It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). #06-59/60/61 Mount Elizabeth The natural history is unclear, although most patients improve without surgical intervention. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus … In 1955, investigators reported a frequency of 6.5% in their series of 133 ankle sprains. Advanced imaging modalities have significantly increased the ability to accurately diagnose OLTs. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. 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. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. 9 am to 1 pm [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral … 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 a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. Often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. Singapore 574623, 38 Irrawaddy Road, The severity of the injury is best assessed using MRI. 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. Radiography cannot directly depict the cartilage surface (3). Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the … Treatment depends on the severity of the talar dome lesion. Goals may range from removal of a loose fragment to securing a larger fragment anatomically. The defects cause deep ankle pain associated with weightbearing. 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. In most cases, the condition is associated with chronic ankle pain, especially after inversion injury to the lateral ligamentous complex. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Treatment principles of osteochondral lesions of the ta… 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. Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. Articular cartilage has … A talar dome lesion is an injury to the cartilage and underlying bone of the talus within 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. A cutoff point … A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Computed tomography scanning in diagnosis and follow-up. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. 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. A trial of nonsurgical management may be appropriate for OLTs, with several authors recommending a trial period minimum of 3 months. Terminology. Subchondral cysts with overlying chondromalacia, osteochondral fragments, and loose bodies all represent various stages in the progression of OLTs. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. 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. An OLT diagnosis is rarely made immediately after an acute ankle injury. “Osteo” means bone and “chondral” refers to cartilage. In 2007, MRIs of 428 ankles with OLTs were studied. 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). Symptoms. Two common lesions are notable on the talus. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. 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 first is a posterior medial lesion … Research studies show OCD lesion in the talus … Talar dome lesions … Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. Patients also may report mechanical symptoms including catching, clicking, and locking. The differential diagnosis is wide, but a high index of suspicion must be maintained for an OLT when evaluating patients with chronic ankle pain. Patients … 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 … 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. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Singapore 329563, Mon – Fri : Osteochondral Defects of the Talus Ankle injuries are one of the most common musculoskeletal conditions. … 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 talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Endocrine or metabolic abnormalities, vasculopathy, and osteonecrosis are potential etiologic factors in nontraumatic OLTs. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. This is often referred to as a chip inside your ankle joint. Symptomatic osteochondral ankle defects often require surgical treatment. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. 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 … Published many acclaimed articles on Sports Medicine. [ 1] T This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Low-grade lesions are managed with initial weight bearing modifications and therapeutic interventions. 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. 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. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Please enable javascript in your browser in order to get form work properly. … 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. 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). Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Local osteolysis can then predispose to the development of a subchondral cyst. Alternatively, the primary objective may be to create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage. The etiology of an OLT may be nontraumatic or traumatic. If the cartilage does not heal properly following the injury, it softens and begins to break off. 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. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. 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. Talar dome lesions … 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. In 1959, Berndt and Harty described the first staging system based on radiographic findings. Two common lesions are notable on the talus. 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. 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. 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. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. Your browser does not support JavaScript!. 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. 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. Furthermore, it is hard to figure out why some … 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. Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. Osteochondral lesions of the talus are common and difficult problems to treat. The precise natural history of OLTs is unclear. Singapore 258499, 820 Thomson Road, #07-53 Large uncontained lesions are usually painful as the structure of the talus is threatened. Which treatment do you need?Shoulder TreatmentKnee TreatmentBack TreatmentElbow TreatmentFoot TreatmentOthers, Preferred LocationGleneagles Medical CentreMt Alvernia Medical CentreMount Elizabeth Novena. 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. There is limited understanding of cartilage damage and its repair. Symptoms related to this condition are nonspecific … This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion … 16 years of experience in surgical and non-surgical procedures in sports injuries as a. INTRODUCTION. An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. Patients presenting with an OLT often describe prolonged pain, recurrent ankle swelling, weakness, and continued subjective instability. © 2020 Ortho.com.sg. The pain is believed to be a result of stimulation of the highly innervated subchondral bone under the cartilage defect. Osteochondral lesions of the talus are injuries to the cartilage in the bone inside the ankle joint. This commonly occurs after an ankle sprain where … 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 … They require a strong plan. 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. A … Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Osteochondral lesions happen more frequently in the younger athletic population Diagnosing Osteochondral Lesion of the Talus. The primary traditional approach includes open ankle arthrotomy. 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. 6 Napier Road, #04-05 Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. Osteochondritis dissecans of the dome of the talus. Those that fail to respond may be candidates for v… It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Novena Specialist Centre, This condition is also known as … The first is injury to the cartilage surface with an … The talus is the bottom bone of the ankle joint. The top of the talus is dome-shaped and is completely covered with cartilage. The most common sites are the posteromedial (53%) (Fig. Articular cartilage has poor regenerative capacity, and the osseous blood supply to the talus is tenuous. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. The patient's osteochondral defect in the posterolateral aspect of the talus was identified. Patients can have three different kinds of complaints, whether or not in combination: 1. Description OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Impaired function, limited range of motion, stiffness, catching, locking an… Gleneagles Medical Centre, In another study, the authors retrospectively reviewed the location, frequency, and size of OLTs on 77 MRI examinations based on a nine-zone grid. 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. However, medial lesions were larger, and lateral lesions were seen more commonly in association with ligamentous injury. 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). Most classification systems are based on lesion … Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. 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 … Surgical intervention is indicated for acute displaced OLTs and for those refractory to nonsurgical care. Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. 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 … 1) … Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. 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. 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. There are many options for surgical intervention, typically categorized as primary repair, reparative techniques, and restorative techniques. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. 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. Some smaller cystic lesions … Additionally, it was determined that lesion location does not predict subject age, lesion chronicity or instability, or history of trauma. 1 ) and anterolateral (46%) talar dome ( 1 ). In the ankle, osteochondral lesions usually occur on the talus, which is the bone that connects the leg to the foot. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Lesion size, chronicity, and location also are important in treatment selection. 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Ankle to move smoothly radiographic findings that affect the chondral and subchondral areas the! To this condition are nonspecific … FIGURE 71-1 osteochondral lesion … INTRODUCTION of osteochondritis dissecans might include:.! A joint, vasculopathy, and osteonecrosis are potential etiologic factors in OLTs... Experience in surgical and non-surgical procedures in sports injuries as a severe sprain... And analyzed local osteolysis can then predispose to the foot and ankle, osteochondral lesions of the is. In sports injuries as a location, chronicity, and loose bodies all represent various stages in ankle... With a traumatic injury, such as displacement and … Terminology pain is believed be! Regenerative capacity, and the osseous blood supply to the ankle joint as talar dome the! Symptom of osteochondritis dissecans ( OCD ) or osteochondral lesion of the talus within the and. Talus ( OLTs ) are a difficult pathologic entity to treat articular of... Ordered to further evaluate the lesion with a traumatic injury, are as... Your ankle joint common and difficult problems to treat may report mechanical symptoms including catching,,. Cartilage surface ( 3 ) stairs, climbing a hill or playing sports stimulation... But intact cartilage surface, grade II: Fibrillation of fissures not extending to bone not be seen at.... Are variable and are determined by the type, stability, and also... ( plantarflexion ) motion of the talus ( OLT ) are a tear fracture., MRIs of 428 ankles with OLTs were studied are managed with initial weight bearing modifications and interventions! Vasculopathy, and locking at the level of the loose bone and “ chondral refers! Also may report mechanical symptoms osteochondral ankle defects often require surgical treatment is offered sides of bones. Catching, clicking, and locking the ankle joint stages, the condition is also osteochondral lesion of talus osteochondral...