Conclusions: This study shows that MRI can be used to evaluate the articular cartilage covering osteochondral lesions of the talus … The study was a review of case records of patients between January 2016 and December 2019 who were diagnosed with osteochondral lesion of the talus and were treated with arthroscope-assisted retroarticular drilling and autologous cancellous bone grafting. Osteochondral Lesions of the Talus Sara Lyn Miniaci-Coxhead, MD Dr. Miniaci-Coxhead or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. It is also termed as Osteochondritis Dissecans of the talus. The defects cause deep ankle pain associated with weightbearing. Nuclear medicine communications 2015. The ankle joint is an articulation of the end of the tibia and fibula (shin bones) with the talus (heel bone). Management of Cystic Osteochondral Lesions of the Talus. Cuttica DJ, Shockley JA, Hyer CF, Berlet GC. 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).Radiography cannot directly depict the cartilage surface ().Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3 –5). Symptomatic osteochondral ankle defects often require surgical treatment. Mechanical malalignment overloads either the medial or lateral boarders of the talus depending if there is tibial or hindfoot varus or valgus . Maeurer Juergen. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Introduction. The most common diagnostic testing of the ankle and osteochondral lesion of the talus is magnetic resonance imaging (MRI) of the ankle. Mild joint effusion is seen at tibio-talar and subtalar joints. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans They may also be called osteochondritis dessicans or osteochondral fractures. 10 Because these lesions typically are undiagnosed, these numbers may be inordinately low. 9 It is reported that the prevalence is 0.002 per 1000 persons. Introduction. The severity of the injury is best assessed using MRI. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). cartilage injury with associated subchondral fracture but without detachment, x-ray findings: usually none; may see fracture as sclerotic or osteopenic area, MRI findings: high signal around osteochondral fracture (, x-ray findings: slight lucency between osteochondral fragment and remainder of the bone, usually joint effusion present, surrounding fragment and filling donor site, x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity. Osteochondral lesions of the talus: a revised classification. Osteochondral lesions of the talus (OLTs) are being increasingly recognized as a concern following trauma to the ankle. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. OLTs typically are preceded by a traumatic event and generally result in vascular damage to the subchondral bone. Figure 2 (right): 28 y.o. A mid-medial osteochondral lesion of the talus is demonstrated on Fig. In the talus, 96% of lateral lesions and 62% of … Unable to process the form. Impaired function, limited range of motion, stiffness, catching, locking an… Adjacent subtle marrow edema seen in the medial aspect of talus bone. A microfracture technique of osteochondral lesion of the talus is demonstrated. An osteochondral lesion of the talus (OLT) is defined as an injury to the talar dome that results in partial or total separation of the articular cartilage or subchondral bone. doi: 10.1007/s00167-008-0607-x CrossRef PubMed Google Scholar Autologous osteochondral grafting of the Talus is normally reserved as a secondary procedure after a failed microfracture. cartilage injury with associated subchondral fracture but without detachment Posadzy, M, et al. Osteochondral lesions of the talus (OLTs) are lesions involv-ing the articular cartilage of the talus and associated sub- chondral bone. A number of repair strategies exist, including microfracture, osteochondral autograft transfer, and cell-based transplantation techniques, but each has its own limitations. Higashiyama I, Kumai T, Takakura Y. The term osteochondritis dissecans has persisted, and has since been broadened to describe a similar process occurring in many other joints, including the knee, hip, elbow, and metatarsophalangeal joints . 2008;36 (9): 1750-62. Small well defined hypointense signal lesion is seen on the T1W images in the medial talar dome at subchondral region. The MR Grade corresponded to the surgical fmdings. Of the remaining 7 lesions, all were identified within 1 grade. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. The OCLT was graded as follows: 0, … Cheng and colleagues20 further developed arthroscopic staging of the lesions. c-d, Complete filling of the osteochondral defect 2 years after arthroscopic microfracture with atelocollagen augmentation Am J Sports Med. [] Although majority may be associated with trauma, some may develop insidiously. Figure 1 (left): 31 y.o. Of the remaining 7 lesions, all were identified within 1 grade. Ferkel RD, Zanotti RM, Komenda GA et-al. In stage A, the articular cartilage is smooth and intact, but soft. Content may be subject to copyright. Apr 22. Osteochondral lesions of the talus (OLTs) are a difficult pathology to diagnose and effectively treat. Available via license: CC BY. Foot Ankle Int. Surgical treatment is indicated after a failed conservative trial, larger lesion and can be broadly split into cartilage repair, replacement, and regenerative strategies. Large (area >1.5 cm2) or cystic (volume >3.0 cm3) osteochondral lesions of the talus when autografting would be inadequate due to lesion size, depth, or location. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). Thieme, 2006. MRI is a reliable modality to evaluate the size, grade and location of osteochondral lesions. Osteochondral lesions of the talus: a revised classification. . correctly grading osteochondral lesions of the talus. 8 Of all osteochindritides, those involving the talus account for 4% of the total. INTRODUCTION. Thieme, 2006. Osteochondral lesions of the talus can arise from a number of potential causes. Conclusion: The MRI grading of osteochondral lesions in the talus was useful and showed a fairly good correlation with … 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 . 2. Anterolateral (2), anteromedial (1), and accessory portals (3) are demonstrated on Fig. 2005;87(1):41-46. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. The incidence of OLTs is only 0.09% of all fractures and 1% of talus fractures. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Grade C and E showed poor (25.0%) and intermediate correlation (66.7%), respectively. 2010). (1999) Foot & ankle international. Hepple S, Hepple WI, Hepple GD et-al. Check for errors and try again. 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 . Introduction. J Bone J Joint Surg Br. Eine sogenannte OCL ("Osteochondrale Läsion") ist eine Verletzung im Bereich des Gelenkknorpels und Knochens am Sprungbein. Follow-up study of MRI for osteochondral lesion of the talus. McGahan PJ, Pinney SJ. OCD usually causes pain during and after sports. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral 3. 17 The etiology of OLTs is primarily due to damage of the talar articular surface and the subchondral bone. Osteochondral Injuries of the Ankle. 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). 3. Talar dome lesions are usually caused by … Current concept review: osteochondral lesions of the talus. Perform the initial testing without contrast dye injection. . 1. talus; capitellum of the humerus; Staging. Unable to process the form. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. ... the anterior syndesmosis is thickened with edema, indicating partial tearing or grade 2 injury. 2. Thompson JP, Loomer RL. This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Orthopaedic… Osteochondral lesions of the talus (OCLs/ OLTs), also called osteochondritis dissecans or osteochondral fractures, constitute a gamut of injuries to the articular surface of the . Successful management of osteochondral lesions of the talus remains a clinical conundrum for surgeons—not simply in terms of intraoperative decision-making regarding optimal treatment technique and use of biological adjuncts but also in terms of reliable postoperative assessment of treatment success. Prospective study on diagnostic strategies in osteochondral lesions of the talus: is MRI superior to helical CT? Correlation of MRI edema and clinical outcomes following microfracture of osteochondral lesions of the talus. Annals of Clinical and Analytical Medicine. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. cartilage injury with associated subchondral fracture but without detachment, x-ray findings: usually none; may see fracture as sclerotic or osteopenic area, MRI findings: high signal around osteochondral fracture (, x-ray findings: slight lucency between osteochondral fragment and remainder of the bone, usually joint effusion present, surrounding fragment and filling donor site, x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity. Hiervon unterscheiden wir die Osteochondrosis dissecans 5. 1. Medial lesions are more common than the lateral ones and typically located at the posteromedial talar dome, with a typicall deep - cupshaped figure. Fig. Reticular bone bruising, distant from the articular surface. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. 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). Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus. Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Tóth F, Nissi MJ, Ellermann JM, et al. Preoperative magnetic resonance imaging (MRI) showing (a-b) an osteochondral lesion of the talus (arrow). Annals of Clinical and Analytical Medicine; inquiry Hepple S, Hepple WI, Hepple GD et-al. Top arrow indicates bruising of the distal tibia and the lower red arrow indicates bruising of the talus. Collapsing all grades into disease-negative status (grades 0 and 1) and disease-positive status (grades 2, 3, 4, and 5) yielded sensitivity of 95%, specificity of 100%, negative predictive value of 88%, and positive predictive value of 100%. Though there is some evidence that the high grade lesions do less well with an arthroscopic debridement and microfracture this is a much smaller operation than open grafting and a number will settle with no more intervention required. Ferkel RD, Zanotti RM, Komenda GA et-al. The diagnosis of these cases was established preoperatively by plain radiographs and confirmed by MRI. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. 2010;31(1):90-101. 3. When analyzing osteochondral lesions on MR images of the knee, the radiologist must first consider patient demographics, clinical presentation, and history of trauma. Imaging strategies for the knee. Imaging strategies for the knee. 6. MRI correctly graded 33 of 40 (83%) of the osteochondral lesions using the described 5-point scale. It is often associated with a traumatic injury, such as a severe 2011 Oct. 4(5):274-9. . In a double-blind prospective study, 12 patients with osteochondral lesions of either the knee or talus were studied using magnetic resonance imaging (MRI) prior to arthroscopic treatment. Osteochondral lesions of the talus (OCL) occur in the articu-lar cartilage and subchondral bone of the talus and are com- monly associated with ankle injuries, such as sprains and frac-tures (Bruns 1997, van Dijk et al. Foot Ankle Int. 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. Maeurer Juergen. They usually involve both the subchondral bone and the overlying articular cartilage. Arthroscopy MRI Talus Osteochondral Lesion Radiofrequency Coil 1. On review of all literature describing transchondral fractures of the talus, Berndt and Harty developed a classification system for staging of osteochondral lesions of the talus (OLTs). Knee Surg Sports Traumatol Arthrosc 16(11):1047–1051. Classically, the typical patient with an osteochondral lesion of the talus presents clinically with low-grade aching ankle pain months after an ankle sprain. MR grade 3 lesions showed the best correlation (83.3%) and MR grade 1 and 2B lesions showed the worst (50.0 and 55.6 %). Foot Ankle Spec. Pathophysiology of OCLs of the talus : Talar osteochondral lesions tend to involve the medial and lateral corners of the talar dome. Abstract. female with a Grade 3 lesion with a cartilaginous flap exposed. 3 illustrates the classification of osteochondral lesions of the talus using MRI. pain, later studies showed that 30–43% of talar OCL diagnosed on MRI were invisible on CR [5]. They are most commonly associated with ankle trauma and wh… Osteochondral Repair of Talus: The Course Of Treatment. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). There is also a bone on top of the talus. Although exact causal mechanisms can be difficult to determine, most OLTs are likely caused by either an acute traumatic insult or repetitive chronic loading of the ankle joint. Dieser Teil des Sprungbeins bildet mit dem unteren Schien- und Wadenbein das sogenannte obere Sprunggelenk. With an estimated incidence of 27 per 100 000 person-years, these lesions are not uncommon. Check for errors and try again. Localized articular cartilage lesions in young patients are relatively common, 1 and treatment remains a challenge. 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. Revision surgery after failed prior marrow stimulation for large (area >1.5 cm2) or cystic (volume >3.0 cm3) osteochondral lesions of the talus when autografting would be inadequate due to lesion size, depth or location. Osteochondral lesion of the talus, also known as OLT, is a disorder, which consists of a section of damaged cartilage. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. MATERIALS AND METHODS: Preoperative MRI of 153 patients with ankle fractures who underwent operative fixation was studied. 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). ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Osteochondral lesions of the talus encompass important clinical conditions encountered in day-to-day practice. Varied etiology and non-specific clinical signs make the diagnosis of these lesions challenging. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Novel Application of Magnetic Resonance Imaging Demonstrates Characteristic Differences in Vasculature at Predilection Sites of Osteochondritis Dissecans. The most common diagnostic testing of the ankle and osteochondral lesion of the talus is magnetic resonance imaging (MRI) of the ankle. Pritsch and coworkers19 were one of the first to grade talar osteochondral lesions with arthroscopic findings according to cartilage quality. netic resonance imaging [MRI]), has been targeted as a viable entity to treat in a therapeutic strategy to relieve pain.2 Inhibition of subchondral lesions has been shown to alleviate joint pain.1 Several arthroscopic and open sur-gical techniques have been used to address subchondral disease, including osteochondral autograft and allograft,3 Background Magnetic resonance imaging (MRI) has been used as an optimal technique for evaluating articular cartilage (1, 2).It can provide information about cartilage damage and correlates closely with arthroscopic findings ().MRI has greater sensitivity to cartilage and helps clarify cartilage damage (). As such, it can go on to produce a partially or completely detached osteochondral fragment [ 1 – 3 … Treatment of OCL may be operative or nonoperative. Am J Sports Med. The unstable cartilage rim … Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Page 6 of 19 talar dome in the ankle joint. Patients and methods - This study included 142 patients w … It also aids in the assessment of stability and determination of the presence of a cystic component. This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March 1, 2011, and May 31, 2018. Collapsing all grades into disease-negative status (grades 0 and 1) and disease-positive status (grades 2, 3, 4, and 5) yielded sensitivity of 95%, specificity of 100%, negative predictive value of 88%, and positive predictive value of 100%. Until 2007, location distribution was mainly reported in a medial, central, or lateral manner. We report the outcome of a nonoperative treatment for symptomatic OCL. A reduced or painful range of motion, mild non-pitting edema and medial or lateral tenderness to palpation may be evident on a physical exam. Thus, it is an important aid in surgical planning and in follow-ups. Cheng & Ferkel’s grading system based on arthroscopic findings, later explained on MRI grading system; MRI offers improved three-dimensional localization and sizing of the lesion. Osteochondral lesions of the talus in a … PubMed CrossRef [26] Mintz DN, Tashjian GS, Connell DA, Deland JT, OMalley M, Potter HG. They occur most commonly secondary to trauma when the ankle is sprained or … Dieser Teil des Sprungbeins, der häufig betroffen ist, wird als Talusrolle bezeichnet. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral; medial talar dome lesions more common; location medial talar dome. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. Ligamentous structures around the ankle and OCLT were assessed by MRI. We studied the incidence of osteochondral lesions of the talus (OCLT) with various ankle fracture patterns and assessed their impact on functional outcome. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. 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