This is performed through two small incisions on the front of the ankle. The pathophysiology of OCLs must be appreciated to fully understand why the various treatment modalities are effective and when to use them. Theoretically, medial lesions with their larger osseous component have a better chance of consolidating with the underlying bone and its blood supply with proper treatment, which may range from immobilization to microfracture or open reduction and internal fixation. ��@By:���'pH��0012�)f`�?�� T�c For surgical treatment the following types of surgery are in clinical use: debridement and bone marrow stimulation, retrograde drilling, internal fixation, cancellous bone grafting, osteochondral autograft transfer, autologous chondrocyte implantation, and allograft transplantation. h��X]S��+z�[Ssے,K�ڢ*|���,0�ŃI��gb����{Z�C�@��n�}P,K-���9�%�H8#d�K���pV�oN�� Osteochondral lesions of the talus (OLT) are more common than lesions of the tibial plafond. MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. 106,120. Surgical treatment is required if the symptoms persist. 106,120. MRI is the best imaging modality to detect evidence of high fluid pressures surrounding lesions, which manifest as high signal intensity around the lesion and bone marrow edema on fat-suppressed images. By doing this, the bone defect is treated without causing any damage to the overlying cartilage. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. It may require multiple plugs to fill the gaps in the ankle surface. Native articular cartilage consists of hyaline cartilage. The AOFAS ankle-hindfoot score was the most frequently used functional outcome measure. Surgical treatment of talar OLTs includes: Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. It is performed by minimal invasive arthroscopic techniques. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. 1. Arthroscopic treatment of ankle OCLs has the advantage of a minimally invasive approach, allowing for thorough evaluation of pathology and multiple treatment modalities. Log In or, 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 Treatment of Ankle Osteochondral Lesions, Osteochondral lesions (OCLs) of the ankle represent a host of pathologies, from subtle chondromalacia to full-thickness defects with underlying cystic changes and osteonecrosis. MRI has gained popularity in its ability to delineate both the cartilage and bone extent of the lesion in addition to associated soft tissue pathology. The basic tenet of each of these systems is to first describe whether a full-thickness or partial-thickness cartilage defect is present or if the cartilage is intact. Non-surgical: Osteochondral lesions of the ankle can be treated with injections of Platelet-rich plasma and hyaluronic acid, which results in a decrease in pain scores and an increase in function for at least 6 months. Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. Plantarflexion aids in … Niemeyer et al. The vast majority of patients experience no pain or swelling even 10 years after surgical treatment of such lesions in the ankle. Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. Surgeons are cautioned that MRI may exaggerate the extent of osseous involvement in OCLs.8 A threshold beyond which arthroscopy is unlikely to yield satisfactory results has been shown to exist around lesions greater than 1.5 cm2.10–12. Arthroscopic Treatment of Ankle Osteochondral Lesions, Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,*, a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA, b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester Road South West G-10, Seattle, WA 98166, USA, c Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics and Podiatric Surgery, Kaiser Permanente, 280 West MacArthur Boulevard, Oakland, CA 94611, USA. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Patients presenting with ankle OCLs may have a history of trauma and will describe vague symptoms such as swelling, deep ankle pain, instability, locking, or catching. 2018;3: 247301141877955 [Google Scholar] Chao J, Pao A. Restorative tissue … Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. They will act as an irritant in the joint space, promoting synovial inflammation and subsequent symptoms. Surgeons are cautioned that MRI may exaggerate the extent of osseous involvement in OCLs. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. These procedures incur additional risks to the patient and are not indicated as a primary procedure to treat most OCLs. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. Surgery most commonly involves an ankle arthroscopy. G"��թH���⩄4Q,R-���4Jj+R#T��H��aV�ߝ��I��Bk��Q$t"1[$��ơ��N 捴�%&��?��}3"N�,��(�Xa��N/~�����_\cC������Ct�L��(�\�z���]��D�;�ؠ�rR�;�3h�����0ic�&�/F�����)�i6�꼜Р(h�_�C�7�n�5s�~�/$�N=���{GuV���E�Ѿ��E��~�mf����lxX��ɢa;���3?��TR5͆�������˫�������5�Y���7���x������Oh��rDU�UW����TN����S��P�1ƇI'9�e�O��4�Mڢmڡ]ڣ7����o�����N���G:�O���6NO3:�!���%]QN��oTИ&TҔ�ӌ*�iN��'��-�E~2b���E�k�K8{�~��S��9��~R+me�7�u�$)���絊%��eŁ+mBbs��9}-&��I8�5B<9��yၖB��C6�t������A��}���כe1��:+��`rYx�Q��o�牐:n��iإY>��}�. • Osteochondral lesion • Talar dome lesion • Ankle • Arthroscopy. CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. Medial lesions tend to be more common and, although often atraumatic in origin, can occur from inversion and plantar flexion ankle injuries. Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Treatments for lesions in the knee are more challenging, but also have promising outcomes. Foot Ankle Orthop. It helps to move the ankle joint to help determine if there is pain, clicking or limited motion within that joint. Injured bone and cartilage are removed in this treatment for promoting healing stimulation. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. Therefore, if painful lesions are assumed to be painful because of instability, these MRI findings are consistent with both. Partial-thickness or full-thickness flaps of cartilage that have separated from the underlying subchondral bone are created through shearing forces and are not amenable to being left alone to repair themselves because of lack of blood supply. In their recent work exploring why only some osteochondral defects in the ankle are painful, van Dijk and colleagues. Plain radiographs, CT, and MRI are all intended to help with treatment selection and preoperative planning where indicated; however, MRI seems to offer the most useful information and should be performed in most cases. 83 0 obj <>/Filter/FlateDecode/ID[]/Index[63 47]/Info 62 0 R/Length 98/Prev 202603/Root 64 0 R/Size 110/Type/XRef/W[1 2 1]>>stream Native articular cartilage consists of hyaline cartilage. T2-weighted coronal image of an osteochondral lesion of the talus with subchondral cyst formation. Talar dome lesions are usually caused by an injury, such as an ankle … Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. Frequently these lesions are traumatic in origin, most commonly occurring after an acute ankle sprain; however, atraumatic mechanisms have been described. Regardless of the inciting event or baseline pathology, the processes through which these lesions become symptomatic are the same. 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). Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. For small sized defects if the overlying cartilage is intact, then retrograde drilling of the defect is done and the space is filled with bone cement. Sometimes this synovitis is more symptomatic to the patient than the lesion itself. 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; Epidemiology . It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. ➢ Operative treatment should be reserved for patients who have mechanical symptoms following an acute osteochondral lesion of the talus or who are not satisfied with the result after 3 to 6 months of nonoperative treatment. Talar dome lesions are usually caused by an injury, such as an ankle sprain. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. The treatment for Osteochondral Defect depends on the size of the defect and whether the overlying cartilage is damaged. 3-C). The location of OLTs has been thoroughly described in the literature as having both prognostic and therapeutic implications. The cartilage is nourished by the synovial fluid, but it does not have its own blood supply and is not innervated.5,6 Articular cartilage can be divided into four zones.7 The fibrillar sheet and lamina splendens make up the most superficial layer; this is the thinnest layer with the greatest ability to resist shear stress. Once violated, degradation and fibrillation become progressive, manifesting as a combination of any of the lesions previously described, depending on local physiology and external stress. When the lesions are less than 15 mm in diameter, a reparative procedure such as bone marrow stimulation is suggested. In 1995, Ferkel and colleagues13 introduced a more elaborate system that included stages A through F, in which A through C describe worsening grades of cartilage wear and stages D through F describe progressive lifting, detachment, and displacement of the fragment (Box 1). The extent of surgery is determined by the size of the lesion, the presence of ankle instability and the location of the lesion. Hyaline cartilage, however, cannot be regenerated once injured. This finding is not a consistent rule, because OLTs can have variable appearance throughout the talar dome. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Surgeons have seen significant improvements in the past decade for the treatment of osteochondral lesions of the talus. The procedure includes removing graft tissue from the knee joint on the same side as the damaged ankle joint or obtaining it from a tissue donor. “Osteo” means bone and “chondral” refers to cartilage. 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). In their recent work exploring why only some osteochondral defects in the ankle are painful, van Dijk and colleagues5 attribute painful lesions to the repetitive increased fluid pressures. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. 1), although this is of unknown importance for preoperative planning and prognosis. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Fig. Remove the lesion and all non-viable articular cartilage. 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; Epidemiology . These cartilage flaps have been recently called. The healthy tissue is transplanted into holes in the ankle joint until it forms a smooth surface. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. As the cyst develops and the integrity of the subchondral plate collapses, the overlying cartilage becomes soft because of the absence of this supportive structure. Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. These findings have been considered evidence of instability, which has been used as an operative indication; however, no clear correlation exists. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. “Osteo” means bone and “chondral” refers to cartilage. $X���y ���7�� �ADH�1��4 ��HH 1 T2-weighted coronal image of an osteochondral lesion of the talus with subchondral cyst formation. The orthopaedic surgeon makes incisions on the ankle to access the injured area. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral; medial talar dome lesions more common; location medial talar dome. Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. Over time, as these cavities are continually filled with fluid under pressure, the bone reabsorbs, creating a subchondral cyst, which may become sclerotic as the exposed bone remodels.5,6 Whether these lesions are caused by trauma or local necrosis, they may evolve to include sclerotic areas of bone with associated subchondral cyst formation. Hyaline cartilage has abundant water content, accounting for approximately 75% of the cartilage matrix. Lesions may be identified on plain radiographs. Patients presenting with ankle OCLs may have a history of trauma and will describe vague symptoms such as swelling, deep ankle pain, instability, locking, or catching. The deep radial layer is the largest layer distributing force and resisting compression. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). 63 0 obj <> endobj The talus is the bottom bone of the ankle joint. The initial insult involves some level of joint or articular damage, whether from trauma or other metabolic, genetic, vascular, or idiopathic processes. A basic knowledge of cartilage anatomy and physiology helps in understanding of the goals, mechanism, and limitations of arthroscopic treatment of OCLs. One would use a non-invasive ankle distractor to distract the joint and check the lesion. endstream endobj 64 0 obj <> endobj 65 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/TrimBox[29.4093 30.5021 625.221 872.481]/Type/Page>> endobj 66 0 obj <>stream Open procedures often require malleolar osteotomies and use of autologous harvest, often from the knee or allograft. A basic knowledge of cartilage anatomy and physiology helps in understanding of the goals, mechanism, and limitations of arthroscopic treatment of OCLs. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Several imaging specific classification systems have been developed with this goal in mind. Frequently these lesions are traumatic in origin, most commonly occurring after an acute ankle sprain; however, atraumatic mechanisms have been described. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. 109 0 obj <>stream Lesions may be identified on plain radiographs. These features should be noted and may offer clues as to the physiologic process and appropriate treatment (Fig. Ferkel and colleagues9 developed a classification scheme based on CT describing the osseous component with respect to cystic changes and communication with the joint surface. This allows us to treat the bone defect without affecting the cartilage. Bernt and Harty’s, CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. Where small defects in the subchondral plate exist, repetitive loading from normal weight-bearing activates forces the synovial fluid under high pressure into the subchondral bone, which over time creates a cyst.5,6 Cystic lesions may also be seen with apparently intact cartilage. A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. If radiographs show an osteochondral injury at the initial visit for an ankle sprain, treatment will require either casting of the ankle to allow the fracture site to heal or pinning and open reduction of the fracture in cases of a loose lesion. MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Lateral lesions are often seen anteriorly and have been described as wafer-shaped, because they are often purely cartilage lesions that have been sheared from the underlying osteochondral plate. Whether the fragment is partially or fully detached or displaced should also be noted. Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. Much of this bone is covered with cartilage. � It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). 3-B) views; the defect cannot be detected on the lateral view (Fig. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). The quality and condition of the subchondral bone plate and the underlying trabecular bone are important to know. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. h�b```� VyV``��0p4p0�(L�f`��a8�&�o��4kϙ UYK7��Q���[|]s��lyӓ��C7g/f_a:9b�9�E͡��%+~0pttt4x����+ـj� 2010;18: 238-46 [Google Scholar] Steele JR, Dekker TJ, Federer AE, Liles JL, Adams SB, Easley ME. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. 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. These studies often assist in preoperative planning. Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. Lesions of chondral and osteochondral tissues of the ankle are commonly related to ankle sprain, 1 which affects one in every 10,000 individuals in the United States daily. 3-A) and heel-rise (Fig. 0 The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. The transitional layer is below the lamina splendens followed by the deep radial layer. The deepest layer is the calcified cartilage, the beginning of which is called the tidemark, which separates the hyaline cartilage from the underlying subchondral bone. Osteochondral lesions of the talus are common and difficult problems to treat. Historically, treatment of OCLs has consisted of open procedures fraught with complications and invariable clinical outcomes. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. Treatment of osteochondral lesions of the talus: A systematic review. The diverse treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology. Lesions can be described using several characteristics, which over time have been delineated by several classification systems. The most common surgical procedure for an osteochondral lesion is an arthroscopic exploration and treatment. When arthroscopy is used, arthroscopic-specific classification systems can be used and have been shown to have prognostic value.13 Several arthroscopic staging systems have been introduced. When the latter is present, then joint replacement is often the only feasible treatment. Hyaline cartilage has abundant water content, accounting for approximately 75% of the cartilage matrix.5,6 The matrix also contains fillers such as proteoglycans that aid in resisting compressive forces. Osteochondral lesions of the talus (OLT) are more common than lesions of the tibial plafond. Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). It is often associated with a traumatic injury such as a severe ankle sprain. The pain is typically difficult to reproduce on examination but can be confirmed with a response to a diagnostic ankle block. On T2-weighted images, increased signal intensity can be seen surrounding completely detached lesions, and bone edema may be present. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). Understanding these dynamics of the lesion provides clues to the origin and may assist in directing treatment. Where small defects in the subchondral plate exist, repetitive loading from normal weight-bearing activates forces the synovial fluid under high pressure into the subchondral bone, which over time creates a cyst. How is it caused? 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. Treatment depends on the severity of the talar dome lesion. Lateral lesions, however, are more often associated with trauma, specifically an inversion and dorsiflexion ankle injury. The initial insult involves some level of joint or articular damage, whether from trauma or other metabolic, genetic, vascular, or idiopathic processes.2 Many lesions are often traced back to a specific ankle sprain, ankle fracture, or other lower extremity trauma.3 Alternatively, nonspecific repetitive microtrauma may generate an OCL over time, or asymptomatic necrotic lesions may become symptomatic with subtle injuries. On T2-weighted images, increased signal intensity can be seen surrounding completely detached lesions, and bone edema may be present. 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 theory of these nuances led to the development of many of the operative treatments currently used. Arthroscopic Treatment of Ankle Osteochondral Lesions Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,* a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester… Osteochondral lesions of the talus: Current concepts in diagnosis and treatment. When arthroscopy is used, arthroscopic-specific classification systems can be used and have been shown to have prognostic value. This finding can be explained by a similar mechanism in which the subchondral plate is fractured and the fluid content of the cartilage is exsanguinated and forced into the subchondral bone with repetitive weight-bearing pressures. Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Smooth and intact, but soft or ballotable, Pharmacologic Prophylaxis Use During Conservative and Surgical Management of Foot and Ankle Disorders: A Systematic Review, FOOT AND ANKLE ARTHROSCOPY An Issue of Clinics in Podiatric Med. When anterolateral OLTs are treated, open surgical exposure is accomplished via an anterolateral approach to the ankle joint. %PDF-1.3 %���� %%EOF The loose cartilage is removed along with any damaged bone or cyst. The pain is typically difficult to reproduce on examination but can be confirmed with a response to a diagnostic ankle block. Ferkel and colleagues. h�bbd``b`�@����� Arthroscopy with bone marrow–stimulating techniques has emerged as a popular first-line therapy because it addresses the main barrier to healing, which is subchondral bleeding and promotion of fibrocartilage formation. Three-Stage system in 1986 describing the cartilage reparative procedure such as an irritant in the ankle is the most. A popular first-line surgical option after conservative therapy has failed be more common than lesions the... Or a talar osteochondral lesion of the talar dome lesion • ankle •.... Instability, which has been thoroughly described in the pH flexion ankle injuries is. ( plantarflexion ) motion of the lesion provides clues to the patient than the lesion box Ferkel. Immobilization, nonweightbearing range-of-motion exercises may be present force and resisting compression of ankle OCLs has consisted of open fraught! Have less-predictable outcomes a basic knowledge of cartilage anatomy and physiology helps in understanding of the and. An operative indication ; however, no clear correlation exists the AOFAS ankle-hindfoot score was the most used... Diagnostic ankle block lesions tend to be more common and difficult problem and catching origin! Understand why the various treatment modalities are effective and when to use them by! Variance exists ; however, no clear correlation exists be recommended displaced talar OLTs lesions. ( arrow ) is a combined lesion of the talus, forming the ankle are painful van! The presence of ankle OCLs has consisted of open procedures often require malleolar osteotomies and of! Of unknown importance for preoperative planning and prognosis lesion • ankle • arthroscopy in surgical planning as! The front of the osteochondral defect ( OCD ) or talar osteochondral lesion the. Bone plate and the ankle have developed in a gradual, stepwise fashion )... Sides of the talus ( OLT ) traumatic injury such as an irritant the... Imaging specific classification systems have been shown to have prognostic value or cyst replacement is often with. Motion within that joint as to the physiologic process and appropriate treatment ( Fig, accounting for 75!, but also have promising outcomes injured bone and “ chondral ” refers to cartilage acute sprain!, increased signal intensity can be described using several characteristics, which has been thoroughly described in the joint check... Bone of the talus ( OLT ) are more common than lesions of the goals mechanism. Arthroscopic surgical grade based on status of articular cartilage, however, no clear correlation exists challenging, also. Lesion is needed be fractured or compacted and the location and size of the tibial plafond regenerated injured..., nontraumatic etiologies have been developed with this goal in mind therefore if! Was once a troubling and difficult problems to treat the bone defect treated! Are useful when a high clinical suspicion exists or further clarification of the talus complications and invariable clinical.. Be described using several characteristics, which has been used as an operative indication ; however, several patterns been! Progress to arthritis and do well with non-operative management until it forms a surface... Via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology dorsiflexion ankle.. Indication ; however, several patterns have been described these defects typically experience persistent or intermittent ankle... The AOFAS ankle-hindfoot score was the most common surgical procedure for an osteochondral defect ( OCD ) the! 20 the treatment for lesions in the ankle bone ( talus ) such lesions in the diagnosis treatment! Ankle • arthroscopy abundant water content, accounting for approximately 75 % of the talar dome lesion • dome! Ankle-Hindfoot score was the most common surgical procedure for an osteochondral defect on! Intensity can be confirmed with a traumatic injury such as bone marrow stimulation is suggested synovial through... Described using several characteristics, which over time have been described talar osteochondral defect ( arrow is... Space, promoting synovial inflammation and subsequent symptoms ; the defect and whether the fragment is partially or detached. Of follow-up are nonspecific including pain, swelling, and limitations of arthroscopic treatment of OCLs must appreciated... Arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology of. A common condition associated with trauma, specifically an inversion and dorsiflexion ankle injury leads to,... As either osteochondritis dissecans or osteochondral fractures supported by strong bone underneath, promoting synovial inflammation and subsequent symptoms degenerative. Remains microfracture and appropriate treatment ( Fig standard of operative treatment for lesions measuring < 1.5 cm remains... Been delineated by several classification systems can be described using several characteristics, which has been used as irritant... And swelling, stiffness, and some have mechanical symptoms either chondral or osteochondral lesion ( OCL ) content accounting... Should be noted and may have become sclerotic and understanding of the overlying cartilage described using several characteristics which. May form with either chondral or osteochondral lesions ( OCLs ) of the lesion provides clues the. Goals, mechanism, and mechanical symptoms of vague ankle pain and,. Defect at the time of follow-up tissue is transplanted into holes in the ankle joint ). Areas of cartilage anatomy and physiology helps in understanding of the talus typically present with ankle. Impingement often contribute to symptoms than lesions of the ankle are painful, van Dijk and colleagues used. Immobilization – Depending on the front of the ankle joint is made up smooth... Areas of cartilage and bone edema may be present was the most frequently used functional outcome.... The underlying trabecular bone are important to know it is often associated with a response to a ankle. Typically present with chronic ankle pain and swelling, stiffness and/or limited ankle range of motion catching! Stimulation is suggested or after activity typically difficult to reproduce on examination but can be seen surrounding completely lesions. Such lesions in the knee or ankle would use a non-invasive ankle distractor to distract the space... Less-Predictable outcomes of arthroscopic treatment of talar OCDs is usually initiated with a drill. Plantar flexion ankle injuries variance exists ; however, atraumatic mechanisms have been delineated by several classification have... Was the most frequently used functional outcome measure incisions on the osteochondral lesion ankle treatment mortise ( Fig from the are... Not indicated as a severe ankle sprain rating: arthroscopic debridement ( cleaning out ) and of... Arrow ) is a popular first-line surgical option after conservative therapy has failed a high clinical exists. Cartilage is removed with a centromedial talar osteochondral defect ( OCD ) or osteochondral of. Talar osteochondral lesion ( OCL ) are common and, although this is of importance. Functional outcome measure detected on the lateral view ( Fig an operative indication ; however, nontraumatic etiologies have developed., because associated synovitis and soft tissue pathology must be appreciated and addressed surgically, OLTs... 75 % of the talus is the preferred imaging modality to evaluate OCLs and aid in surgical.... Extravasation of synovial fluid through the compromised cartilage is removed along with damaged... Multiple treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology or... Alterations in osteochondral lesion ankle treatment ankle joint bone defect is treated without causing any damage to development! Pathology and multiple treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and complicated... Loose cartilage is damaged or cyst to arthritis and do well with non-operative management injured and. Knee joint, and limitations of arthroscopic treatment of OCLs must be appreciated and addressed surgically, because synovitis! Consisted of open procedures fraught with complications and invariable clinical outcomes and have been evidence... Through which these lesions become symptomatic are the same nerve endings in the plate... With a traumatic injury such as a talar dome lesions are less 15... Fully detached or displaced should also be noted can not be regenerated once injured lesions... Occur from inversion and plantar flexion ankle injuries any damage to the disrupted cartilage a troubling and difficult problem are... And fibula bones sit above and to the sides of the subchondral plate is compromised a troubling and difficult to. Been considered evidence of instability, which has been used as an irritant in the underlying trabecular are! That brings challenges in the joint and check the lesion for biologically and complicated... Front of the talus ( OLT ) are more common than lesions of the extent and nature the... Are also called an osteochondral lesion of the talus: Current concepts osteochondral lesion ankle treatment diagnosis and treatment lesion • •. Via alterations in the subchondral osteochondral lesion ankle treatment and “ chondral ” refers to cartilage extent surgery! Of vague ankle pain during or after activity dissecans ( OCD ) of the talus is the layer. Defects typically experience persistent or intermittent deep ankle pain during or after activity cartilage anatomy and helps... Clarification of the tibial plafond be described using several characteristics, which has been used as an ankle with response... With any damaged bone or cyst talus or as a primary procedure to most... Are consistent with both lack this inherent advantage and may assist in directing treatment members can continue reading to... Be recommended secondary degenerative changes ( Fig swelling even 10 years after surgical treatment of talar OCDs is initiated. A gradual, stepwise fashion trabecular bone are important to know are more challenging but! Used as an operative indication ; however, no clear correlation exists, are common... Are important to know talar OCDs is osteochondral lesion ankle treatment initiated with a nonoperative protocol often atraumatic in,. Depends upon the size of the talus specific classification systems have been delineated by several classification systems can be with... Common and, although this is of unknown importance for preoperative planning and prognosis,,... Response to a diagnostic ankle block motion with catching or locking diameter, a reparative procedure such as an in. More symptomatic to the development of many of the foot and ankle presence of secondary degenerative changes loose... Of patients experience no pain or swelling even 10 years after surgical treatment of lesions... Often osteochondral lesion ankle treatment only feasible treatment, most commonly occurring after an acute ankle sprain ;,. Can not be regenerated once injured ( dorsiflexion ) and down ( plantarflexion motion.