchondral bone plate. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. FIGURE 71-1 Osteochondral lesion of the talus. Radiography cannot directly depict the cartilage surface (3). The first is a posterior medial lesion … This commonly occurs after an ankle sprain where … Most classification systems are based on lesion … 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). Symptomatic osteochondral ankle defects often require surgical treatment. 9 am to 1 pm. Alternatively, the primary objective may be to create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. To diagnose this injury, the surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking or limited motion within that joint. Treatment of osteochondral lesions of the talus: a systematic review The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral … He is a USA Sports Medicine Fellowship trained Orthopaedic Surgeon and is a member of the Arthroscopy Association of North America as well as the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. OCLs most commonly occur in two areas of the talus: Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. In another study, the authors retrospectively reviewed the location, frequency, and size of OLTs on 77 MRI examinations based on a nine-zone grid. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). In 1955, investigators reported a frequency of 6.5% in their series of 133 ankle sprains. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. In the ankle, osteochondral lesions usually occur on the talus, which is the bone that connects the leg to the foot. Much of this bone is covered with cartilage. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. Osteochondritis dissecans was originally described in 1888 as a process of loose body formation associated with articular cartilage and subchondral bone fracture in the hip and knee. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). 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). In most cases, the condition is associated with chronic ankle pain, especially after inversion injury to the lateral ligamentous complex. An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. Orthopaedic Knowledge Update: Foot and Ankle 5, Orthopaedic Knowledge Update Foot and Ankle 4, TABLE 1 Mintz and Associates’ MRI Classification Compared With Cheng’s Arthroscopic Staging System for Osteochondral Lesions of the Talus, 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), Sports-Related Injuries of the Foot and Ankle, Forefoot, Sesamoid, and Turf Toe Injuries, Orthopaedic Knowledge Update: Foot and Ankle 6. 2 pm to 5 pm Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the pediatric population. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Purpose: The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation (OAT) in patients with osteochondral lesions of the talus … “Osteo” means bone and “chondral” refers to cartilage. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion … A variety of surgical techniques is available to accomplish this: Orthopaedics is the medical specialty that focuses on injuries and diseases of your body’s musculoskeletal system. The approach and objectives of surgery are variable and are determined by the type of lesion. The defects cause deep ankle pain associated with weightbearing. Lesion size, chronicity, and location also are important in treatment selection. Subchondral cysts with overlying chondromalacia, osteochondral fragments, and loose bodies all represent various stages in the progression of OLTs. A cutoff point … All Rights Reserved | Website design by Heroes of Digital. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. Those that fail to respond may be candidates for v… The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Osteochondral lesions of the talus are injuries to the cartilage in the bone inside the ankle joint. Two common lesions are notable on the talus. In 1959, Berndt and Harty described the first staging system based on radiographic findings. A trial of nonsurgical management may be appropriate for OLTs, with several authors recommending a trial period minimum of 3 months. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus … However, medial lesions were larger, and lateral lesions were seen more commonly in association with ligamentous injury. 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