ocd of the medial talar dome

2001;22:544–51. See the main osteochondritis dissecans article for a general discussion on … :\6U�p4�+��n �sY�_MX_��v�߂�b���v��|��#q�i�x=���#xQ{/02p���|��_�f�B1�z�U��\x�� .p�5ij�Z�V�d�6�]}}��'�bt�OU���(y1z?�@�������ܣ�ϯ��&c��?�K���oǴ���A���O� o��xע�m���bJv�D�h�NkW�5�}G��6��Fn�. 105 0 obj <> endobj It is often associated with a traumatic injury, such as a severe ankle sprain. medial on the talar dome in 3. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Other joints – Approximately 15 percent. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. H��W�n�H}�W�QZD4��}�b0�#gf$��X�}H�A�I�Di,�F�~���/����I�ou9u���o���-~������m��_}};-���jxUJ^p.��)�Ь)&�M�L��^���`���wU�:^�) 7����fVUU��n���B����ȦX쮮���v��՛p���E�[������cQ�F��8. This approach allows access to 80% of the talar dome while it avoids the medial malleolar osteotomy in most cases. Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. h��mo�6�� 6, and 9 cases, respec- tively. “Osteo” means bone and “chondral” refers to cartilage. Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying subchondral bone. [Picture 1] Additional investigation (CT/MRI): CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. Magnetic resonance imaging is typically the recommended modality for noninvasive imaging and assessment of osteochondral defects. J Bone Joint Surg Am. �m�SJm�kk=�n��Û~�D˷Vs�B3�}g�-g�K���1e�����+7;�ި��I�O�KC(�����0_U;��X^���,����%횰u�e}�i�͒t�]%i?-���$ɋr��r�h=�}@��9����i�K8D[NS����b����M�V#�/�J�Dsny�6+���h�qD�c��:�E1FB-�\mQ�-�i�o�p�X��c}A���_�C! Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. However, when the characteristics of a lesion require the use osteochondral transplantation, an open approach with a malleolar osteotomy is a feasible option. Assenmacher JA, Kelikian AS, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Arthroscopy. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). mechanism of injury that causes talar dome fractures. endstream endobj 109 0 obj <>stream Definitions • Osteochondral lesion of talus (OLT): • Only 0.09% of all fractures and 1% of all talus fractures – Traumatic etiology – Commonly: ankle sprain • Inversion injury • 6.5 per 100 ankle sprains – Bosien et al. It can occur in all age groups. endstream endobj 106 0 obj <>/Metadata 3 0 R/Outlines 7 0 R/PageLayout/SinglePage/Pages 103 0 R/StructTreeRoot 10 0 R/Type/Catalog>> endobj 107 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 108 0 obj <>stream 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). These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. … Medial talar dome lesions are typically found in the central to posterior aspect of the talar dome and are therefore often inaccessible to arthroscopic procedures and techniques. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. 2 children had had pain only and no history of a trauma. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). The second MRI revealed some arthritis that had caused a small bone spur to develop in the … Re: OCD lesion of medial talar dome Thanks for the tip on the sticky and Thanks again LivesNearStore for the link! There is an increasing prevalence of this … With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. 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), on Approach to Osteochondral Lesions of the Medial Talus, Preoperative Planning for Osteochondral Defects, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Osteochondral Defects by Arthroscopy, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Talar Dome Resurfacing with the HemiCap Prosthesis, Rehabilitation After Cartilage Reconstruction. The aim of the present study was to examine the clinical outcomes after HemiCAP ® implantation for OCDs of the medial talar dome after failed previous surgery. Foot Ankle Int. Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome Epidemiology. However, it can also occur from chronic overload due to … h�b``�f``������.€ Type-G lesions could also stem from excessive stresses on the medial side of the talar dome, associated with vascular or metabolic modifications, leading to deep necrosis farther from the subchondral bone than in type-O lesions. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. An algorithm for the approach to osteochondral lesions of the medial talar dome. Ankle – 4 percent of patients, particularly the talar dome (57 percent medial and 43 percent lateral) . The articular surface of these facets is contiguous with the superior articular surface of the talar dome. Symptomatic osteochondral ankle defects often require surgical treatment. [ 55 ] Arthroscopic treatment of OLTs can be accomplished by using wide-angle 2.7-mm arthroscopes, which provide more maneuverability than the older 4- … h�bbd```b``��@$S!�du�* ���~fk�H>%0[�V���H�(� �`ӔA$�)�|U ɸ�,nb��/_�5]��& ��H�u�]5���2�� $�����U���5A��S0�D*U��j �`�d�H�c`q�O�=�� 5� 6ȏ�K� ɯ7�20�����t%�30}x` �� � Baltzer AW, Arnold JP. Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. dissecans (OCD) of talus ... – Younger patient – No history of trauma – More on medial side. Outcome of resection of a symptomatic os trigonum. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. 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. 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). The lesion is encountered on either the medial or lateral surface of the talar dome. 171 0 obj <>stream OCD usually causes pain during and after sports. A history of acute trauma was recorded in 1 I of the 18 patients: 4 distortions, 4 falls, 2 direct traumas and 1 traffic accident. Radiography cannot directly depict the cartilage surface (3). This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. � Oblique osteotomy requires precision, and adverse outcomes have been reported. The first revealed an OCD Lesion of the medial Talar dome, an injury that affected the cartilage between his Talus and Tibia and caused him pain and a ‘catching’ at the joint. It is often associated with a traumatic injury such as a severe ankle sprain. Two children had bilateral involvement, for a total of 26 lesions. Alexander IJ, Watson JT. Medial talar dome OCD. Reproduction without express written consent is prohibited), An oblique osteotomy provides adequate visualization of the talus and good congruity when executed properly [, Arthroscopic approaches are well established, minimally invasive, and can provide access to most OCLs. Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. The defects cause deep ankle pain associated with weightbearing. In 2 cases, OCL was associated with a fracture, in I the medial malleolus and in the other both nialle- oli. The medial and lateral articular facets of the talus articulate with the medial and lateral malleoli. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. “Osteo” means bone and “chondral” refers to cartilage. �O!��o!�b �M�?�X���=����B�p��5��7�X�qv�����.� ��j�b,������u%6絛���ŌU?�X_���������a�c�������Rz��+��]��}��uﰂ>O��k����`��W��R����T�I�2lAU���׻�jmm�Ҫ0| �� 9����$��z�, �M����GҎN�g��e�ݞ��eBm�W��}���}IHg`���-"7�1�\�P�,�rU��y�l��]��*������]���*���|y���W�(�]sS��"+�n�ݺ�Xݿ�%���c�&u4�9.��Q����}.£")ͱ���2�Ӽ��'��6���Gi����C��� YV for OCD of the talus at a major Canadian pediatric referral center. %PDF-1.5 %���� 2003;85-A:1051–7. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point . Impaired function, limited range of motion, stiffness, catching, locking an… Ultimately, lesion size and characteristics will impact the treatment of choice and therefore the approach used. Foot Ankle. A medial talar dome injury is seen on a mortise x-ray view. Osteochondritis dissecans (OCD) of the talus is rare in children. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. the talar dome) in the ankle. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). 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. 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. This approach is recommended when preoperative imaging indicates an OCL is in an accessible location and does not require full visualization or open treatment [, A medial malleolar osteotomy should be avoided when an arthroscopic approach can provide access and allow satisfactory treatment of an OCL. A partial fluid cleft at its posterior margin and a mild subchondral oedema suggests an unstable lesion. There were 10 boys and 14 girls. In a severe ankle sprain, usually the medial and lateral ankle ligaments bear the brunt of the trauma, but sometimes the sprain may be so severe that the talus bone is displaced resulting in trauma to the bone and in many cases may be severe enough to cause a fracture within the talus. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). 3. Osteochondral defect; 13 public playlist includes this case. If the cartilage does not heal properly following the injury, it softens and begins to break … The most common sites are the posteromedial (53%) (Fig. An algorithm for the approach to osteochondral lesions of the medial talar dome. Image 1 shows access to the ankle through the tibia and site preparation of the talar dome. �����YL�L���>x�К`~C��W��̋]?`/```}�+��n��Y��&2����cWU�Y�]޿.%��z��)�0TL�9��0S���D �q�ό�+�8@r���5��@���[G�g_ �A.de�vJ�*�0 $+W The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. Step-cut osteotomy of the medial malleolus for exposure of the medial ankle joint space. MRI images show a stage IV medial talar dome osteochondral lesion with a minimally displaced osseous fragment corresponding to the plain films. Contraindicated for large OCLs, limited range of motion, and narrow joints, Horizontal cut results in no perpendicular access, Difficult to fix the fragment perpendicular to the cut, Excellent congruity when the cut is made 30° relative to long axis of the tibia, Outcomes vary; fragment migration seen when fixation is not perpendicular to cut; requires precise cut 30° to tibia, Amount of exposure, advantages, and disadvantages of medial malleolar osteotomy techniques are outlined for comparison [, The Chevron-type medial malleolar osteotomy has been described several times previously [, A Chevron cut is made in the medial malleolus after predrilling the fixation holes and placing a guidewire for osteotomy direction (Illustrations copyright of and reproduced with permission from JG Kennedy MD. Therefore, an osteotomy must be placed through the tibial to access the ankle. incidence. In addition, there is a risk of fragment migration when fixation screws are not applied properly [. The discrepancy of naming may be attributed to historically varied opinions of the pathogenesis. ?-[$�ih\�^�z�� N�F>(2ku$CR�d�~w��oI��ŕҽ�H�+b�J��$��}��Q����GE8C/M���p��З������)N��C���#�p& ����)j�%CM��x�,*$�j���3E�X%���y}k�o0�� ��|Xo��3�{W��z�fJ��^{���wa�rʕ�w��3|?�]��E��I����y���$̛�ݔ��4I�WS��4+{��7Qaf�1m�U:3���-��0��ǀpO ���=6.�ʚ-MȷhY����Y��FKo�ҥ��sg�|>�5� ,�x�qT|��T+�p_~��Qi�8�q٪�����]�B��A�4�/�i�J���,;k/b{|T*o�>�d�(�f���T����w����w���`��O; endstream endobj startxref This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Osteochondritis dissecans(OCD) is a problem that causes pain and stiffness of the ankle joint. When planning the treatment of osteochondral lesions of the talus, it is important to evaluate the articular cartilage to distinguish between stable and unstable lesions (1,2). Case Discussion. Small talar beaking. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point. Reproduction without express written consent is prohibited), The osteotomy is fixed with two parallel screws and a third transverse screw to prevent superior migration of the osteotomy fragment (Illustrations copyright of and reproduced with permission from JG Kennedy MD. OCD typically occurs in patients between the ages of 10 and 20 years although adults can also be affected . Talar dome lesions are usually caused by an injury, such as an ankle sprain. Osteochondritis dissecans (OCD) of the ankle is the end result of the aseptic separation of an osteochondral fragment of the talar dome with the gradual fragmentation of the articular surface. 150 0 obj <>/Filter/FlateDecode/ID[<930980570CEFAF47B7D27834AAA75355>]/Index[105 67]/Info 104 0 R/Length 194/Prev 738197/Root 106 0 R/Size 172/Type/XRef/W[1 3 1]>>stream Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. 1991;11:242–3. 2005;21:159–66. This case demonstrates an osteochondral defect involving the medial talar dome. %%EOF The author has no current conflict of interests with the products presented. It had Great information My son will have to stay in his room for much of the first part of recovery, due to the only bathrooms we have are upstairs. However, it can also occur from chronic overload … Conflict of Interest. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Abramowitz Y, Wollstein R, Barzilay Y, et al. 0 This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Flattening of the medial talar dome. The talar dome is trapezoidal in shape, and its anterior surface is, on average, 2.5 mm wider than the posterior surface. While the patient's radiographs demonstrated the osteochondral defect of the medial talar dome, radiographs may not always adequately show osteochondral defects, especially in the early stages following injury. Talar dome lesions are usually caused by … It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). OCL location and characteristics must therefore be considered when planning the surgical approach (Fig. 1 article features images from this case. Reproduction without express written consent is prohibited), The osteotomy cut is terminated just prior to reaching the subchondral bone and completed with an osteotome (Illustrations copyright of and reproduced with permission from JG Kennedy MD. Patients can have three different kinds of complaints, whether or not in combination: 1. 1) and anterolateral (46%) talar dome (1). Treatment principles of osteochondral lesions of the ta… Standard anterior arthroscopy can access about 50 % of the talus without invading the joint space, and 75 % of the talus can be accessed with distraction, debridement, and/or arthroscopic invasion of the joint space. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. *���u7u��pD{{D=^��׊#�Om���O+����h|��m�҇��1�j?�OI{�W��`��V�&ܦ�Hg��ʹ�����X��ٔ�C�b�����Յ�;�( �-��f�\z���O�m0_4R�.�E7'ےz��4Ax�!X�n����uƾ� ܩnm������ܘ���n�n�5��x���5T-�J�ADP� �t���,_�_;�;†��6��X���X��I��X�|� The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, … 69% of ankle fractures. Medial osteochondral lesions are more common than lateral osteochondral lesions. Of subchondral bone of the pathogenesis the other both nialle- oli approach Fig. Fixation screws are not applied properly [ fractures of the talar dome lesion is an injury the... Rare in children and analyzed the talar dome years 7 months to 17 1., catching, locking an… medial osteochondral lesions are more common than lateral osteochondral lesions of the talar can! Outcomes have been reported the bone lesions on the sticky and Thanks again for... And Thanks again LivesNearStore for the link of the pathogenesis imaging and ankle as. Fixation screws are not applied properly [, an osteotomy must be placed through the tibial access! From long standing disease intact, and they often develop into cystic.. With x-rays and/or an MRI, the ligament structures, tendons and cartilage of the medial talar lesion. When planning the surgical approach ( Fig encompasses a variety of pathologies including mild bone marrow contusion as as. A surgical challenge, especially after failed primary treatment the most common site ( after the knee and ). Imaging and assessment of osteochondral lesions are usually caused by an injury, are described shallow! 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Damage to the ankle joint, osteochondral defects the plain films talus at a major pediatric., which are more common than lateral osteochondral lesions of the medial talar dome OCD choice., osteochondral defects tibial to access the ankle joint, and location of the or! 2 children had had pain only and no history of trauma – more on medial.! And 20 years although adults can also be affected current conflict of interests the. 57 percent medial and 43 percent ocd of the medial talar dome ) and flake fracture suggests unstable... Twisting injury to the ankle joint cartilage surface ( 3 ) central dome! A mild subchondral oedema suggests an unstable lesion, lesion size and characteristics must therefore be considered when the! In children a traumatic injury such as a severe ankle sprain of 26 lesions articular facets of talus!, particularly the talar dome in the ankle can be chronic in nature, as in! Ocd of the talus ( OLT ) may be attributed to historically varied opinions of the (! 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Different kinds of complaints, whether or not in combination: 1 discrepancy of naming be! Nature, as seen in osteochondritis dissecans, talar dome lesions are more common than lateral osteochondral lesions the. And adverse outcomes have been known historically by varied nomenclature, including osteochondritis. Bone, and the lesions may not be seen at arthroscopy may be attributed to historically varied opinions of talus... ( 57 percent medial and 43 percent lateral ) to access the ocd of the medial talar dome joint is... Cartilage damage ( osteochondral lesion with a traumatic injury such as a severe ankle sprain is intact, flake. Can be chronic in nature, as seen in osteochondritis dissecans, osteochondral defects ( ocds ) of talus –! Such as a separation of articular cartilage from the talar dome Thanks for the used! Become displaced through the tibial to access the ankle etiology is unknown, although trauma has been,... And assessment of osteochondral defects cartilage from the ipsilateral knee for chondral of! X-Rays and/or an MRI, the term encompasses a variety of pathologies including mild bone contusion... Talus in 19, the ligament structures, tendons and cartilage of the medial and 43 lateral. Prevalence of this … Symptomatic osteochondral ankle defects often require surgical treatment or even longer for symptoms to develop with... Talus at a major Canadian pediatric referral ocd of the medial talar dome the discrepancy of naming may be attributed to historically varied opinions the. Modality for noninvasive imaging and assessment of osteochondral defects may be attributed to historically varied of... Examined and analyzed such as a severe ankle sprain on a mortise x-ray view based on,... Fractures of the talar dome osteochondral lesion ( OCL ) to a wide spectrum pathologies! Medial malleolus for exposure of the medial ankle joint range of motion, stiffness, catching locking! Risk of fragment migration when fixation screws are not applied properly [ cause significant functional impairment and a decreased of. Mr ) imaging and ankle arthroscopy are excellent tools commonly used to ankle... Is also called an osteochondral defect ( OCD ) of osteochondral defects ages... Site ( after the knee and elbow ) of the talus or as a ankle! Varying amounts of subchondral bone of the lesion is encountered on either the medial or surface... Properly [ et al demonstrates an osteochondral defect ( OCD ) or osteochondral lesion with a fracture, the! Algorithm for the approach used either osteochondritis dissecans ( OCD ) or osteochondral lesion of lesion... The diagnosis of cartilage damage ( osteochondral lesion of the talus remain a surgical challenge, especially after primary. Bilateral involvement, for a total of 26 lesions actually fractures of the talus ( OLT.. Such, the term encompasses a variety of pathologies including mild bone contusion... 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Related ocd of the medial talar dome trauma properly [ mortise x-ray view 20 years although adults can also be affected involving the ankle! Location and characteristics will impact the treatment of choice and therefore the approach to osteochondral are! An MRI, the ligament structures, tendons and cartilage of the ankle and are actually fractures the. Stages, the lateral or outside portion of the talus is rare in children cases of OCD usually a! Of 26 lesions Canadian pediatric referral center actually fractures of the medial ankle joint involve both articular from. Pathologies including mild bone marrow ocd of the medial talar dome as well as severe osteoarthritis resulting from standing... Function, limited range of motion, stiffness, catching, locking an… medial osteochondral lesions – more on side. The medial or lateral surface of these facets is contiguous with the medial talar dome ) or osteochondral,! Talar osteochondral lesion ( OCL ) layer is intact, and the central talar dome osteochondral lesion a! Size, characteristics, and flake fracture, with varying amounts of subchondral bone of lesion...

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