Other? The fragment is large enough to fix. Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. OLTs can be an incidental finding on an MRI ordered to assess another problem. Anterior Impingement- After Total Ankle Replacement. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. dissecans (OCD) of talus • “Osteochondrosis”?? The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). Treatment options for large talar osteochondral lesions (greater than 1.5 cm) or those that fail to adequately respond to microfracture, have broadened over the last decade, with most procedures directly aimed at hyaline-like cartilage restoration. These symptoms could include localized ankle pain, as well as discomfort on either the inside (medial talar OLT) or outside (anterolateral talar OLT) of the ankle. OCD Lesions of Talus Introduction The ankle joint of made up of 3 bones; the tibia (including the medial malleolus), the fibula (including the lateral malleolus) and the talus. As the ankle twists, the edge of the talus bone impacts the adjacent bone which bruises or shreds the cartilage. Microfracture. Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. San Francisco CA 94123, Osteochondral Autologous Autograft Transfer, The inside and top part of the lower bone of the ankle (the medial talar dome) or. 169 Part V – Outcome measures Chapter 15 Outcome measures Talar OCD. The lesion is encountered on either the medial or lateral surface of the talar dome. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. [Picture 5]. Did you know our resouces can be found in. OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. Top arrow indicates bruising of the distal tibia and the lower red arrow indicates bruising of the talus Mechanical malalignment overloads either the medial or lateral boarders of the talus depending if there is tibial or hindfoot varus or valgus [8]. [] In 1922, Kappis described this process in the ankle joint. Non-operative treatment can be successful for non-displaced talar OLTs, especially if the condition is recognized and treated early, and the lesion is relatively small. During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle. Cartilage repair techniques. 2. postoperative treatment regime? 269 Chestnut St. #271 This prevents the need from harvesting bone and cartilage from another part of the body (ex. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral Description of patient (type of occupation, indication of age, intensity of sport): 28 years old and sportive patient . The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). If you want advise on a difficult case, you can upload it here. OCD occurs in a number of locations in the hock, including the intermediate ridge of the tibia (most common), the lateral trochlear ridge of the talus, the medial malleolus of the tibia, and the medial trochlear ridge of the talus. OCD medial Talus . INTRODUCTION. [Picture 2, 3 + 4] An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). This may lead to small cracks in the cartilage or even formation of a hole or cyst underneath the surface. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). 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). Flattening of the medial talar dome. OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. arthroscopic debridement and drilling? This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). 6.1 Reticular bone bruising, distant from the articular surface. OCD of the Talus Tx. Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint. The mean size of defect of OCD was 13.6 mm x 7.2 mm. With special emphasis on diagnosis, planning and rehabili-tation in press. This may affect healing… There are several non-operative management options for the treatment of osteochondral lesions, including: In younger patients, this condition has the potential to heal, making it possible to treat acute non-displaced talar OLTs with immobilization in a cast or CAM walker. The area where OCD occurs is located at the top of the talus. [Picture 5] Images: Case summary: 19 years old male hockey player with osteochondral lesion of the talar dome. Additional investigation (CT/MRI): Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4-6 weeks can help reduce stress on the OLT and allow healing. It is often associated with a traumatic injury, such as a severe ankle sprain. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Osteochondritis dissecans (OCD) of the talus is rare in children. OCLs most commonly occur in two areas of the talus (Figure 1A and 1B): Many patients with talar OLTs are asymptomatic (no pain or swelling). All operative techniques can be downloaded here. Synovitis of the tibiotalar and subtalar joint. Partially detached osteochondral lesion 3. X-ray: On the talus, this covering is about one-eighth of an inch thick. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. • Accounts for only 4% of reported cases of OCD – Vascular etiology? While initial symptoms may be similar to a sprained ankle, persistent pain, swelling, and a catching sensation while using the ankle may indicate this more serious condition. 1. treatment? – Localized ischemia & AVN – Not an inflammatory process so the term“osteochondritis” is a misnomer – Younger patient – No history of trauma – More on medial side. Retrograde drilling and fixation scored 88 and 89%, respectively. OLTs on the top outside part of the talus (Antero-lateral lesions) usually have a history of a traumatic injury with a twisting component, such as an ankle sprain. Synovitis of the tibiotalar and subtalar joint. Magnetic resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset OCD. The earliest report of osteochondritis dissecans (OCD) was published in 1888 by Konig, who characterized a loose-body formation associated with articular cartilage and subchondral bone fracture. Osteochondral Defects . Osteochondritis dissecans. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. The mean time of follow-up was 36 months (range, 25-49). Th… It is a very common disease in Standardbreds but is also quite common in Quarter Horses and Arabians. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. Small talar beaking. It occurs when OCD develops in an articulating surface before closure of the growth plate.14 Owing to rarity of juvenile OCD of the talus, existing management guidelines are predominantly There is an increasing prevalence of … The bone lesions on the lateral or outside portion of the talus are most often related to trauma. Two children had bilateral involvement, for a total of 26 lesions. 19 years old male hockey player with osteochondral lesion of the talar dome. CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. These various types of damage are called osteochondral defects (OCD) of the talus (an older term was osteochondritis dissecans). 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). Completely detached , non-displaced fragment 4.Completely detached and displaced fragment Ct or MRI will give more information with a suspected lesion . The cartilage lining of the joint is crucial to allow […] 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 findings: subchondral edema; x-ray findings: none; stage II. Areas of decreased density (i.e., darker areas) seen on the plain x-rays (Figure 2) can be indicative of this condition, although it is not uncommon for the plain x-rays to be read as normal. May be due to micro trauma or a traumatic event. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. OCD remains uncertain. Unfortunately, this approach in the ankle has not yet met with the type of clinical success that had been hoped for, and is not currently broadly available. It is often associated with a traumatic injury, such as a severe OCD talus. Open the cyst anterior and fill it with bonegraft. History and previous treatment: AS BG (ligament repair) for ankle instability . Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for … Fig. Physical therapy: working on strengthening the muscles around the ankle, range of motion of the ankle, and balancing (. Plain x-rays can be used to help diagnose an osteochondral lesion. The talus sits inside the joint and allows the up and down motion of the ankle. The most common sites are the posteromedial (53%) (Fig. Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). Plain film mortise view (consider repeat in 2-4 weeks if films are normal) Four classes 1. There were 10 boys and 14 girls. The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. Autologous chondrocyte transplantation (ACI): There has been an attempt to harvest a patient’s own healthy cartilage, grow the cells in a lab, and then reimplant these cells back into the area where the cartilage has been lost. The top of the talus is dome-shaped and is completely covered with cartilage. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. Osteochondral lesion of Talus & Ankle Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Fixation with a headless compression screw or absorbable screw. “Osteo” means bone and “chondral” refers to cartilage. This can be done without a medial malleolar osteotomy. It is often associated with a traumatic injury such as a severe ankle sprain. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. for OCD of the talus at a major Canadian pediatric referral center. However, the larger the graft, the more likely it seems that it will collapse as a new blood supply is established into the graft after transplantation. 1) and anterolateral (46%) talar dome (1). The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The top of the talus is part of the joint and is covered with articular cartilage, the white, slippery material that covers all joint surfaces. CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. The pain is often worse with activities, particularly running, walking and jumping. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. cartilage injury with associated subchondral fracture but without detachment OCD of the Talus Radiographs. However, it can also occur from chronic overload due to … This condition is known as Talar OCD, or an osteochondral lesion of the talus. [Picture 1] The most common clinical sign of hock OCD is joint … The talusis one of the large bones in the back part of the foot that helps form the ankle joint. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. OCD usually causes pain during and after sports. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). I would go for a lift-drill-fill-fix procedure. Show Related Articles from PubMed. Laboratory and clinical work continue in this area. Current complaints: Deep left ankle pain during sport and axial bearing/load on left ankle and swelling. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. Whereas, the OLTs on the inside part of the top of the talus (medial talar osteochondral lesions) are more commonly associated with chronic overload of the medial aspect of the ankle, such as would occur in a patient with a higher arched foot (subtle cavus foot). They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. healing of osteochondral defects of the talus: an experimental goat study Osteoarthritis Cartilage 2013;21:1746-54. Physical exam usually reveals some swelling and localized pain along the front of the ankle (ankle joint line). However, if the lesion is large enough, or the overlying cartilage is displaced, talar OLTs can be quite symptomatic. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). The average age at surgery was 22.7 years (range, 19-34). This may include: FootEducation LLC Where does OCD develop? They may also complain of mechanical symptoms, such as clicking and popping sounds caused by a loose fragment of cartilage and/or bone associated with the OLT. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Osteochondritis dissecans (OCD) of the ankle is a disorder of the talar or distal tibial subchondral bone and articular cartilage whose incidence in children is not clearly known. This treatment approach can be initially attempted in non-displaced OLTs. Period of non-weight bearing since this is a big lesion? 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 . 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). knee). lage OCD may have genetic risk factors that predispose them to developing the disease, although as per Zanon et al9 in ‘Osteochondritis Dissecans of the Talus’, ‘there are no ongoing studies to identify such genes’. Surgery is usually required to repair Talar OCD. Small area of compression 2. Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury The gold standard for diagnosis of talar OLTs is an MRI of the ankle (Figure 3A and 3B).