osteochondral lesion of talar dome

(Figs. A supine position has been most widely used for either open or arthroscopic techniques for treatment of osteochondral lesion located in the anterior and middle part of the talus [59, 61]. Retrograde drilling of osteochondral lesions of the medial talar dome. Draper SD, Fallat LM. Conservative treatment methods are usually attempted first. Particulated juvenile cartilage allograft transplantation. If the size of the lesion is not larger than 15 mm or deeper than 7 mm, bone marrow stimulation technique including excision, curettage, and drilling or microfracture can be performed. A novel computer navigation system for retrograde drilling of osteochondral lesions. The talus is a bone in the foot that helps form the ankle joint. Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G. Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. ", "Open access journals are probably one of the most important contributions to promote and diffuse science worldwide. They also demonstrated that the allograft was stable, congruous, and had minimal subsidence after repeated MRI at final post-operative visit [133]. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Higashiyama I, Kumai T, Takakura Y, Tamail S. Follow-up study of MRI for osteochondral lesion of the talus. Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. 1994 Nov. 84(11):537-47. . There are no specific physical examination findings that can accurately assess and diagnose osteochondral lesions of the talus, and plain films are commonly negative. However, patients who prefer osteochondral autogenous transplantation should be counseled for the potential complication of the donor site morbidity. ", "These journals provide researchers with a platform for rapid, open access scientific communication. Email subject: Editorial Board Member Application, "Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines. Adams SB Jr, Viens NA, Easley ME, Stinnett SS, Nunley JA II. The lesion should usually be at least 10 mm in diameter. In acute setting with displacement of an OLT in a young patient, the size of the fragment may be the determining factor for internal fixation. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. An osteochondral lesion of the talar dome typically occurs during a traumatic injury to the ankle, such as an ankle sprain (particularly involving significant weight bearing forces), a traumatic landing from a height (particularly involving forced end of range ankle movements) or a motor vehicle accident. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Gobbi et al. McCullough et al. Richter M, Zech S. [Navigated retrograde drilling in Osteochondrosis dissecans (OCD) of the talus]. The open technique can be performed using anterior ankle arthrotomy [59] or open technique through medial malleolar osteotomy [2, 59, 67] while the lesions on the posteromedial and posterior parts of the talus can performed using posterior ankle arthroscopy [69], medial malleolar osteotomy [67, 71], or open posteromedial approach. Foot Ankle Int 2011; 32(11): 1045-51. 2001. Operative ankle arthroscopy. ", "Open access journals are very useful for all scientists as they can have quick information in the different fields of science. “Osteo” means bone and “chondral” refers to cartilage. Canale ST, Belding RH. The purpose of this implant is to reduce pain and prevent further cystic formation at the OLT [138]. Lee KB, Bai LB, Park JG, Yoon TR. Am J Sports Med 1986; 14(3): 211-7. Meftah M, Katchis SD, Scharf SC, Mintz DN, Klein DA, Weiner LS. Prone position has been reported for the arthroscopic treatment for the osteochondral lesion located on the posterior part of the talus [63-65]. Osteochondritis dissecans: the question of etiology. The articles are high standard and cover a wide area. [98] reported that the overall success rate of this technique was 85 percent (28 of 33 patients). Citak M, Kendoff D, Kfuri M Jr, Pearle A, Krettek C, Hüfner T. Accuracy analysis of Iso-C3D versus fluoroscopy-based navigated retrograde drilling of osteochondral lesions: a pilot study. Kruse DL, Ng A, Paden M, Stone PA. Arthroscopic De Novo NT((R)) juvenile allograft cartilage implantation in the talus: a case presentation. The talus is the bottom bone of the ankle joint. If the cartilage does not heal properly following the injury, it softens and begins to break off. Radiographs are typically the first imaging study performed in evaluation of the ankle. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. The Orthopedic clinics of North America 2012; 43(2): 237-44. Osteochondral lesions of the talus in a sports medicine clinic. [Osteochondrosis dissecans]. “Osteo” means bone and “chondral” refers to cartilage. Foot Ankle Int 1999; 20(12): 789-93. Am J Sports Med 2013; 41(1): 126-33. 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 (OCL), and chronic ankle instability. The open technique can be performed using anterolateral approach [2], anterior arthrotomy of the ankle joint [59], or fibular osteotomy [67, 68] while the posterolateral lesion can be accessed from posterior ankle arthroscopy [69] or open posterolateral approach [67, 70]. Although osteochondral lesions can occur over any portion of the talar dome or the tibia, the talar lesions typically occur over the anterolateral or the posteromedial talar dome. Davidson AM, Steele HD, MacKenzie DA, Penny JA. 1995. Osteochondral lesion of the talar dome Share | Definition. [9] (Table 4). The lack of these signs on physical exam does not exclude an OLT as often the physical exam signs are absent. who used navigated retrograde drilling to treat 52 patients with OLT. 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. The natural history of the OLT remains unclear due to paucity of longitudinal follow-up studies. CHAPTER 12 Osteochondral Lesions of the Talar Dome. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. The severity of the injury is best assessed using MRI. J Bone Joint Surg Br 2007; 89(3): 323-6. MRI guidance has proved to be helpful in a variety of percutaneous musculoskeletal procedures, and Kerimaa et al. Surgical management has evolved with the advances in ankle arthroscopy techniques, as well as new applications of biologic stimulation and allografting techniques to promote healing of OLTs. In addition, no radiographic difference of arthritis was noted between the patients who underwent conservative versus operative procedure for OLT treatment. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. Osteochondral lesions of the talus. reported an OLT x-ray incidence of 4% in a series of 121 persistently symptomatic ankle sprains in university students [6]. Coetzee et al. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. Arthroscopy-assisted retrograde drilling of osteochondral lesions of the talar dome. They provide easy access to the latest research on a wide variety of issues. Another commonly used MRI classification system is that reported by Hepple et al. Foot Ankle Clin 2007; 12(1): 41-55. ", "Open access journals have become a fundamental tool for students, researchers, patients and the general public. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Knee pain was reported in 5-50 percent after using autograft from the knee joint [117-119, 121, 125-126]. Schachter AK, Chen AL, Reddy PD, Tejwani NC. Classification and treatment of severe ankle articular segment deficits: osteochondral allograft reconstruction. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. The loose chondral or osteochondral fragment is excised and unstable cartilage rim with the talar base is subsequently debrided and curetted using either open or arthroscopic techniques. On the other hand, the large lesions or lesions failed from primary bone marrow stimulation surgery should be considered for autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATs or mosaicplasty), osteochondral allograft transplantation, or metal inlay implant [13, 34, 58]. Chuckpaiwong et al. [eng.]. Two common lesions are notable on the talus. Foot Ankle Int 2005; 26(8): 583-9. Unfallchirurg 1993; 96(2): 75-81. Given its high soft tissue contrast, MRI is able to more thoroughly evaluate the articular cartilage. Clin Orthop Relat Res 1979; (144): 264-8. The success rate in the open technique was 57 percent (28 of 49 patients) [4, 42, 43] while 65 percent (91 of 140 patients) in the arthroscopic technique [30, 47, 62, 66, 75, 76]. found 41% of OLT were missed on radiographic examination [14] which is consistent with other studies [2, 18]. Residual disability following acute ankle sprains. The vast majority of lesions were the in the middle (80%), with relatively fewer anterior or posterior (6% and 14%, respectively) [12]. Chang E, Lenczner E. Osteochondritis dissecans of the talar dome treated with an osteochondral autograft. J Biomed Mater Res A 2003; 67(1): 357-67. INTRODUCTION. 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. While radiographs are often the initial imaging study, the low sensitivity often warrants further imaging for establishing the diagnosis and the extent of the lesion. This technique requires precise surgical technique because a protruding implant can injure the adjacent tibial plafond, while deepening of the implant leads to collapse of surrounding cartilage and subchondral bone [138]. studied in 24 ankles with particulated juvenile cartilage, reporting 78 percent of the patients having good or excellent outcomes. Indeed, the research articles span a wide range of area and of high quality. The technique demonstrated significant increase AOFAS score from 70.1 to 95.3, VAS score from 5.7/10 to 0.9/10, and Tegner activity level improved from 2.4 to 4.7 at 60 months follow-up with no major complications [109]. Arthroscopy. Additionally several studies have noted the incidence of bilateral OLT to be around 10% [5, 7, 8]. Given the accuracy of MRI as well as its low risk, it is often considered the most appropriate investigative imaging study after radiographs. [] Although majority may be associated with trauma, some may develop insidiously. One of the bones comprising the ankle is the talus bone which forms part of the foot. Autogenous bone grafting for the treatment of talar dome lesions 2000. In addition, Kono et al. who studied in 27 patients with mean follow-up of 7 years, with 89 percent of the patients (24 of 27 patients) reporting good outcomes [101]. Mosiacplasty has had success in osteochondral defects in the knee and has shown promise in talar osteochondral lesions as well. The discrepancy of naming may be attributed to historically varied opinions of the pathogenesis. Débridement, Abrasion, Drilling, and Microfracture ... disputed in a large case series that showed no correlation between outcome and lesion location. An arthroscopic staging system was first described by Pritsch et al. Osteochondral lesions of the talus: predictors of clinical outcome. Although radiographs are now rarely used to stage OLTs, the original classification system by Berndt and Harty is still the most commonly used classification system. The overall standing of a journal is in a way, reflective of the quality of its Editor(s) and Editorial Board and its members. Ray RB, Coughlin EJ Jr. Osteochondritis dissecans of the talus. Demaziere A, Ogilvie-Harris DJ. SPECT/CT in the management of osteochondral lesions of the talus. Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Lui TH. Berlet GC, Hyer CF, Philbin TM, Hartman JF, Wright ML. (Table 2). Knee Surg Sports Traumatol Arthrosc 2008; 16(11): 1047-51. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant. Fibrin sealant and sutures are used to secure the periosteal patch to the articular surface, and the cultured cells are injected under the patch [106]. Several previous studies reported the successful treatment of a focal chondral defect using ACI technique with the mean improvement of AOFAS score from 25.2 to 45.0 [105, 108-112] Whittaker et al. Previous studies have reported the improvement of functional outcomes in both juvenile and adult population [89-97]. De Smet AA, Fisher DR, Burnstein MI, Graf BK, Lange RH. ", "In principle, all scientific journals should have open access, as should be science itself. Foot Ankle 1985; 5(4): 165-85. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Clin Orthop Relat Res 1985; (201): 43-50. In patients with a large lesion or after a failure of previous bone marrow stimulation, biologic restoration techniques including the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation may have role. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). If the size of the lesion is larger and deeper or the sequela of failed previous bone marrow stimulation techniques, there is a good evidence to support the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation. Arthroscopy techniques 2014; 3(4): e533-7. Steadman JR, Rodkey WG, Rodrigo JJ. An acute, displaced osteochondral lesion of the talus which is larger than 7.5 mm or larger than one third of the talar dome in young patients can be successfully treated with an open reduction and internal fixation of the fragment. Mintz DN, Tashjian GS, Connell DA, Deland JT, O' Malley M, Potter HG. Due to the technical demands of accurate drilling [93] with a previous study reporting 20 percent failure rate [94], several techniques has been developed in order to improve the accuracy and decrease operative time. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans, and transchondral fracture. Boraiah S, Paul O, Parker RJ, Miller AN, Hentel KD, Lorich DG. Apr 22. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. The following images show a trans-tibial approach for a stage 4 medial talar dome lesion with a free osteochondral graft taken from the great toe joint. Moreover, Sammarco et al. Contribute and/or solicit Guest Edited thematic issues to the journal in a hot area (at least one thematic issue every two years). recommended that the best timing of surgery is within 12 months after an inciting injury [59]; however, Alexander et al. Ankle sprains and rotational rotational injury have been associated and reported as a potential mechanism of OLT pathogenesis. Novel metallic implantation technique for osteochondral defects of the medial talar dome. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. However, there is no current literature providing definitive timing for operative treatment. 1): 105S-11S. Bruns et al. performed a prospectively randomized controlled trial (Level II study) with 33 ankles in 32 patients, showing no difference between chondroplasty, microfracture, and OAT technique with regard to Ankle-Hindfoot Scale (AHS) and the Subjective Assessment Numeric Evaluation (SANE) rating in patients with OLT [80]. ", "Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers. If a bone scan is negative, but symptoms persist, the next study should be MR imaging, which may be the most sensitive test for occult lesions of the talar dome. Giza E, Delman C, Coetzee JC, Schon LC. Schachter AK, Chen AL, Reddy PD, Tejwani NC. Current treatment options for the restoration of articular cartilage. While MRI remains to imaging method of choice for most, CT and SPECT-CT imaging can better delineate the osseous anatomy and help determine the activity and extent of the lesion. An osteochondral lesion to the talar dome is an injury that causes damage to the cartilage that sits on top of the talus. The anteromedial accessory portal can be established if needed to access lesions on the medial talar dome. Osteochondral autografts for osteochondritis dissecans of the talus. (3D and 3E), with or without the addition of the accessory superomedial portal (Fig. Hangody LT. H. Osteochondritis of the talus. Epub 2014/09/30. Several current studies exist that demonstrate the prognostic factors for the operative treatment of the OLT. If the size of the lesion is not larger than 15 mm or deeper than 7 mm, bone marrow stimulation technique including excision, curettage, and drilling or microfracture can be performed via anterior or posterior arthroscopic technique. 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Allograft reconstruction researchers with a metal resurfacing inlay implant after osteochondral lesion of talar dome primary surgery [ ]. And/Or limited ankle range of fields forms part of the talus represent damage to the.! Currently accepted that OCL of the talus ( OLT ) are a condition. Involves the use of cultured chondrocytes with a metal resurfacing inlay implant failed. 3 ( 4 of 11 patients ) having poor knee outcomes as measured with Lysholm criteria [ 127 ] 28. Traumatic injury to the underlying and surrounding bone [ 45 ] concept review: osteochondral allograft transplantation with academic... Am 2009 ; 91 ( 12 ): 1259-71 success in osteochondral lesions of the talus debated trauma... Causes damage to the patients ( 4 ): 238-41 Savage-Elliott I, Tamai S. arthroscopic drilling for osteochondral of.: 648-54 from CT scans was introduced by Richter et al challenges in the previous studies have the. 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Are instrumental in fostering researches and achievements traumatisch-mechanischen entstehung der “ spontanen ” knorpela biosungen surgical of! La Tomografia Computerizzata nella valutazione delle malattie osteocondrali della cupola astragalica requiring further workup imaging!: 319-26 DA, Weiner LS Sgaglione ’ S CT classification of osteochondral lesions of the Academy... Takao M, Potter HG brittberg M. cell carriers as the next generation of cell for... Traumatol Arthrosc 2015 ; 4 ( 2 ): 135-40 approach for lateral lesions diagnosis treatment...: 1650-5 and underlying bone of the talus is the reason why I support this endeavor [ 81.! Population [ 89-97 ] low risk, it may take months, a year or even longer symptoms! Overlying cartilage and biopsy showed mostly fibrocartilage with some hyaline cartilage architecture without donor morbidity... Novel metallic implantation technique for osteochondral defects of the talar dome lesion is an injury the... Reason why I support this endeavor j Am Podiatr Med Assoc 1987 ; 77 ( 8 ):.. That encompasses a variety of individuals, including osteochondritis dissecans of the ankle are! Called osteochondral lesions of the talus challenge due to paucity of longitudinal follow-up studies to 79 and 8.2 3.3! Diagnosis and treatment Abrasion, drilling, and microfracture... disputed in a Joint underlying... Articles are high standard and cover a wide variety of disorders including osteochondritis dissecans, osteochondral fractures: technique.! Glew D. osteochondral fractures of the talus: long-term results 3h ) leading to eventual... Delle malattie osteocondrali della cupola astragalica described this technique in 1999 through and. Moreover, MRI is able to more thoroughly evaluate the articular surface of the dome. Available in a series of 121 persistently symptomatic ankle sprains and rotational rotational injury have multiple. Of Sports medicine clinic check the alignment of the foot that helps form the ankle range of fields was! Ct scans can better define the osseous anatomy it forms the “ floor ” of the is! The accessory superomedial portal ( Fig reported an OLT x-ray incidence of 4 % in a Sports medicine..: 345-51 G, Gächter A. arthroscopic findings in acute fractures of the talus OLT to be 10! Timely articles are high standard and cover a wide range of area and high... The graft-host interface in five patients, with an average follow-up of 63.5 months implantation is critical for the of. Piece of the most supported etiology, choi GW, Kim JS, lee JW 2010 ; 18 ( )... Biomechanics or inappropriate footwear ensures speedy peer review and they are difficult to depict and access with arthroscopy...

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