A second point to consider is the level of activity the patient would like to return to. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. Osteochondral defects generally linger or get worse unless they’re treated. Employ CT scanning to check for a solid repair at the six- to eight-week point. Osteochondral Lesions of the Talus Sara Lyn Miniaci-Coxhead, MD 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. Often, performing an injection of local anesthetic into the involved joint will reduce pain but clinicians should not rule out other problems such as loose bodies, synovitis and ligament injury. An X-ray may be ordered, but a cartilage tear is difficult to see on an X-ray, so a magnetic resonance imaging (MRI) or computed tomography (CT) scan may be required. 108. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. The prevailing thinking is that magnetic resonance imaging (MRI) is better in cases of pure cartilage damage or for superficial lesions while computerized tomography (CT) is better for cystic lesions and lesions that involve both cartilage and bone injury. Treatment. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1.In adolescence, the cartilage‐bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2.The biomechanical strength of immature osteochondral junction was lower … bone graft may be placed if underlying cyst and bone loss. Most commonly, a surgeon will perform an arthroscopic exploration and treatment. The treatment approach of the osteochondral lesion is influenced by a number of factors, such as: location and size of the lesion, presence of secondary degenerative changes. With an inversion or eversion stress on the ankle, the talus and tibia and/or fibula will contact each other with a massive stress, resulting in a compression or shear stress on the surface of the talus and underlying injury. INTRODUCTION. The treatment approach of the osteochondral lesion is influenced by a number of factors, such as: location and size of the lesion, presence of secondary degenerative changes. Treatment depends on the severity of the talar dome lesion. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … It can be challenging to diagnose an osteochondral lesion at the time of injury. The most common cause is from a crush or injury to the surface of the bone during the abnormal motion of the ankle in a sprain. They require a strong plan. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Conservative care of osteochondral lesions is difficult. Lesions can be stable or unstable. Usually, an osteochondral lesion occurs when there is an injury to the joint, especially if there is an ankle sprain or if the knee is badly twisted. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. However, in most cases, the MRI gives us enough information. Repetitive trauma has also been associated with the development of such lesions. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical treatment options may be considered: Immobilization. If the MRI shows a cystic lesion and we are concerned about the overlying cartilage and bone seal, and if there is a small fracture in the overlying subchondral bone region, we will often get a CT scan after the MRI. FIGURE 71-1 Osteochondral lesion of the talus. Scranton PE and McDermott JE. An OLT is an injury to the cartilage and underlying bone of the talus within the joint, where it begins to soften and break off as a result of not healing properly. Treatment is split up into three grades, depending on how severe the injury is: Grade 1: This treatment doesn’t require any invasive procedures. Within the ankle, these lesions … There is a great deal of debate as to whether you should use autograft, fresh allograft or graft substitutes. In some cases, both an MRI and CT are needed to diagnose an osteochondral lesion. As always, it is essential to check for ligament laxity and tendon injury, and address both of these issues at the time of surgery if they are problematic. the lateral osteochondral defect. Operative Treatment . this is sutured … Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte … If a lesion is a corner lesion involving both the dorsum and lateral wall of the talus, remove the entire lesion with a saw and use a square block to replace the defect. If the fragment is unstable or loose in the joint, surgery may be necessary to remove and repair the injured area. We prefer the use of autograft and often harvest the material from either the calcaneus or distal tibia. Treatment. Patients may have an OLT that is present a… 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. Pain often occurs with an increase in activities such as sports and is not present with rest. If the damage is small, the surgeon may drill into the bone, which causes a small amount of bleeding and encourages healing. 109. When the latter is present, then joint replacement is often the only feasible treatment. This surgery may be performed open or arthroscopically. 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. If the fragment is unstable or loose in the joint, surgery may be necessary to remove and repair the injured area. 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; … 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: 1. The best option is a fresh allograft talus. What Orthotic Modifications Do Podiatrists Use The Most? © 2020 HMP. This may be followed with gradual progression of weightbearing and physical therapy. Treatments for lesions in the knee are more challenging, but also have promising outcomes. Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. When there is a break, tear, separation, or disruption of the cartilage that could be referred to as an osteochondral lesion… Foot and Ankle International, May 2001; 22(5): 380-384. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions … A medial lesion was reproduced by plantarflexing the ankle in combination with slight anterior displacement of the talus on the tibia, inversion, and internal rotation of the talus on the tibia. Peroneal Tendon Dysfunction: Why Peroneal Tendon Tears Should Be Treated Like Posterior Tibial Tendon Tears. Microfractures, are often considered the first-line surgical treatment option due to the low costs and ease of the technique (34-38), while ACI is rather reserved as a salvage procedure (39-41, 45). The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. The damaged cartilage is cleaned out and removed. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. 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. Then you fill the region with either allograft or autograft. 108. Osteochondral lesions of the talus occur for several reasons. By Jeffrey E. McAlister, DPM, FACFAS, and Eric So, DPM, AACFAS |. Clean out the lesion with a small curette and debride the sclerotic walls. Cartilage is a connective tissue that covers the bones between joints. Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage and bone tissue from the joint. The past several “Treatment Dilemmas” columns have dealt with the treatment of chronic ankle pain subsequent to an ankle sprain (see page 92, July issue and page 88, September issue). The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Non-surgical treatment is appropriate for certain lesions and usually involves immobilization and restricted weightbearing. The most common surgical procedure for an osteochondral lesion is an arthroscopic exploration and treatment. In the ankle, osteochondral lesions usually occur on the talus, which is the bone that connects the leg to the foot. Our preferred technique is to use a 0.62 K-wire and drill lesions in the posterior medial region that cannot be reached with a chondral pic through a medial incision approach. However, if the osteochondral lesion is identified at an earlier stage, other treatment solutions are feasible. One should physically examine the ankle to check for instability and tendon or ligament injury. Each type of injury will have different treatment options and require a different type of workup. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical … Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. Most of the lesions requiring surgical treatment are posteromedial in location, have poor quality articular cartilage, a loose bone fragment, necrotic bone beneath the lesion, and are poor candidates for healing with internal fixation. Scranton PE and McDermott JE. In our hands, we will get an MRI as our primary diagnostic test as it gives us information on the ligament, tendon and synovial regions as well as the osteochondral lesion. A medial lesion was reproduced by plantarflexing the ankle in combination with slight anterior displacement of the talus on the tibia, inversion, and internal rotation of the talus on the tibia. We have found equally good outcomes with the use of autograft and fresh allograft, and therefore use the fresh allograft as our primary option. Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. At earlier stages (stage 1 to 4), a number of options exist including: osteochondral … Then using a microvector guide, the surgeon would drill a tunnel from the sinus tarsi region into the cystic lesion with a guide pin. All Rights Reserved. This type of treatment is best in large lesions with a major defect of over 1 cm with extensive depth. Younger patients, particularly … Over the next few years, one may be able to begin treating cartilage lesions with cartilage cell transplants through an injection and with cartilage caps. All Rights Reserved. In the knee, such cartilage damage can occur between the femur (thigh bone) and the tibia (shin bone). How To Diagnose And Treat Osteochondral Lesions Of The Talus, How To Assess And Treat Ligamentous Laxity Syndromes In The Foot And Ankle, Pertinent Pearls In Evaluating And Treating Chronic Ankle Instability, Current Best Practices In The Treatment Of Plantar Plate Tears. This is the most common type of injury that will require care. Individuals who play sports such as soccer, football, rugby and golf may be at risk of an osteochondral lesion. Although the treatment of osteochondral lesions of the talus has evolved and improved, there is a need to understand the full spectrum of treatments and be well-versed in all forms of treatment in order to have a complete bag of tools necessary to treat these complicated occurrences. After the initial pain and discomfort of a strain or sprain subsides, individuals usually resume or even increase their activity level. A 501(c)(3) non-profit organization, Osteochondral Lesions/Osteochondritis Dessicans, Translation is unavailable for Internet Explorer. The goal of treatment is to ease pain and get your child back to using their joint normally. After performing this procedure, one should emphasize non-weightbearing for six to eight weeks and again use a CT scan to check healing. The type of surgery that is most effective depends on the size, location and severity of the lesion. I hope the information presented is helpful for your patient care. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. In cases of osteochondral lesion, the patient will begin to experience swelling and pain in the ankle with this increased activity. “Osteo” means bone and “chondral” refers to cartilage. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. The treatment of an osteochondral lesion is based on the stability of the lesion. Diagnosing an osteochondral lesion is very difficult on a physical exam and one rarely diagnoses this without further testing. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The treatment approach is based on the size, location and degree of separation of the bone and cartilage. Operative treatment might also be necessary if … Dr. Baravarian may be reached at bbaravarian @mednet.ucla.edu. Choose a doctor and schedule an appointment. Operative Treatment . In this type of lesion, the pain is from the constant compression of the cyst with activity but there is no overlying damage to the cartilage and bone. 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. In order to treat the problem properly, one must diagnose the cause, the amount of injury and the residual problem present. The goal of non-surgical treatment is to allow the injured cartilage and bone to heal.  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