Outcome of resection of a symptomatic os trigonum. Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. 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). Reproduction without express written consent is prohibited), The osteotomy is fixed with two parallel screws and a third transverse screw to prevent superior migration of the osteotomy fragment (Illustrations copyright of and reproduced with permission from JG Kennedy MD. 1991;11:242–3. Arthroscopy. OCL location and characteristics must therefore be considered when planning the surgical approach (Fig. Re: OCD lesion of medial talar dome Thanks for the tip on the sticky and Thanks again LivesNearStore for the link! Contraindicated for large OCLs, limited range of motion, and narrow joints, Horizontal cut results in no perpendicular access, Difficult to fix the fragment perpendicular to the cut, Excellent congruity when the cut is made 30° relative to long axis of the tibia, Outcomes vary; fragment migration seen when fixation is not perpendicular to cut; requires precise cut 30° to tibia, Amount of exposure, advantages, and disadvantages of medial malleolar osteotomy techniques are outlined for comparison [, The Chevron-type medial malleolar osteotomy has been described several times previously [, A Chevron cut is made in the medial malleolus after predrilling the fixation holes and placing a guidewire for osteotomy direction (Illustrations copyright of and reproduced with permission from JG Kennedy MD. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point . [ 55 ] Arthroscopic treatment of OLTs can be accomplished by using wide-angle 2.7-mm arthroscopes, which provide more maneuverability than the older 4- … There were 10 boys and 14 girls. The articular surface of these facets is contiguous with the superior articular surface of the talar dome. J Bone Joint Surg Am. The lesion is encountered on either the medial or lateral surface of the talar dome. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. In addition, there is a risk of fragment migration when fixation screws are not applied properly [. This approach is recommended when preoperative imaging indicates an OCL is in an accessible location and does not require full visualization or open treatment [, A medial malleolar osteotomy should be avoided when an arthroscopic approach can provide access and allow satisfactory treatment of an OCL. Talar dome lesions are usually caused by … The discrepancy of naming may be attributed to historically varied opinions of the pathogenesis. See the main osteochondritis dissecans article for a general discussion on … Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. 2003;85-A:1051–7. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. Assenmacher JA, Kelikian AS, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Alexander IJ, Watson JT. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 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. 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. Osteochondritis dissecans (OCD) of the talus is rare in children. It can occur in all age groups. Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. 1) and anterolateral (46%) talar dome (1). Impaired function, limited range of motion, stiffness, catching, locking an… While the patient's radiographs demonstrated the osteochondral defect of the medial talar dome, radiographs may not always adequately show osteochondral defects, especially in the early stages following injury. Foot Ankle Int. 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), on Approach to Osteochondral Lesions of the Medial Talus, Preoperative Planning for Osteochondral Defects, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Osteochondral Defects by Arthroscopy, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Talar Dome Resurfacing with the HemiCap Prosthesis, Rehabilitation After Cartilage Reconstruction. MRI images show a stage IV medial talar dome osteochondral lesion with a minimally displaced osseous fragment corresponding to the plain films. Reproduction without express written consent is prohibited), The osteotomy cut is terminated just prior to reaching the subchondral bone and completed with an osteotome (Illustrations copyright of and reproduced with permission from JG Kennedy MD. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. Standard anterior arthroscopy can access about 50 % of the talus without invading the joint space, and 75 % of the talus can be accessed with distraction, debridement, and/or arthroscopic invasion of the joint space. It had Great information My son will have to stay in his room for much of the first part of recovery, due to the only bathrooms we have are upstairs. An algorithm for the approach to osteochondral lesions of the medial talar dome. Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. Baltzer AW, Arnold JP. h�bbd```b``��@$S!�du�* ���~fk�H>%0[�V���H�(� �`ӔA$�)�|U ɸ�,nb��/_�5]��& ��H�u�]5���2�� $�����U���5A��S0�D*U��j �`�d�H�c`q�O�=�� 5� 6ȏ�K� ɯ7�20�����t%�30}x` �� � 0 Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, … Step-cut osteotomy of the medial malleolus for exposure of the medial ankle joint space. 1 article features images from this case. Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome 105 0 obj <> endobj Small talar beaking. Image 1 shows access to the ankle through the tibia and site preparation of the talar dome. 2001;22:544–51. Two children had bilateral involvement, for a total of 26 lesions. Treatment principles of osteochondral lesions of the ta… Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). In 2 cases, OCL was associated with a fracture, in I the medial malleolus and in the other both nialle- oli. �O!��o!�b �M�?�X���=����B�p��5��7�X�qv�����.� ��j�b,������u%6絛���ŌU?�X_���������a�c�������Rz��+��]��}��uﰂ>O��k����`��W��R����T�I�2lAU���׻�jmm�Ҫ0| �� 9����$��z�, �M����GҎN�g��e�ݞ��eBm�W��}���}IHg`���-"7�1�\�P�,�rU��y�l��]��*������]���*���|y���W�(�]sS��"+�n�ݺ�Xݿ�%���c�&u4�9.��Q����}.£")ͱ���2�Ӽ��'��6���Gi����C��� YV 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. 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. Magnetic resonance imaging is typically the recommended modality for noninvasive imaging and assessment of osteochondral defects. %%EOF The most common sites are the posteromedial (53%) (Fig. “Osteo” means bone and “chondral” refers to cartilage. The author has no current conflict of interests with the products presented. In a severe ankle sprain, usually the medial and lateral ankle ligaments bear the brunt of the trauma, but sometimes the sprain may be so severe that the talus bone is displaced resulting in trauma to the bone and in many cases may be severe enough to cause a fracture within the talus. Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. 3. Reproduction without express written consent is prohibited), An oblique osteotomy provides adequate visualization of the talus and good congruity when executed properly [, Arthroscopic approaches are well established, minimally invasive, and can provide access to most OCLs. Foot Ankle. endstream endobj startxref Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. The aim of the present study was to examine the clinical outcomes after HemiCAP ® implantation for OCDs of the medial talar dome after failed previous surgery. ?-[$�ih\�^�z�� N�F>(2ku$CR�d�~w��oI��ŕҽ�H�+b�J��$��}��Q����GE8C/M���p��З������)N��C���#�p& ����)j�%CM��x�,*$�j���3E�X%���y}k�o0�� ��|Xo��3�{W��z�fJ��^{���wa�rʕ�w��3|?�]��E��I����y���$̛�ݔ��4I�WS��4+{��7Qaf�1m�U:3���-��0��ǀpO ���=6.�ʚ-MȷhY����Y��FKo�ҥ��sg�|>�5� ,�x�qT|��T+�p_~��Qi�8�q٪�����]�B��A�4�/�i�J���,;k/b{|T*o�>�d�(�f���T����w����w���`��O; It is often associated with a traumatic injury such as a severe ankle sprain. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Access to the ankle total of 26 lesions or osteochondral lesion ( OCL ) Barzilay Y, Wollstein,... This condition is also known as osteochondritis dissecans ( OCD ) of the joint.... % ) ( Fig only and no history of a trauma locking an… medial lesions. 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