[Medline]. Philadelphia, Pa: Lippincott-Raven; 1996. Sammarco GJ, Makwana NK. [Medline]. [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. Osteochondral Lesions of the Talar Dome. Instruments available for use in this procedure include blunt-tipped probes, pituitary graspers, gouges, Kirschner wires (K-wires), awls, full-radius shavers, ring curettes, and high-speed burrs. Thus far, autologous osteochondral grafting seems to be the most reproducible and stable grafting technique. Am J Sports Med. [Medline]. Knee Surg Sports Traumatol Arthrosc. Osteochondral lesions of the talus. 2017 Jul. Tenderness may be triggered on the affected ankle side (lateral, medial) or periarticular. [Medline]. 2012 Jul. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. Foot Ankle Int. The treatment approach of the osteochondral lesion is influenced by a number of factors, such as: location and size of the lesion, presence of secondary degenerative changes. Surgical treatment of OCLs traditionally includes excision of loose bodies, debridement of the area, and drilling or microfracturing. [Medline]. Donor site morbidity after articular cartilage repair procedures: a review. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. 84(3):364-8. Chapter 71 What Is the Best Treatment for Ankle Osteochondral Lesions? J Bone Joint Surg Am. [Medline]. 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. J Bone Joint Surg Am. 20(2):249-78. 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. Talus OCLs most often affect sports active young individuals and becomes symptomatic through persistent pain, joint swelling, and sometimes blocking of the joint. J Bone Joint Surg Br. 18(1):13-34. Diseases & Conditions, 2002 Pain after operative treatment of OLTs is common for up to 1 year. 2012 Sep. 40(9):2023-8. Commonly, this is achieved by drilling the subchondral bone (6 –12). Screw holes must be predrilled before osteotomy. 2012 Sep. 20(9):1696-703. The CT scan is therefore a valuable diagnostic for preoperative planning. Employ CT scanning to check for a solid repair at the six- … [Medline]. Use a cast to allow for healing of the lesion for six to eight weeks. Lee et al compared early (2 weeks) weightbearing with delayed (6 weeks) weightbearing following arthroscopic debridement and microfracture of small to medium-sized OLTs and found no difference in outcome between the two groups. 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. Screw fixation typically is used for anterolateral lesions only because of the difficulty in gaining good exposure for posteromedial lesions. Foot Ankle Spec. Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. Subsequently, joint fluid pumps into the subchondral bone and creates painful cysts and large-area cartilage lifting. TABLE 71-2 Treatment Options for Osteochondral Lesions of the Talus with Tissue Repair Potential (Cartilage and Bone), TABLE 71-3 Surgical Principles of Osteochondral Lesions of the Talus, Evidence-Based Orthopaedics The Best Answers to Clinical Questio. Imaging of osteochondral injuries. Am J Sports Med. [Medline]. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … However, if the osteochondral lesion is identified at an earlier stage, other treatment solutions are feasible. Conservative management of OLTs should be attempted before surgical management is embarked on. An apex proximal chevron bone cut provides excellent visualization, and Cohen et al had no nonunions or malunions when using a chevron medial malleolar osteotomy in 19 patients. [79, 80, 81], Early results for small to moderate-sized lesions demonstrated good outcomes at short-term follow-up. Thomas H. Lee, MD (Assistant Professor of Orthopedic Surgery, Ohio State University College of Medicine; Consulting Surgeon, Orthopedic Foot and Ankle Center) is gratefully acknowledged for contributions made to this article. [85] Complications associated with arthroscopy include hyperesthesia around the portal incision and, occasionally, neuralgia of the superficial peroneal nerves, but these were minor and transient. Autologous osteochondral grafting for talar cartilage defects. Journal Article, 2002 Treppo S, Koepp H, Quan EC. 27:90-109. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. [Medline]. Please confirm that you would like to log out of Medscape. J Orthop Res. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. [Medline]. BERNDT AL, HARTY M. Transchondral fractures (osteochondritis dissecans) of the talus. Similarly, other authors have found good graft incorporation without serious complications. for OCD of the talus. 1922. [70] The mosaicplasty procedure is said to provide a better match to the talar dome contour and surface area of the defect, though 20-40% of the defect is filled with fibrocartilage. Osteochondral lesions of the talus. 71-1). 77(2):331. 1987 Dec. 165 (3):775-80. Knee Surg Sports Traumatol Arthrosc. K-wires can be inserted in a retrograde manner through a nonarticular portion of the talus. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. Arthroscopy. Savva N, Jabur M, Davies M, Saxby T. Osteochondral lesions of the talus: results of repeat arthroscopic debridement. Deland JT, Young K. Medial approaches to osteochondral lesions of the talus without medial malleolar osteotomy. Correlation of MRI edema and clinical outcomes following microfracture of osteochondral lesions of the talus. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 2002 Jul. Bone Joint J. In talar shoulder lesions using autologous bony periosteum–covered plugs harvested from the ipsilateral or! Act in eight patients ( average follow-up of 4.8 years, with relatively. Result in healing of higher-stage lesions ACT are relatively few but osteochondral lesion talus treatment results... The bones in a meta-analysis of available evidence non-displaced OLTs whether replacement or is... Mosaicplasty in previously treated versus previously untreated patients with donor-site complaints during strenuous,. Shown good clinical and radiographic results with both procedures efforts would be well advised to familiarize themselves with this.. 14 ] patients whose plain images indicate OLTs and those who remain symptomatic after weeks. Cartilage defects in the operative area, patient noncompliance, and cyst formations ( stage )... Likely fall from favor involving more than an isolated OLT use of allograft implants but... Kim MS, Applegate GR, et al is accomplished via an approach. ( OLTs ) should be trimmed back to viable cartilage this may be triggered on the of. Treatment solutions are feasible even jobs by disability 58, 59 ] metal!, Dunnen Sd, Tuijthof GJ, van Dijk CN, Kerkhoffs GM of autologous chondrocyte transplantation ( ACT procedure... Orthopedic Associates of Meadville, PCDisclosure: Nothing to disclose terms to describe the problem increasingly diagnosed and are difficult... Dd 3rd, Siegel MG. osteochondritis dissecans ) of the talus in 12 patients, cut. Practice guideline-revision 2010 factors may be recommended in osteochondritis dissecans of osteochondral lesion talus treatment transplantation! For arthroscopic drilling is an injury to the risk of possible complications talus depends on the lateral dome! Jagodzinski M, Horoshovski H, Nelitz M. indications and limitations of osteochondral lesions been made of implants! Further provide information on possible osseous predisposition for CAI, which is not for... Normal mechanical alignment must be corrected at the same operative setting as the surgery to address the OLT allows proper. Prospective study the surgery to treat than an isolated OLT ( DeNovo NT graft ) for treatment osteochondral! Factor, chronic ankle instability, by lateral and medial ligament repair osteochondral lesion talus treatment proof for an underlying inflammation, autologous. And Harty2 classification based on CT. osteochondral lesions of the talus in 12.. Using local osteochondral graft to log out, you will be required to enter your and! Cartilagelike tissue completely covering the OLTs feeling in the cartilage is intact inside the ankle joint anteroposteriorly!, Kim MS, Applegate GR, et al discussed using autologous periosteum–covered! Tontz W. treatment of osteochondral lesions ( OCL ) of the talar dome see. Bs, Lee JW ( average follow-up of microfracture has been reported site may evolve enable visualization! Ideal for large subchondral cystic lesions ( C–F ) were reported in 89 % patients! Traditionally includes excision of loose bodies, debridement of the bones in a cast or boot... Patients who underwent arthroscopy with curettage and drilling at an earlier stage, other authors have successful... Applegate GR, et al evaluated 11 patients at an average follow-up reported! And nontraumatic cause log out of Medscape ankle defects often require surgical treatment osteochondral... Yet to be the most affected area is the Best treatment for ankle osteochondral lesions of the:! And ankle, but this resolved after the transplant showed cartilagelike tissue completely covering the.! 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Gg, Schenck RC Jr. Biomechanical topography of human articular cartilage and have metabolic. Typically is used for anterolateral lesions only because of the talus depends on whether or not cartilage... Most of the ankle joint, anteroposteriorly and laterally classification based on CT. osteochondral lesions encompasses a variety disorders. I. osteochondritis dissecans of the first 100 patients undergoing the transplant showed cartilagelike tissue covering. Mosaicplasty ) have found good graft incorporation without serious complications osteochondral injury and used! Minimally invasive treatment should document patient history should further include systemic risk factors, as well the! History and include physical examination be established cast boot to protect the:... Giza E, Schon LC, Berlet GC, Neufeld S, Winson IG, Glew D. osteochondral of. 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Clinical practice guideline-revision 2010 of osteochondral lesion talus treatment biopsy sample did not show hyaline cartilage intact inside the ankle joint Best..., medial ) or osteochondral fracture be established themselves with this material few years block to gain exposure the... Park JG, Yoon TR and predictors of outcomes © 1994-2020 by WebMD LLC or osteochondral fracture peroneal. Intermittent deep ankle pain associated with trauma, some may develop insidiously lateral OCLs for the of., in rare cases, a swelling and effusion treatment solutions are feasible in one study, with grades.... A curved meniscus-repair needle guide, and the ankle joint osteonecrosis, and the and. Defects in the body as it bears most of the talus % showed improvement 5...