Osteochondral defects of the talus is aseptic bone necrosis. x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity. Treatment algorithm for OLT lesions overlaps with the treatment for OCD and depends on lesion stability. Radiography cannot directly depict the cartilage surface (3). 1–3 Two common lesions are notable on the talus. the talus” (OLT) . Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Microfracture or drilling: 4–6 weeks of nonweightbearing is recommended to allow the defect to heal, with ankle ROM encouraged. Subchondral bone is penetrated to allow bleeding and fibrin clot formation. • Open articular surface lesion with the overlying nondisplaced fragment. Procedures that regrow hyaline cartilage, such as autologous chondrocyte transfer: Cartilage is harvested (usually from the knee) and grown in culture. Treatment principles of osteochondral lesions of the ta… He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus.  This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Read More, Copyright ©2007 Lippincott Williams & Wilkins, > Table of Contents > Osteochondral Defect of the Talus. The incidence of osteochondral defects (OCD) of the talus is 0.09 % in the literature with a prevalence of 0.002 per 100,0001-3. Cartilage damage was noted in 17–66% of ankles with lateral ligament injuries [ 3 , 12 , 21 , 26 ]. Stage 2 - partially attached osteochondral fragment / flap . Talar hemiarthroplasty Using a metallic prosthesis for OCL of the talus was first described in 2010 for a defect of the medial talar dome in a cadaver .
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, ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT, ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT, possible repeitive microtrauma creates ischemic environment and loss of integrity of subchondral bone, leads to softening and disruption of overlying cartilage, among the thickest in the body (implications for osteochondral autografting), maintains tensile strength longer than femoral head with aging process, deltoid artery supplies majority of talar body and dome. The injury occurring on the medial aspect of the Talus is often deeper and cup shaped. © 2020 - TeachMe Orthopedics. Santrock RD, Buchanan MM, Lee TH, et al. The options for treating OCL are numerous and a number of surgical procedures can be performed arthroscopically. Radiographs at the time were negative and his pain improved over the next two months. Giannini S, Vannini F. Operative treatment of osteochondral lesions of the talar dome: current concepts review. The patient is followed regularly to make sure that ROM, The patient should be actively involved in the. Loomer R, Fisher C, Lloyd-Smith R, et al. Osteotomy usually is required as part of the surgical approach. Children are thought to have better healing potential than adults. Weightbearing radiographs should be obtained initially. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. What is the next appropriate step in the management of this patient? The most common sites are the posteromedial (53%) (, Most classification systems are based on lesion descriptions by Berndt and Harty (, Stage 2: Partially detached osteochondral fragment, Stage 3: Detached but stable/nondisplaced osteochondral fragment, Stage 5: Subchondral cyst (added by Loomer et al.) MRI is less useful for determining healing of OCD lesions because clinical healing may not correlate with imaging [ 5,20 ], and, in patients with operative repair, bony edema from instrumentation interferes with identification of healing during the postoperative period [ 44 ]. 1, 24 This debridement is limited to loose The MRI demonstrates the osteochondral lesions of the talus (OLT). Pathology . Osteochondral defect (OCD) or lesion of the talus can accompany chronic lateral ankle instability (CAI). (, No clear method is available for preventing this, Most patients who develop OCDs are in their 2nd–4th decades, with a mean age of 26.9 years (. Overlying cartilage may degenerate . He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. • Complete fragment detachment but not displaced. Stage 1 - subchondral compression fracture . Although biomechanically inferior to hyaline cartilage, fibrocartilage formation appears to be sufficient for smaller lesions. The average age at surgery was 22.7 years (range, 19-34). For patients with CAI accompanied by talus … If a lesion is seen on plain radiographs, Best method for accurately characterizing the size and extent of a defect, Tends to overestimate the size of a lesion because of bone marrow edema. Berndt & Harty Xray Classification . Pathology . Loose bodies, fibrous tissue, and unstable cartilage are débrided. It is thought that mesenchymal stem cells in the clot lead to the formation of fibrocartilage. Cannot evaluate subchondral abnormalities. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Procedures that reduce and stabilize the displaced fragment: Usually recommended only for lesions that are large enough to be amenable to internal fixation. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. The differential diagnosis includes any cause of chronic pain in the region of the ankle joint: Occult fracture (5th metatarsal, lateral process of talus, medial or lateral malleolus). The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The historical term for this grouping of pathologies, osteochondritis dissecans (OCD), emphasized a localized vascular deficiency within the talus as the principle pathology with the symptoms being secondary to loss of adequate chondral support &/or cyst formation within the talus. Osteochondral lesions of the talus. Once enough cells are available, the chondrocytes are reimplanted into the defect.
Osteochondral lesion (OCL) is a term used to describe an injury or abnormality of the articular … It often develops above a bone cyst. Osteochondritis dissecans (OCD) of the talus is a disea-se affecting the subchondral bone and secondarily the articular cartilage. Procedures that transfer hyaline cartilage to the defect: OATS/mosaicplasty, allograft transfer, Generally recommended for large lesions or lesions that fail other forms of treatment. 3 A debridement of the chondral part is required if symptomatic. Therefore, ankle fracture, sprain, and chronic ankle instability are risk factors. The average age at surgery was 22.7 years (range, 19-34). 3rd-generation techniques rely on a 3D bioscaffold to contain the cells instead of a periosteal flap (, Short-term clinical results generally are. ROM usually is started 2–6 weeks after surgery, depending on the quality of the osteotomy fixation. • Cartilage injury with underlying fracture and surrounding bony edema, • Stage 2a without surrounding bone edema, often limited secondary to pain or effusion, evaluate for ligamentous laxity or insufficiency, suspicion for OLT in setting of equivocal radiographs, helpful in evaluating subchondral bone and cysts, less reliable in purely cartilaginous lesions of nondisplaced OLTs, provides fine detail of lesions for pre-operative planning, persistent pain following injury, ankle sprains that do not heal with time, variable edema patterns, may overestimate degree of injury, unstable lesions show fluid deep to subchondral bone, predicts stability of lesion with 92% sensitivity, nondisplaced fragment with incomplete fracture, size > 1 cm and displaced lesions, shoulder lesions, salvage for failed marrow stimulation or drilling, period of immobilization in cast or boot for 6 weeks, followed by progressive weight bearing with physical therapy emphasizing peroneal strengthening, range of motion, and proprioceptive training, Arthroscopy with marrow stimulation (microfracture or antegrade drilling), debridement of unstable cartilage flaps to create stable and contained defect using curettes or shaver, loose bodies and cartilage removed using shaver or grasper, microfracture awl placed perpendicular to surface and tapped into subchondral bone 2-4 mm deep, inflow stopped to allow fat or blood to emanate from holes, indicating adequate penetration, Kirschner wire can be passed using anterior portals, or transmalleolar for central or posterior lesions, talus dorsiflexed and plantar flex to necessitate only 1 transosseous passing of wire, articular cartilage delamination and graft failure, 65-90% improvement in patient reported outcomes, fibrocartilage formation at site of lesion in 60% of patients on second-look arthroscopy, no correlation noted with patient outcomes, Arthroscopy with retrograde drilling and bone grafting, evaluate cartilaginous surface for softening, dimpling with probe seen, Kirschner wire drilled from sinus tarsi into defect, fluoroscopy often helpful to confirm location, if bone grafting indicated, cannulated drill placed over K wire, Osteochondral autograft and allograft transplant, dictated by location of OLT and concomitant procedures required (i.e. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Traumatic chondral defects, on the other hand, are often related to shear. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain (OBQ13.46)
Letts M, Davidson D, Ahmer A. Osteochondritis dissecans of the talus in children. Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. With proper treatment, the prognosis generally is good. Start as acute intra-articular fracture . KEY FACTS • The natural history of osteochondral lesions of the talus appears to be fairly benign, especially as it relates to the risk of the development of arthritis.
Die OCD kann die meisten Gelenke des men… OD, angloamerikanisch auch Osteochondritis dissecans) ist eine umschriebene Knochenläsion unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper (Gelenkmaus) enden kann. We'll assume you're ok with this, but you can opt-out if you wish. Although the cartilage cap remains viable (. These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). Cyst may develop under fragment . A 30-year-old professional ballet dancer presents with persistant ankle pain after an ankle sprain 6 months ago. 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. Die Osteochondrosis dissecans (kurz OCD bzw. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of … Acute fractures do better than chronic lesions. When compared to medial talar OCDs, which of the following statements is true regarding lateral talar OCDs? - James Stone, MD, Evolving Technique: The Role Of Osteotomy For The Treatment Of Osteochondral Lesions Of The Talar Dome - Listen Up!- Phinit Phisitkul, MD, MACI & Newer Techniques: I Told You This Before: Wake Up Everyone! [ 2 ] unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV Delaying surgical intervention for chronic OCD does not appear to alter results of later surgery. The area where OCD occurs is located at the top of the talus. Die Osteochondrosis dissecans (OCD, auch angloamerikanisch Osteochondritis dissecans) ist die umschriebene aseptische Knochennekrose unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper enden kann. Any procedure that requires an osteotomy necessitates nonweightbearing until the osteotomy heals (4–8 weeks). This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. 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. “Osteo” means bone and “chondral” refers to cartilage. Giannini S, Buda R, Grigolo B, et al. INTRODUCTION. Ankle ROM exercises, peroneal strengthening, progressive ambulation, and proprioception training. Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. However, for the last six months, he has developed persistent ankle pain with intermittent swelling. Osteochondritis dissecans, unspecified ankle and joints of foot. Fig. There is an increasing prevalence of … Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. Weak evidence suggests that a genetic component might be involved in some OCDs (, OCDs can be produced in cadaveric models by shear and compression forces (, Chronic: Recurrent injury from chronic ankle instability, Lateral OCD is associated with a recognized traumatic episode in 93% of cases (, Medial OCD is associated with a recognized traumatic episode in 61% of cases (. Other surgical options: Concurrent chronic ankle instability should be addressed with ligament reconstruction. - can have family history of talus OCD . On the lateral aspect of the ankle it most often occurs from trauma. Radiographs are unremarkable. 2F) (arrow). Physical examination elicits pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal. All Rights Reserved. The top of the talus is part of the joint and is covered with articular cartilage , … Stage VI: massive osteochondral defects of the talus. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. 1 ) and anterolateral (46%) talar dome ( 1 ). Bei der Osteochondrosis dissecans stirbt ein Teil des Knochens unterhalb des Gelenkknorpels ab, sodass sich dieser ablösen kann und in der Gelenkhöhle lose vorliegt (Dissektat). The coronal plane of the MRI demonstrates anteromedial lesions of OLT, Hepple stage 1 and 2A in figure 2A, and 2B (arrow), respectively. Raikin SM. Nonoperative management recommendations range from activity modification alone to nonweightbearing in a cast. The top of the talus is dome-shaped and is completely covered with cartilage (connective tissue that allows the ankle to move smoothly). • Cystic lesion within dome of talus with an intact roof on all view, • Cystic lesion communication to talar dome surface. The diagnosis of OCD most frequently depends on obtaining an imaging study: Plain radiographs or CT, MRI, or bone scans. Stage 1 • Cystic lesion within dome of talus with an intact roof on all view: Stage 2a • Cystic lesion communication to talar dome surface: Stage 2b • Open articular surface lesion with the overlying nondisplaced fragment. Physical exam reveals some joint swelling but no ligamentous instability. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. The mean size of defect of OCD was 13.6 mm × 7.2 mm. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. A 43-year-old male sustained a left ankle injury 3 years ago. Accept The mean time of follow-up was 36 months (range, 25-49). Table 3. Although OCD of the talus is, by definition, detachment of an osteochondral fragment of the talar dome occurring in a growing patient, symptomatic OCD is more typically observed in adults. 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). The goal in osteochondral defects of the talus in Stages I and II according to Berndt and Harty is revascularization of the lesion. 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 authors of this study have since published the clinical outcome of one case with good improvement in functional scores and return to sports after one year. 1. Osteochondral lesions of the talus. ACI is a 2-stage procedure in which hyaline cartilage is harvested from the anterior aspect of the talus or a nonweightbearing portion of the knee in the first stage. Figure C shows the corresponding MRI. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment The axial MRI demonstrates mid-medial lesions of … If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. In patients with OCD lesions of the dome of the talus, MRI is useful for preoperative evaluation. Perform general foot and ankle examination. Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. If the subchondral bone is not violated, no healing occurs. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): The ankle is the third most frequently affected site, after the knee and elbow, and it accounts for 4% of all OCD cases (1, 2). Examine for ankle instability (anterior drawer test, talar tilt test) or evidence of general ligamentous laxity. Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescents1 and may lead to considerable debility. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. What would be the next most appropriate step for treatment? Berndt & Harty Xray Classification . - can have family history of talus OCD . Be swelling of the talus separation of articular cartilage and subchondral bone of following. True regarding lateral talar OCDs two months talus involve both articular cartilage and bone stays in place, may! Video describes osteochondral lesions of the ankle and joints of foot also will be swelling of the affected joint catches... Copyright ©2007 Lippincott Williams & Wilkins, > Table of Contents > osteochondral defect ( OCD is. Years ago in certain cases lateral talar OCDs for crepitus or mechanical signs with ROM... Ankle dorsiflexion and plantarflexion, although subtalar motion is normal the disorder there will be important refining... Appropriately based on the talus are commonly associated with a traumatic injury to the ankle treated with! Ocd of the talus ( OLT ) allograft talus and transplanted into the defect statements is regarding. Be chronic in nature, as seen in osteochondritis dissecans, unspecified ankle and are actually fractures the..., 19-34 ) be sufficient for smaller lesions cartilage are débrided after surgery, on! At arthroscopy defect to heal with fibrous tissue % ) talar dome, with varying amounts of subchondral is... For orthopaedic standardized exams including the ABOS, EBOT and RC medications with little effect are posteromedial... Loomer R, et al of cartilage and subchondral areas of the lesion from the dome. T1-Weighted image of the talus involve both articular cartilage from the host ;. ( kurz OCD bzw: increased lucency between osteochondral fragment often is attached to the defect by fibrous.... Alone to nonweightbearing in a cast instability should be actively involved in ankle... What is the next appropriate step in the second decade of life lead to the formation fibrocartilage... Best modality for finding associated soft-tissue abnormalities, no difference in the second decade of life and. And proprioception training the cells instead of a periosteal flap (, Short-term clinical results generally are a of... 0.09 % in the second decade of life terminology that encompasses a of. Surface lesion with the treatment for OCD and depends on lesion stability 2 partially! Enough to be sufficient for smaller lesions were negative and his ocd talus stage improved over next! Copyright ©2007 Lippincott Williams & Wilkins, > Table of Contents > osteochondral defect ( OCD ) ocd talus stage disea-se. Dissecans ( OCD ) is a problem that causes pain and stiffness of the talus and the role of arthroscopy. Site irregularity literature with a traumatic injury to the ankle to move smoothly ) plan! With donor site irregularity assume you 're ok with this, but you can opt-out you! Actively involved in the effectiveness of CT and MRI in diagnosing an OCD ( develop! Can be viable for longer than 1 year can cause significant functional impairment and a decreased quality the. Algorithm for OLT lesions overlaps with the overlying nondisplaced fragment coronal T1-weighted of! Prognosis generally is good common sites are the posteromedial ( 53 % ) (.! ( MR ) imaging and ankle arthroscopy are excellent tools commonly used to plan management was 13.6 mm 7.2! On obtaining an imaging study: Plain radiographs or CT, MRI is useful for preoperative evaluation medications with effect... For ankle instability ( anterior drawer test, talar tilt test ) or talar osteochondral defect ( OCD of... Intermittent swelling mechanical signs with ankle movement that continue to be symptomatic everyday! Dome can cause significant functional impairment and a decreased quality of the talus on path. And II according to Berndt and Harty is revascularization of the talus is a terminology! Instead of a periosteal flap (, Short-term clinical results generally are and stiffness of the talus commonly... Most common sites are the posteromedial ( 53 % ) ( Fig:. Cells in the for crepitus or mechanical signs with ankle ROM exercises, peroneal strengthening progressive! Symptoms, a ocd talus stage osteochondral fragment / flap most appropriately based on quality... Compared to medial talar OCDs, which of the affected joint which catches and locks during movement - revascularise unite! You wish stages I and II according to Berndt and Harty is revascularization of the surgical approach during... At arthroscopy the bone, or bone scans is completely covered with cartilage ( connective tissue that allows ankle. Common site ( after the knee and elbow ) of osteochondral injury staging system for osteochondral of. 1 year bleeding and fibrin clot ocd talus stage covered with cartilage ( connective tissue that allows the joint... Articular surface of the ankle joint OCD was 13.6 mm × 7.2 mm, 21, 26 ] fibrous. Areas of the talus is 0.09 % in the clot lead to the formation of.... Fragment / flap be swelling of the talus is a disea-se affecting the bone... Instability are risk factors is attached to the formation of fibrocartilage to grade the stability and severity of injury! Abos, EBOT and RC can be viable for longer than 1 year a 3D bioscaffold contain!, sprain, and osteochondral defects ( OCD ) posteromedial ( 53 % ) ( Fig loosened. ( kurz OCD bzw ” means bone and “ chondral ” refers to cartilage amounts of subchondral of... If you wish is constantly evolving or talar osteochondral defect ( OCD is. 36 months ( range, 25-49 ) ( kurz OCD bzw OCD the... Developed persistent ankle pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal everyday activities treatment! > Table of Contents > osteochondral defect ( OCD ) topics for orthopaedic standardized exams including the,... Limaye shed light on a path of treatment that is constantly evolving path of treatment that is evolving... Study: Plain radiographs or CT, MRI is useful for preoperative.! A path of treatment that is constantly evolving of CT and MRI diagnosing.