Begin Range of Motion 4. Physicians can upload their anonymized problem case for expert advice. Osteochondral defects . During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). (OBQ12.74) A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. INTRODUCTION. The experts opinion can be of interest for other physicians who meet similar problems. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. Osteochondral defect or Cyst. It may result in a defect that subsequently affects the subchondral bone and, in severe cases, may lead to formation of an osteochondral fragment. Osteochondral Defects – OCD of Foot and Ankle, Talus, Metatarsal. Immobilization of the ankle, medications, steroid injections and physical therapy are commonly tried but this often fails to relieve symptoms and surgery may be required. They include lateral or medial ankle pain, functio laesa and swelling. How is it caused? Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) These data may have implications toward OLT size thresholds for surgical decision making in symptomatic lesions (ie, primary osteochondral transplantation procedure vs curettage and debridement). Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. Clinical Relevance: The location of peak stress in the ankle joint becomes closer to the rim of the defect in OLTs at a threshold of 10 mm and greater in diameter. 1, in a review of >580 osteochondral defects … OCDs usually develop after an inversion or high impact injury to the ankle, leading to a portion of the cartilage to be injured. With disease progression, the fragment may detach, leading to degenerative osteoarthritis . 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. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. What causes it? A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. Control post operative pain/swelling Treatment: - Patient to be progressed to PWB (up to 30% body weight) if a small lesion (per MD’s recommendations). 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. Joint preservation is challenging in cases with large osteochondral defects (OCDs) of the tibia plafond after trauma or septic arthritis of the ankle joint (1,2), and it is particularly necessary among young individuals or athletes.Several treatment strategies—namely, arthrodesis, osteochondral allograft, and total ankle replacement (TAR)—have been described for large OCDs of the ankle (). Because of excessive overlying fibrous tissue and synovium, the defect cannot be adequately visualized. The condition typically affects just one joint, however, some children can develop OCD in several joints. Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. Non-operative measures such as mobilisation, a heel lift and steroid injections are reasonable non-operative techniques to try before surgical referral, but pain from mechanical symptoms is often resistant to non-operative measures. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an … Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities World J Orthop. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. Many synonyms for OCLs of the ankle have been used, such as osteocartilaginous bodies, joint mice, intra-articular fragmentary fractures, transchondral fractures, and osteochondral defects, with the acronym OCD being used interchangeably to refer to osteochondral defect or osteochondritis dissecans. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). It is then matched to the surface area of the defect and impacted into place. This allows us to treat the bone defect without affecting the cartilage. Tol et al. Osteochondral defects in the ankle: why painful? Osteochondral Defects in the articular cartilage can result from trauma, arthritic conditions, chronic wear and tear. During loading, compressed cartilage … In patients with an isolated ligamentous ankle injury, these symptoms usually resolve after functional treatment within 2–3 weeks. Talar dome lesions are usually caused by an injury, such as an ankle sprain. However, it can be subdivided into a traumatic and nontraumatic cause. “Osteo” means bone and “chondral” refers to cartilage. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. To make these surfaces slide more easily, there is also fluid in the joint that is created by the capsule of the joint. 31. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for. In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. problems after ankle fracture. Information from your Foot and Ankle Osteochondral Defect Surgeon in Orange County with offices in Newport Beach and Irvine – Southern California. Through the years members of Ankle Platform have asked for treatment advise. (Eds.) It is often associated with a traumatic injury such as a severe ankle sprain. The ankle is plantarflexed to visualize the osteochondral defect (OCD). An osteochondral defect (OCD) of the ankle joint can lead to localised pain, swelling and stiffness in the ankle with difficulty weight bearing and mobilising. 2015 Dec 18;6(11):944-53. doi: 10.5312/wjo.v6.i11.944. 3-B) views; the defect cannot be detected on the lateral view (Fig. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. If the fragment has come loose, it can also cause locking or instability symptoms. 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. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. 6 The cause of OCLs of the talus has multiple facets. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Keywords Osteochondral defect Cartilage Ankle joint Subchondral cyst Natural history Pain Introduction An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 46, 47, 50]. 3-C). Therefore a small anteromedial synovectomy is done using a 5.5 mm bonecutter shaver with the ankle in the dorsiflexed position. The most common joints affected by osteochondritis dissecans are the knee, ankle and elbow, although it can also occur in other joints. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). 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). A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. Sports Traumatol Arthrosc 18:570–580. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). If the cartilage does not heal properly following the injury, it softens and begins to break off. In osteochondral autograft transplantation, cartilage is transferred from one part of the joint to another. Knee Surg. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. [] Although majority may be associated with trauma, some may develop insidiously. Healthy cartilage tissue -- a graft -- is taken from an area of the bone that does not carry weight (non-weightbearing). When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. Osteochondral defects and loose bodies are common causes of mechanical symptoms in the ankle. 3-A) and heel-rise (Fig. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Trauma plays the most important role in the pathomechanism of talus OCLs. Submissions are anonymized and transformed to cases which you can find in this section. Editors: van Dijk, C. Niek, Kennedy, John G. “Osteo” means bone and “chondral” refers to cartilage. 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. Talar Osteochondral Defects Diagnosis, Planning, Treatment, and Rehabilitation. Osteochondral lesion (OCL) describes an injury to the articular cartilage surface of bone within a joint. We prefer to use the broader term osteochondral lesion to define a lesion of any origin … The broad term “osteochondral lesion of the talus” describes an injury or abnormality of the talar articular cartilage and adjacent bone.1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. Free Preview. The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect … Protect surgical ankle 2. In acute conditions, symptoms of osteochondral ankle defects are similar to those of acute ankle injuries. The ankle joint has a high congruency. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). The graft is taken as a cylindrical plug of cartilage and subchondral bone. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Fig. 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). Ankle: Chondral/Osteochondral Defect Repair ... 1. They may also be called osteochondritis dessicans or osteochondral fractures. In most joints of the foot and ankle, this layer of cartilage is one to a few millimetres thick. Overall, more than 80% of the talus OCLs are of traumatic origin. Definition. 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