22(7):544– 51, 2001. The various treatment options currently available are briefly reviewed. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. 2. Scintigraphy showed to be useful in evaluating OCLs when radiographs appear to be normal.4,13 Addressing the lack of anatomic accuracy of the classic scintigraphy, a new diagnostic tool for OCLs emerged: the SPECT-CT. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. Osteochondral Defect (OCD) Rehabilitation Protocol . 1173185, Durur-Subasi B, Durur-Karakaya A, Yildirim O S; Osteochondral Lesions of Major Joints Eurasian J Med 2015; 47: 138-44, Osteochondral Lesions of Major Joints Durur-Subasi B, Durur-Karakaya A, Yildirim O S; Eurasian J Med 2015; 47: 138-44, Patrick J. McGahan, MD and Stephen J. Pinney, MD, Current Concept Review: Osteochondral Lesions of the Talus , FRCS(C) Sacramento, CA; Foot & Ankle International/Vol. 10. Total lesion size unchanged. 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 (Tables 71-2 and 71-3). Strengthening and range-of-motion exercises can help once your injury has healed adequately and can reduce swelling and pain. Last, a commonly used arthroscopic classification is the OCL classification of the International Cartilage Repair Society.5, Epidemiologically, the ankle registers 4% of all the human osteochondral defects.6 The cause of OCLs of the talus has multiple facets. Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. Trauma plays the most important role in the pathomechanism of talus OCLs. Ankle osteochondral lesions are usually as a result of traumatic events and present as deep ankle pain, affecting gait and range of movement especially on weight wearing. 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. Surgical treatment of OCLs traditionally includes excision of loose bodies, debridement of the area, and drilling or microfracturing. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. 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. The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). What Are the Best Diagnostic Criteria for Lateral Epicondylitis? It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Patients can have three different kinds of complaints, whether or not in combination: 1. In most joints of the foot and ankle, this layer of cartilage is one to a few millimetres thick. Terminology. That is usually the journal article where the information was first stated. Ankle sprains are exceedingly common, with >2 million such injuries diagnosed in the United States each year 2. Patient history should further include systemic risk factors, as causative factors of avascular necrosis, systemic diseases, and others. 6. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJA. On images it is easy to see the extent of damage to the surface of the cartilage. To include all these causes and others, for example, idiopathic osteonecrosis, the term osteochondral lesions (OCLs) provides the most cautious terminology. Management may be non surgical or surgical with follow up physiotherapy treatment essential for a return to normal activities and/or to sport. If osteochondral lesions on the ankle are not diagnosed early the bone fragment is not likely to heal and can continue to cause problems. Subsequently, joint fluid pumps into the subchondral bone and creates painful cysts and large-area cartilage lifting. Traditional Methods to Ankle Cartilage Replacement. A non-weight bearing cast is attached for 6 weeks and is then followed by a gradual return to weight bearing and athletic activity. Pain and stiffness in the foot and ankle is not only detrimental to gait and posture, but also how you feel and your well-being. Vrije Universiteit Brussel Evidence-Based Practice Project, https://www.physio-pedia.com/index.php?title=Ankle_Osteochondral_Lesions&oldid=241981, exercises to improve flexibility, strength and balance. It can be done with an arthroscope. 31, No.1, January 2010, Current Concept Review: Osteochondral Lesions of the Talus Patrick J. McGahan, MD and Stephen J. Pinney, MD, FRCS(C) Sacramento, CA; Foot & Ankle International/Vol. The diagnostics of OCLs of the talus include first conventional weight-bearing radiographs of the ankle joint, anteroposteriorly and laterally. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Ankle fusion is also used in some cases, if the talus is very badly damaged. Hale S, Hertel J, Reliability and Sensitivity of the Foot and Ankle Disability Index in Subjects With Chronic Ankle Instability, J Athl Train. 23. Tol et al. 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. 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. MRI is the gold standard for OCL diagnosis, providing information about bone bruise, cartilage status and soft tissues. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Rehabilitation Exercises – to be done every 2 hours. metric exercises, proprioceptive facilitation exercises, After preparation of the lesion, osteochondral grafts and muscular strengthening, which are gradually in- MOSAICPLASTY FOR KNEE CARTILAGE DEFECTS 465 FIGURE 1. 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. [13] Reduced ROM usually persists for 4-6 weeks after the acute event and walking on uneven ground may aggravate symptoms. The SPECT-CT and diagnostic arthroscopy confirmed a lateral talus OCL stage III-IV with cystic lesions (C–F). 2015 Dec 18;6(11):944-53. doi: 10.5312/wjo.v6.i11.944. Attempts to elicit tenderness with palpation should be made by focusing on the common sites of osteochondral lesions. MRI: Medial osteochondral lesion of the talus, with central piece of bone. In the ankle joint, OCLs are mostly seen in the talus, at the posteromedial and anterolateral talar dome, closely related to the top of the curvature. Osteochondral autograft transplantation is used to address small to medium defects (1–4 cm 2), often with associated bone loss. 6 The cause of OCLs of the talus has multiple facets. The Ferkel and Sgaglione3 classification is a CT-based classification describing fragmentation, osteonecrosis, and cyst formations (stage I-IV). Osteochondral defects in the ankle: Why painful? If only the cartilage is damaged it is termed chondral and if the cartilage and bone is involved then the diagnosis is a osteochondral lesion. The medial anterior aspect of the talar dome is the area most injured. Physiotherapy treatment is vital for all patients with an osteochondral lesion of the talar dome to maximise the healing process, ensuring an optimal outcome and to reduce the likelihood of recurrence. Osteochondral defects (OCDs) of the talus are a common cause of residual pain after ankle injuries. In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision.[17]. To make these surfaces slide more easily, there is also fluid in the joint that is created by the capsule of the joint. The best way to prevent osteochondral lesions is to avoid sustaining serious ankle injuries. Damage to your cartilage, the padding between the bones in your knee joints, can lead to pain and difficulty moving. Osteochondral cylinders are harvested from lesser marginal weight-bearing areas of the knee joint and press-fitted into the prepared defect. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Specific changes in the program will be made by the physician as appropriate for the individual patient. Symptomatic osteochondral ankle defects often require surgical treatment. However, medial lesions are more common than lateral OCLs. Doctors give unbiased, helpful information on indications, contra-indications, benefits, and complications: Dr. Yousefpour on physical therapy for osteochondral defect knee: Physical therapy would involve a programs or range of motion, and strengthening. Ankle sprain is the most common medical history noted by patients. Treatment Options for OCD Ankle Lesions. 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. [6][2] Younger people have a higher incidence of trauma history and the lesion size is usually larger as they are exposed to more diverse sporting activities. Surgical Treatment for Osteochondral Defect. Radiographs provide information on the OCL location and stage only if the x-rays hit the OCL perpendicular, that is, if the OCL lies on the highest point of the talar dome. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. 1, in a review of >580 osteochondral defects of the talus, reported that trauma was implicated as the cause in 76% of the cases. Because currently there is no proof for an underlying inflammation, the traditional term osteochondritis dissecans introduced by König1 in 1888 should be abandoned. This surgery may be performed open or arthroscopically. These findings are nonspecific because the tenderness could likely be related to joint synovitis instead of an osteochondral lesion. Osteochondral injuries commonly affect the ankle joint and involve the dome of the talus. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. Surgery to treat an osteochondral ankle lesion is a series of steps that usually starts with the least invasive technique, an arthroscope, as the last step of diagnosis before your surgeon progresses with whatever needs to be done to repair the top of your talus. Their clinical presentation is described and advice is given on how to diagnose and investigate suspected osteochondral injuries. The talus is a bone in the foot that helps form the ankle joint. 2001, 22(7):544– 51. Overall, more than 80% of the talus OCLs are of traumatic origin. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. If OLT is diagnoses immediately after the injury, immobilization of the foot and ankle for a period of time usually resolves the problem. Tenderness may be triggered on the affected ankle side (lateral, medial) or periarticular. 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. Osteochondral Defects of the Talus. Other predisposing factors may be a periarticular fracture or severe ankle trauma. 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). The patients, usually of young age (mean age in a meta-analysis on 734 patients, 26.9 years). Posteromedial lesions: Tenderness may occur on palpating the ankle in dorsiflexion and the region posterior to the medial malleolus is palpated. Woo Jin Choi, Kwan Kyu Park, Bom Soo Kim and Jin Woo Lee; Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, 120-752, South Korea (e-mail: Choi W, Park K, Kim B and Lee J, Osteochondral Lesion of the Talus: Is There a Critical Defect Size for Poor Outcome? Regarding the ligament instability, one may find pathologic signs for lateral ankle instability (anterior drawer test, inversion tilt test), medial ankle instability (eversion tilt test), or a combination of both (rotational ankle instability). 24. The SPECT-CT combines data of the scintigraphy and CT scan and fuses it to one picture: SPECT providing the activity and metabolic rate of the OCL surrounding bone, and the CT the precise anatomic localization (Fig. Along with their details, we also reviewed them to ensure that you’re aware of all the pros and cons before you make a buying decision. [14]Anterolateral lesions: Tenderness may occur when the ankle is palpated laterally with a plantar flexion. What Is the Best Treatment for End-Stage Hallux Rigidus? Specific changes in the program will be made by the physician as appropriate for the individual patient. In recent years, diagnosis of OCL increased substantially with the widespread use of modern diagnostic tools, such as computed tomography (CT), arthrocomputer tomography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT)-CT, and other tools. OCLs are articular injuries of the subchondral bone and the overlaying cartilage. Here’s a list of the 15 best ankle braces and supports for all kinds of injuries: Zamst A2-DX Ankle Brace. The therapist would probably focus on the quadriceps (a thigh muscle) and especially on the vastus medial;is (part of the quadriceps). 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. What Is the Best Treatment for Achilles Tendon Rupture? This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). 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). Look no further when you can have direct access to the globally acclaimed specialist team of foot and ankle surgeons, supervising & managing your Osteochondral repair of talus with diligence and dedication. The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus. Foot Ankle Int 21:119–126 PubMed Google Scholar. should be checked. What Is the Best Treatment for Recurrent Ankle Instability? A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. X-ray and CT’s are also valuable, but rather to rule out fractures and for the detection of subchondral bone injuries. Osteochondral lesion of the talus. The dimensions of the created defect depth and diameter and the distance between the microfracture holes in this study were scaled down using the respective ratio between a critical-size osteochondral defect in the human (15 mm diameter) and in the smaller goat talus (6 mm diameter) [ 9 , 17 ]. The top of the talus is dome-shaped and is completely covered with cartilage. In most cases Physiopedia articles are a secondary source and so should not be used as references. An additional description of identifying whether the lesion is contained or not contained (shoulder) may also be included. Finally, although no accepted definition of lesion size exists, OLTs can generally be considered as either small or large based on their cross-sectional area or greatest diameter (area greater than or less than 1.5 cm² or diameter greater than or less than 15 mm).[3][4][5]. [15] Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. Radiographs further provide information on possible osseous predisposition for CAI, which represents a possible causative factor of OCL in the ankle joint. This type of injury can be due to a severe ankle sprain that causes bone and cartilage to become loose, resulting in ongoing ankle pain. With CT, the stages described by Berndt and Harty can be better defined, OCL cysts and fragments better visualized, and the integrity of the subchondral bone better analyzed. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. Currently, ankle arthroscopy allows beside direct diagnostic visualization and palpable assessment, as well as simultaneous minimally invasive osteochondral treatment (debridement, drilling, microfracturing, and others). An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. On the basis of repetitive microtraumas, avascular necrosis, genetics, endocrinic reasons, or systemic reasons, the nontraumatic causative agent with osteonecrosis represents to date still an unclear pathomechanism of chronic OCLs (longer than 2 months). Osteochondral Lesions of the Talus; Are There Any Differences Between Osteochondral and Chondral Types? Commonly, multiple cylinders have to be transplanted to fill larger defects. OCLs are articular injuries of the subchondral bone and the overlaying cartilage. Berndt and Harty2 reported in 1959 that nonoperatively treated patients obtained poor results, and that good results were registered in 84% of the cases after surgical treatment (Level IV). As the foot is inverted on the leg, the lateral border of the talar dome is compressed against the face of the fibula (stage I), while the collateral ligament remains intact. Furthermore, hindfoot malalignment (hindfoot varus or valgus) and foot deformity (pes planovalgus, cavovarus, etc.) [1] 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. If a cartilage defect is too large for an autograft, an allograft may be considered. 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. Osteochondral autograft transplantation is used to address small to medium defects (1–4 cm 2), often with associated bone loss. Keywords Osteochondral defect Cartilage Ankle joint Subchondral cyst Natural history Pain Introduction An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 46, 47, 50]. Foot Ankle Int. Based in the heart of NY, Advance Foot and Ankle Solutions offers the best facility for performing Osteochondral repair of talus, while catering to all other various foot and ankle problems. Osteochondral lesions may also involve the talar dome, most frequently the medial aspect. 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. Talus OCLs most often affect sports active young individuals and becomes symptomatic through persistent pain, joint swelling, and sometimes blocking of the joint. Osteochondral lesion of the talus (OLT) is a term used to describe an injury or abnormality of the talar articular cartilage also known as osteochondral defect (OCD). If your symptoms are not relieved with non-surgical treatment options, you might need surgery. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. These symptoms place the ability to walk, work and perform sports at risk. How is it caused? Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome 2013;37:1697-1706. A crack in the cartilage on the surface of the bone can occur. The ankle joint is composed of the bottom of the tibia bone (shin) and the top of the talus bone (ankle). Other tests should be performed to measure the range of motion for stiffness and to feel for the crepitus and signs of clicking or locking. Combinations of the different graft sizes are used to allow a greater filling rate. At the end, OCL fragments can break off and dislocate all over the joint. It is often associated with a traumatic injury such as a severe ankle sprain. Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans Wear appropriate shoes when playing sports or working with heavy machinery, and always exercise caution. Ankle injuries are one of the most common musculoskeletal conditions. Mei-Dan O, Michael R. Carmont, Laver L, Mann G, Maffulli N, Meir Nyska, Platelet-Rich Plasma or hyaluronate in the Management of Osteochondral Lesions of the Talus, Clinical Sports Medicine: Medical management and Rehabilitation; Walter R. Frontera; p467 level of evidence : 2A, Jung, HG, Foot and Ankle Disorders: An Illustrated Reference; 2016, Springer Berlin Heidelberg; p.129. Osteochondral lesion of the talus, (cartilage damage of the ankle) can occur from a traumatic fracture or ankle sprain when the bones in the ankle joint hit each other damaging the cartilage surface. These factors should be assessed and corrected by the treating physiotherapist and may include: If there is no sign of improvements, further investigation is required. This is because the healthy graft tissue can only be taken from a limited area of the same joint. 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. osteochondral defects of the ankle ML Reilingh, MD CJA van Bergen, MD CN van Dijk, MD, PhD Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Corresponding address: Academic Medical Centre University of Amsterdam Department of Orthopaedic Surgery Prof Dr C Niek van Dijk PO Box 22660 1100 DD Amsterdam, The Netherlands … 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). The various treatment options currently available are briefly reviewed. [2], A lesion can also be categorised by its location on the articular surface of the talus as medial, lateral, or central with added subdivisions into anterior, central, or posterior as advocated by some authors. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. What Is the Best Treatment for End-Stage Ankle Arthritis. The stability of a lesion can be assessed directly with arthroscopy or indirectly with MRI using DeSmet’s criteria. can best be initially accessed with our initial visualiza-tion and working portals. When refering to evidence in academic writing, you should always try to reference the primary (original) source. What Is the Best Treatment for Pilon Fractures? Am J Sports Med 37 (2009) 105- 111. Despite the large number of publications (Level II-IV evidence), to date, no strong evidences and guidelines are available in the literature. Jun 17, 2019 Posted by admin Uncategorized 0 comments. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) Am J Sports Med 2009 37(10):1974-80 originally published online August 4, 2009, A SYSTEMATIC REVIEW OF OUTCOME TOOLS USED TO MEASURE LOWER LEG CONDITIONS; Susan Shultz; Int J Sports Phys Ther. With this excessive invertion force, the talus is rotated laterally within the mortis joint in the frontal plane, impacting and compressing the lateral talar margin against the articular surface of the fibula. J Bone Joint Surg (Br) 2007; 89(6):772 -777. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 1/January 2010 3A. 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