J Bone Joint Surg Br 1982; 64(4): 494-7. Hermanson E, Ferkel RD. 1999;20(12):789-93. Osteochondral lesions of the talus. The articles are high standard and cover a wide area. In addition, Kono et al. An osteochondral lesion to the talar dome is an injury that causes damage to the cartilage that sits on top of the talus. Foot Ankle Int 2011; 32(3): 233-8. The functional outcomes after conservative treatment of OLT have been described in the literature with variable methods and results [4, 16, 30, 41-44, 46, 47]. Knee pain was reported in 5-50 percent after using autograft from the knee joint [117-119, 121, 125-126]. Débridement, Abrasion, Drilling, and Microfracture ... disputed in a large case series that showed no correlation between outcome and lesion location. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 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. We believe that a dedicated and committed team of editors and reviewers make it possible to ensure the quality of the research papers. The anteromedial accessory portal can be established if needed to access lesions on the medial talar dome. Osteochondral lesions of the talus: size, age, and predictors of outcomes. Arch Orthop Trauma Surg 2012; 132(12): 1765-71. Ankle sprains and rotational rotational injury have been associated and reported as a potential mechanism of OLT pathogenesis. Arthroscopic treatment of osteochondral lesions of the talus. 1. Low-grade lesions are managed with initial weight bearing modifications and therapeutic interventions. Various treatment strategies have been described for OLT, including conservative treatment (rest/restriction of activities and immobilization in the cast) and operative treatment (excision, excision with curettage, excision with curette and drilling/microfracture, excision with curette and autogenous grafting, excision with curetted and particulated juvenile cartilage, retrograde drilling, autogenous chondrocyte implantation, osteochondral autograft transplantation, and osteochondral allograft transplantation) [32-34]. Davidson AM, Steele HD, MacKenzie DA, Penny JA. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. 2015 Sep;21(3):193-7. who studies 20 patients. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondral Lesions of the Talar Dome. The surrounding cartilage and the subchondral bone defect require debridement until the cartilage rim is stable and no necrotic tissue remains on the osteochondral base. 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. They usually relate the pain to a single injury, recurrent sprains, or feelings of chronic instability . Although the standard treatment of the OLT has remained controversial, a non-displaced Berndt and Harty Grade I and II lesion should be initially treated with conservative treatment with immobilization and restriction of the activity. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Radiographs are typically the first imaging study performed in evaluation of the ankle.  Although majority may be associated with trauma, some may develop insidiously. Baker CL Jr, Morales RW. Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture. Choi WJ, Choi GW, Kim JS, Lee JW. (A) Unstable medial talar dome osteochondral lesion of the talus. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. Hintermann B, Regazzoni P, Lampert C, Stutz G, Gächter A. Arthroscopic findings in acute fractures of the ankle. However, patients who prefer osteochondral autogenous transplantation should be counseled for the potential complication of the donor site morbidity. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Raikin SM. A recent analysis of 428 ankle MRIs with known OLTs showed 53% of lesions medial and middle, and 26% lateral and middle. Tamam C, Tamam MO, Yildirim D, Mulazimoglu M. Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus. Yulish BS, Mulopulos GP, Goodfellow DB, Bryan PJ, Modic MT, Dollinger BM. A report of ten cases. reported successful fixation of a posteromedial talus fragment using posterior arthroscopic 3-portal technique . In 1947 Ray and Coughlin recommended adding oblique projections to the standard anteroposterior and lateral views, noting that the malleoli would hide lesions on the medial and lateral aspect on the standard anteroposterior view . Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Arthroscopy 2006; 22(10): 1085-92. Particulated juvenile cartilage allograft transplantation. Osteochondral lesions of talus associated with ankle fractures. They reported that microfracture technique demonstrated significant improvement of functional outcomes as measured with VAS and AOFAS scores (mean pre-operative VAS 8.2/10 improved to 3.8/10 post-operatively and mean pre-operative AOFAS scores 42 improved to 68 points at 12 months post-operatively) . ", "It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. The previous literature reported that the overall success rate of excision and curette was 63 percent (119 of 189 patients); however, the success rate varies between 47 to 89 percent from 9 studies [4, 30, 42, 43, 62, 66, 72, 75, 76]. Scranton PE Jr, Frey CC, Feder KS. OFarrell TA, Costello BG. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): Review of the literature and new surgical approach for medial dome lesions. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals. Stage I: Cystic lesion within the dome of the talus, intact roof on all views. Abstract presented at the Annual Meeting of the American Academy of Orthopedic Surgeons New Orleans . Ideally, OLTs could intrinsically heal from cell migration from the surrounding cartilage. 1): 105S-11S. Current concept review: osteochondral lesions of the talus. Conservative management, including weight-bearing restrictions, physical therapy, and supportive measures, often is first-line treatment. Lesions smaller than 15 mm [50-53], contained lesions , and anterolateral lesions  are considered to be the positive prognostic indicators; negative indicators include older age (> 33-40 years old) [51, 55], lesions deeper than 7 mm [55-57], lesions larger than 15 mm , cystic lesions , medial talar lesions , higher BMI, history of trauma, longer duration of symptom, and presence of osteophytes . Instr Course Lect 2006; 55: 545-54. X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. [eng.]. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. However, there is no current literature providing definitive timing for operative treatment. Foot Ankle Int 2000; 21(2): 127-33. Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. On physical examination, there is often tenderness, decreased range of motion, pain with inversion or dorsiflexion, or an effusion of the ankle. Clin Orthop Relat Res 2001; (391): (Suppl.)S362-9. In patients with a large lesion or after a failure of previous bone marrow stimulation, biologic restoration techniques including the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation may have role. Osteochondral lesions of the talus. Foot and ankle clinics 2003; 8(2): 233-42. Indication for this implant includes the patients who have localized medial talar dome with large defect after failed primary surgery . Indications for operative treatment include failure of conservative treatment for at least period of 6 weeks to 6 months  and acute osteochondral fragment Berndt and Harty grade III and IV [4, 42]. J Bone Joint Surg Br 2000; 82(3): 345-51. If conservative treatment fails, surgical treatment is indicated. Schachter AK, Chen AL, Reddy PD, Tejwani NC. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2013 52(3):402-5 2013; 52(3): 402-5. incidence. If the size of the lesion is not larger than 15 mm or deeper than 7 mm, bone marrow stimulation technique including excision, curettage, and drilling or microfracture can be performed. [Osteochondrosis dissecans]. 3H) leading to the eventual formation of fibrocartilaginous repair tissue mainly type I collagen .  Recently Tamam et al. The DeNovo NT (natural tissue) graft (Zimmer, Warsaw, IN) is a relatively new product that uses scaffold-free allogenic juvenile cartilage that can be implanted into a defect and secured with a fibrin sealant . Talar dome fracture repaired using bioabsorbable fixation. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant. Particulated juvenile articular cartilage is prepacked allograft from donors aged younger than 13 years with viable human cartilage cells. Blom JM, Strijk SP. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. Epub 2014/09/30. Demaziere A, Ogilvie-Harris DJ. J Bone Joint Surg Br 2005; 87(1): 41-6. studied 12 patients after using ipsilateral talar autograft, reporting significant improvement of AOFAS scores from 64.4 to 90.8 at a follow-up of 25.3 months . The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2012; 51(2): 218-. Hangody L, Kish G, Kárpáti Z, Szerb I, Eberhardt R. Treatment of osteochondritis dissecans of the talus: use of the mosaicplasty techniquea preliminary report. In addition, this technique eliminates the donor site morbidity and the single graft use can minimize the fibrocartilagenous ingrowth as a consequence of the multiple graft use in the autograft mosaicplasty . If the cartilage does not heal properly following the injury, it softens and begins to break off. Recently, matrix associated ACI (MACI) has emerged replacing the need for periosteal flap and thereby providing easier and time-saving handling . (B) Lesion debrided to stable margins. J Bone Joint Surg Am 2002; 84-A(5): 763-9. Post-operative radiography demonstrated lucencies at the graft-host interface in five patients, but there was no graft failure . Introduction. https://illinoisfoot.com/.../ankle-joint-pain/talar-dome-lesion-osteochondral-lesion The Open Orthopaedics Journal is seeking energetic and qualified researchers to join its editorial board team as Editorial Board Members or reviewers. Fresh osteochondral allografts. Arch Orthop Trauma Surg 1985; 104(4): 238-41. Zwingmann J, Südkamp NP, Schmal H, Niemeyer P. Surgical treatment of osteochondritis dissecans of the talus: a systematic review. A review of twenty-one cases of transchondral fracture of the talus. Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle. Foot Ankle Int 2004; 25(3): 168-75. Impaired function, limited range of motion, stiffness, catching, locking an… Treatment of osteochondral defects of the talus with a metal resurfacing inlay implant after failed previous surgery: a prospective study. 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. Verhagen RA, Maas M, Dijkgraaf MG, Tol JL, Krips R, van Dijk CN. In addition, Scranton et al. Arthroscopy 1990; 6(3): 242-4. 2003;19(4):353-9. Symptomatic osteochondral ankle defects often require surgical treatment. Midterm results of osteochondral lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. While the concept of spontaneous osteochondritis dissecans was first applied to the ankle in 1922 , a theory of traumatic etiology was popularized by Bernt and Hardy in 1959 . Botchwey EA, Dupree MA, Pollack SR, Levine EM, Laurencin CT. Tissue engineered bone: measurement of nutrient transport in three-dimensional matrices. ", "Open access journals have become a fundamental tool for students, researchers, patients and the general public. One partial graft delamination had been reported at 16 months but no major complications were reported in their study . Der Orthopade 1979; 2(1): 135-40. It is currently accepted that OCL of the talus is primarily traumatic in origin. Multiple authors have noted that the incidence of medial OLT is higher than that of lateral lesions. Am J Sports Med 2013; 41(1): 126-33. Abstract presented at the Annual Meeting of the American Academy of Orthopedic Surgeons New Orleans. Treatment depends on the severity of the talar dome lesion. It was later suggested to add a mortise view of the ankle with the ankle in maximal plantar flexion to evaluate lesions along the posterior medial dome [16, 17]. Baums MH, Heidrich G, Schultz W, Steckel H, Kahl E, Klinger HM. The lack of these signs on physical exam does not exclude an OLT as often the physical exam signs are absent. Int Orthop 2012; 36(11): 2279-85. Due to the technical demands of accurate drilling  with a previous study reporting 20 percent failure rate , several techniques has been developed in order to improve the accuracy and decrease operative time. A patient with an osteochondral lesion of the talar dome will most commonly present with a chief complaint of ankle pain, sometimes poorly localized and nonspecific. Am J Sports Med 2010; 38(6): 1259-71. Experience in experimental and clinical research and surgery in orthopaedics with an academic degree. Low-grade lesions are managed with initial weight bearing modifications and therapeutic interventions.  reported that the overall success rate of this technique was 85 percent (28 of 33 patients). Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. ", "These journals provide researchers with a platform for rapid, open access scientific communication. However, the major disadvantage of the microfracture technique is that the durability of fibrocartilage tissue is inferior to normal hyaline cartilage . MRI was first suggested as an imaging method for known OLT in 1987 but was not recommended for diagnosis at that time . The Open Orthopaedics Journal is an Open Access online journal, which publishes research articles, reviews, letters, case reports and guest-edited single topic issues in all areas of experimental and clinical research and surgery in orthopaedics. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Alexander et al. Advancements in ankle arthroscopy. Moreover, the complex anatomy of the ankle joint makes exact retrograde drilling of the ankle with… Anders S, Goetz J, Schubert T, Grifka J, Schaumburger J. Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. Chuckpaiwong et al. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. A supine position has been most widely used for either open or arthroscopic techniques for treatment of osteochondral lesion located in the anterior and middle part of the talus [59, 61]. J Bone Joint Surg Am 2004; 86-A(6): 1336. 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. Assenmacher proposed the term osteochondral lesions of the talus (OLTs). In addition, El-Rashidy et al. The severity of the injury is best assessed using MRI. Min KS, Ryan PM. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. Am J Sports Med 2008; 36(5): 873-80. Mintz DN, Tashjian GS, Connell DA, Deland JT, O' Malley M, Potter HG. Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T. Osteochondral lesions of the talus. (C) Particulated juvenile cartilage allograft pieces were placed into the lesion bed. Foot Ankle 1985; 5(4): 165-85. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor. Displaced osteochondral fracture of unspecified patella, initial encounter for closed fracture Displaced osteochondral fracture of unsp patella, init ICD-10-CM Diagnosis Code S82.013A Conservative treatment methods are usually attempted first. 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