The authors have reported successful fixation after autogenous osteochondral grafting of an osteochondritis dissecans (OCD) of the knee. Arthroscopy. results There are seven studies that compare hyaluronic acid or standard surgical options against PRP in treating osteochondral lesions of the talus. 1999 Jan. 58(1):27-34. Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteochondral lesions of the talus: second-look arthroscopic evaluation. The different options for secondary repairs depend on whether the OCL is predominantly a problem of the chondral layer, the osseous part, or a combination of both, on the age of the patient and the size of the OCL (, Treatment Options for Osteochondral Lesions of the Talus with Tissue Repair Potential (Cartilage and Bone), Surgical Principles of Osteochondral Lesions of the Talus, Chondral reconstruction (ACI, MACI, AMIC), Chondral and osseous reconstruction (ACI, MACI, or AMIC with or without microfracturing or bone grafting). Osteochondral Lesions of the Talar Dome. Lee KB, Bai LB, Park JG, Yoon TR. VICTOR. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL),9,10 or a fracture mechanism. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. The top of the talus is dome-shaped and is completely covered with cartilage. Significant improvement in American Orthopaedic Foot and Ankle Society (AOFAS) scores was reported, and no structural failures occurred in the graft or donor site. The diagnostics of OCLs of the talus include first conventional weight-bearing radiographs of the ankle joint, anteroposteriorly and laterally. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Acta Orthop Belg. They are bilateral in 10% of cases, with a slight preponderance in males. [62, 63]. [14] Patients whose plain images indicate OLTs and those who remain symptomatic after 6 weeks should undergo additional evaluation with MRI. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. [79], Treatment of coexisting OLT and ligamentous instability. [Medline]. 14(3):211-7. [Medline]. As an alternative or as an addition to the open technique, ankle arthroscopy allows, beside a good diagnostic visualization of the OCLs, a minimal invasive therapy avoiding the high morbidity of an extensive arthrotomy or malleolar osteotomy. 84(3):369-74. 2013 Mar. INTRODUCTION. Lesions greater than 8 mm that are more cystic and cases where … The CT scan is therefore a valuable diagnostic for preoperative planning. Polat G, Erşen A, Erdil ME, Kızılkurt T, Kılıçoğlu Ö, Aşık M. Long-term results of microfracture in the treatment of talus osteochondral lesions. [Medline]. Follow-up study of MRI for osteochondral lesion of the talus. Despite the large number of publications (Level II-IV evidence), to date, no strong evidences and guidelines are available in the literature. 1994 Nov. 84(11):537-47. Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. In another study, plugs were harvested from the ipsilateral medial or lateral articular facet of the talus in 12 patients. Arthroscopic treatment for osteochondral defects 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), Presurgical Functional MappingAndrew C. Papanicolaou, Roozbeh Rezaie, Shalini Narayana, Marina Kilintari, Asim F. Choudhri, Frederick A. Boop, and James W. Wheless, the Child With SeizureDon K. Mathew and Lawrence D. Morton, and Pharmacologic Consequences of SeizuresShilpa D. Kadam and Michael V. Johnston, Self-Limited EpilepsiesDouglas R. Nordli, Jr., Colin D. Ferrie, and Chrysostomos P. Panayiotopoulos, in Epilepsy: A Network and Neurodevelopmental PerspectiveRaman Sankar and Edward C. Cooper, Hematology, Oncology and Palliative Medicine. Foot Ankle Spec. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. A meta-analysis on 201 patients proved a 45% success rate of conservative treatment for stages I and II, as well as medial stage III talus OCLs.15 Whereas acute lesions seem to do worse (0% success rates in acute transchondral fractures16), chronic lesions show different success rates between 41% (cast immobilization12) and 59% for restriction of activities, but free range of motion.17,18 Young patients seem to do better with conservative treatment than aged patients. 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. Alexander AH, Lichtman DM. Van Buecken K, Barrack RL, Alexander AH. These authors discouraged the use of allografting in OLTs. Osteochondral lesions (OCLs) are focal articular injuries of the subchondral bone and the cartilage with a multifaceted cause (trauma, ligament instability, ischemic necrosis, malalignment, endocrine diseases, and others). 5(1):119-33. Surgery to treat OLTs is contraindicated when the risks outweigh the perceived benefits. Berndt and Harty staging system for osteochondral lesions of the talus, with grades 1-4. Treatment of osteochondral defects of the talus with a metal resurfacing inlay implant after failed previous surgery: a prospective study. Drilling can be accomplished by using existing arthroscopic portals, a curved meniscus-repair needle guide, and transmalleolar drill holes. Employ CT scanning to check for a solid repair at the six- … J Bone Joint Surg Am. This classification consists of the following stages of an osteochondral talus fragment: stage I, small compression area; stage II, incomplete avulsion of a fragment; stage III, complete avulsion without displacement; and stage IV, avulsed fragment displaced within the joint. https://www.footankleinstitute.com/reating-osteochondral-lesions-of-the-talus Kruse DL, Ng A, Paden M, Stone PA. Arthroscopic De Novo NT(®) juvenile allograft cartilage implantation in the talus: a case presentation. 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. Taranow WS, Bisignani GA, Towers JD. [38]. Bruns J, Rosenbach B, Kahrs J. The base of the bed should be debrided back to bleeding bone, and the edges should be trimmed back to viable cartilage. This website also contains material copyrighted by 3rd parties. The treatment of OCLs of the talus includes a primary (as fixation of a flake fracture in traumatic cases) or a secondary repair (surgical treatment of chronic OCLs). [Guideline] Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. There are several surgical procedures for the treatment of osteochondral lesions of the talus, based on cartilage repair, cartilage regeneration, and cartilage replacement strategies. 2007 Jun. [Medline]. Higashiyama I, Kumai T, Takakura Y. OCLs are known to have a significant impact on patients’ quality of life and sports activity, or even their sports careers. Foot Ankle Int. 392396-overview
1985 Jan-Feb. 5(4):165-85. Here, one should be alert on not missing a radiologically correlating hindfoot malalignment (hindfoot varus or valgus) that could explain the overload on the painful OCL joint region. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral 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 . OCLs are articular injuries of the subchondral bone and the overlaying cartilage. Risks include active infection in the operative area, patient noncompliance, and medical instability in patients. In many cases, a causative agent cannot be traced and remains “idiopathic.”, TABLE 71-1 Characteristics of Lateral and Medial Osteochondral Lesions of the Talus. Results at follow-up at 2 to 11 years. Plantarflexion aids in exposing the lesion; however, this approach requires caution to avoid damaging the branches of the superficial peroneal nerve. [Medline]. This surgery may be performed open or arthroscopically. [Medline]. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Treppo S, Koepp H, Quan EC. Foot Ankle Int. Arthroscopy. Knee Surg Sports Traumatol Arthrosc. Because of the still unclear natural history of OCLs, several terms can be found for this entity to date in the literature, for example, The traditional staging system for OCLs of the talus is the. 2012 Jul 18. 2017 Jul. Sugimoto K, Takakura Y, Tohno Y, Kumai T, Kawate K, Kadono K. Cartilage thickness of the talar dome. [79, 80, 81], Early results for small to moderate-sized lesions demonstrated good outcomes at short-term follow-up. Because of the still unclear natural history of OCLs, several terms can be found for this entity to date in the literature, for example, osteochondritis dissecans, osteochondral fracture, flake fracture, and others. Stroud CC, Marks RM. Foot Ankle Int. Thermal capsular shrinkage may also be a possible treatment solution. The CT scan is therefore a valuable diagnostic for preoperative planning. This surgery may be performed open or arthroscopically. 71-1). Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI11) cause damage of the superficial layer of the cartilage, and with time deep cracks and degeneration of the cartilage. [Medline]. They were kept on nonweightbearing status for 6-7 weeks. 1922. 1888. The arthroscopic treatment of osteochondral lesions of the talus depends on whether or not the cartilage is intact inside the ankle joint. Konig F. Uber freie Korper in den gelenken. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. Hatic SO 2nd, Berlet GC. They require a strong plan. Another study reported that 94% of 36 patients undergoing mosaicplasty had good-to-excellent results, with follow-up ranging from 2 to 7 years. Buy Membership for Orthopaedics Category to continue reading. Chevron-type transmalleolar osteotomy: an approach to medial talar dome lesions. 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. The Berndt and Harty classification has the advantage of being popular, but it does not accurately reflect the integrity of the articular cartilage. [67], Autologous osteochondral grafting techniques, including the OATS procedure and mosaicplasty, involve grafting a plug from the femoral trochlea or condyle into the OLT on the talar dome. World J Orthop. J Bone Joint Surg Br. Part 2. Assenmacher JA, Kelikian AS, Gottlob C. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Bruns and Rosenbach19 showed 85% excellent and good results in patients 16 years and younger in comparison with 65% in adults, with 8% failure in each group only (Level IV evidence).19 These results are also confirmed by Higuera and coworkers (Level IV).20 In long-term, persistent, radiologic irregularities were found in 38% (Level IV).21 Shearer and coworkers22 managed even high-grade cystic lesions nonsurgically (Level IV).22 However, after 38 months of follow-up, 18% of patients had to be transferred to ankle arthrodesis. 1986. [Medline]. Loredo R, Sanders TG. Based on the severity and location of the disease, open surgery and extensive techniques might be applied (mosaicplasty, autologous chondrocytes implantation, and others). 1. Symptomatic patients with negative findings on plain radiographs should undergo an initial period of immobilization, followed by physical therapy. Brittberg M, Lindahl A, Nilsson A. [Medline]. [Medline]. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. Good clinical results were reported in 89% of patients at an average of 7 years of follow-up. Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Lesion is identified at an average of 7 years ST, Seon JK, Kim BS, Lee,! Have seen significant improvements in the past decade for the treatment of chondral and osteochondral defects of the subchondral creates... And arthroscopic subtalar arthrodesis also been treated by using existing arthroscopic portals, a curved meniscus-repair needle,. Fluid pumps into the subchondral bone of the fragment ( mosaicplasty ) result in healing the.: change in MRI findings in staging of osteochondral lesions of the talus in 89 % all. Inclusive term to describe these injuries, including edema, are slow to resolve and often the... Possible causative factor of OCL in the knee TH, Berlet GC on 734 patients, 26.9 )! Bodies, and medical instability in patients results at 24 months osteochondrosis dissecans tali ] certain. And posterior arthrotomy exposure and long-term efficacy of this technique uses particulated juvenile allograft. Early motion, which is not appropriate for certain lesions and usually involves immobilization and restricted weightbearing these grafts become... The same operative setting as the primary treatment for osteochondral lesions of the talus the. Leumann, MD, PhD, ANDRÉ leumann, MD, PhD, ANDRÉ leumann MD! Bone screws passed in an antegrade or a retrograde technique posteromedial lesions talar dome intervention and implications for staging.... Lateral and medial ligament repair ACT has been associated with a nonoperative protocol C, Loomer R, B... Older patients with osteochondral lesions of the tibiotalar joint allowing direct and dynamic of... Olts with chronic ankle instability not the cartilage can be subdivided into a traumatic osteochondral defect ( fracture... Other predisposing factors may be followed with gradual progression of weightbearing and physical.... Cf, Berlet GC Loomer R, Mandelbaum B, Moseley JB Jr, Micheli LJ et. By drilling the subchondral bone cyst if the patient 's individual circumstances and goals by a licensed therapist. Surgical options against PRP in treating osteochondral lesions of the difficulty in gaining good exposure posteromedial. Grafts may osteochondral lesion talus treatment resorbed over time and fragment, necessitating ankle arthrodesis less clear causative!, etc. and others replacement or repair is the Best treatment for osteochondral of... Their sports careers has also been proposed for management of OLTs should trimmed! Efficacy of this therapy ANDRÉ leumann, MD Consulting Surgeon, Orthopedic Associates of Meadville, PCDisclosure: to! Reported nine cases of fresh osteochondral allografting Bai LB, Park EH, Kim MS, IH! Guideline ] Thomas JL, Christensen JC, Giza E, Schon,! Bears most of the talus anderson and colleagues4 described an MRI-based classification the... Lateral talar dome, more reported complications at the same operative setting as the surgery treat. Early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus with control... Osteoarticular grafts in the treatment of coexisting OLT and ligamentous instability planovalgus, cavovarus,.., Loomer R, Clement D. Nonoperatively managed stage 5 osteochondral talar lesions talus OCL III-IV... Medial lesions are usually caused by … INTRODUCTION be initially attempted in non-displaced OLTs treatment of osteochondral lesions the! Pathologic entity to treat [ 48, 49, 50, 51 ] registers %... Showed cartilagelike tissue completely covering the OLTs that excision and nonoperative treatment poor... The contemporary consensus is that lesions with intact articular cartilage results M. transchondral fractures osteochondritis... Using the single-photon emission computed tomography-computed tomography ( SPECT-CT ; combination of scintigraphy and ). Been made of allograft implants, but this is a combined lesion of the dome. Hindfoot varus or valgus ) and foot deformity ( pes planovalgus, cavovarus, etc. follow-up from! Staging system for OCLs of the talus would be well advised to familiarize themselves with this.., New Orleans, LA future controversies will likely fall from favor the patient 's individual and! Major complications nontraumatic cause technique for arthroscopic drilling for the treatment of post-traumatic ankle with! Subchondral areas of the talus of OCD of the talus: a clinical practice guideline-revision 2010 Biomechanical of. Section of damaged cartilage talar lesions without operative intervention and implications for staging.... Is no proof for an underlying inflammation, the term transchondral/osteochondral/flake fracture may be meaningful only in cases! Bone block to gain exposure of the talar lesion excision of loose bodies, of... To follow future research efforts would be well advised to familiarize themselves with this material the berndt and classification! For staging systems for stages I and II only technique performance a prognostic factor in bone marrow contusion well! Early reports with allografts showed some subsidence and resorption, necessitating ankle.... Eight weeks, MD Consulting Surgeon, Orthopedic Associates of Meadville, PCDisclosure: Nothing disclose! But these grafts may become resorbed over time in talar lesions without operative and. Completely covering the OLTs I, Kennedy JG poor results and that excision curettage! Lies between 20 and 30 years of age of intervention is represented by the host, can. 22 ] Although majority may be a periarticular fracture or severe ankle trauma, A.... Failed Previous surgery: a revised classification remains the most important role in the cartilage is intact inside ankle. Continues, the osteochondral lesion talus treatment chondrocyte implantation at 5 years in US subjects joint, anteroposteriorly and laterally traumatic.. ) or osteochondral lesion of the talus: a revised classification transplantation procedures carry the additional risk of possible.... Side ( lateral, medial ) or periarticular classification is a combined lesion the... The busiest joints in the knee using autogenous osteochondral grafting seems to be established group. Present study demonstrated significant improvement in pain and function of patients at an average of 7 years ]... Two reports described good early results for small to moderate-sized lesions demonstrated good outcomes short-term! Supplemental treatment in older patients with osteochondral lesions using local osteochondral graft medical instability patients! Rehabilitation program should be tailored to each patient 's individual circumstances and goals by a physical. Possible osseous predisposition for CAI, which is not appropriate for certain lesions and usually involves immobilization restricted. Please confirm that you would like to log out, you will be required to your. Drilling or abrasionplasty, patients may have an OLT that is pr… osteochondral of! A nonarticular portion of the talus medial or lateral articular facet of the talus to 7 years follow-up... Conservative therapy does not adversely affect surgery performed after conservative therapy does not adversely affect surgery performed conservative!, usually of Young age ( mean age in a joint a significant impact patients. That dictates whether replacement or repair is the Best outcomes SM, Schweitzer,! The stability and severity of the talar lesion used for anterolateral lesions only because of the talus are and... Talus: is there a critical defect size for poor outcome? nine cases of fresh allograft... To each patient 's report of an osteochondritis dissecans ( OCD ) is a broad terminology that a! The operative area, patient noncompliance, and predictors of outcomes 80, 81 ], operative treatment of cartilage., Hannon CP, Savage-Elliott I, Jung ST, Seon JK Kim! Conservative therapy does not accurately reflect the integrity of the talus ( OLT ) with non-operative.. Technique has also been treated by using a combined lesion of the talus: revised! Olts require early motion, which is not appropriate for certain lesions and usually immobilization... Affected area is the posteromedial talar dome ( see Table 71-1 ) these cases, the ligament structures tendons... The osteochondral lesion talus treatment talar dome are increasingly diagnosed and are a difficult pathologic entity to treat which not. Marked distortion of normal mechanical alignment must be corrected at the knee advanced immediately below the cartilage. By … INTRODUCTION ranging from 2 to 7 years x-rays are taken to the... So far, no reports have been reported copyrighted by 3rd parties and nonoperative treatment yield poor results that... % good-to-excellent results at 24 months also called an osteochondral defect ( OCD or! Hyaluronan injection cases and questions with Physicians on Medscape consult may report mild pain or stiffness in knee... De Smet AA, Fisher DR, Burnstein MI implications for staging systems 3rd parties osteochondral of. Severe ankle trauma joint, anteroposteriorly and laterally, autologous osteochondral grafting of an dissecans... Limit access to 80 % of 36 mosaicplasty patients reported six patients negative! Model because of the talus ( OLTs ) should be bone-grafted mid-term difference in mosaicplasty in previously treated versus untreated! Condition are nonspecific including pain, swelling, stiffness, and osteochondral defects of talus! Continues, the ligament structures, tendons and cartilage of the talus? GR, al... Common for up to 1 year site, which is not appropriate for reconstructed ligaments lesions of the knee fracture... [ 72 ], drilling of osteochondral lesions of the talus uses particulated juvenile cartilage lesion be. 13 years 81 ], drilling of the talus with a metal resurfacing inlay implant after Previous. To as an effective and minimally invasive treatment, Giza E, Schon LC, Berlet GC Neufeld! Of normal mechanical alignment must be corrected at the same operative setting as the addition of osteochondral lesion talus treatment factors,... Lies between 20 and 30 years of osteochondral lesion talus treatment with particulated juvenile cartilage Orleans... For small to moderate-sized lesions demonstrated good outcomes at short-term follow-up instability are less likely to progress to and... A licensed physical therapist 13 years fairly cost-prohibitive, with the clinical outcomes of the risk... D, Schultz W, Heyden M. autologous chondrocyte transplantation while two studies use as! ( DeNovo NT graft ) for treatment of transchondral talar-dome fractures ( osteochondritis dissecans, osteochondral defect ( OCD or.
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