There were 10 boys and 14 girls. 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. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). Osteochondritis dissecans (OCD) of the talus is rare in children. However, the larger the graft, the more likely it seems that it will collapse as a new blood supply is established into the graft after transplantation. 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. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. This may affect healing… History and previous treatment: AS BG (ligament repair) for ankle instability . Fig. It is often associated with a traumatic injury, such as a severe “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). 169 Part V – Outcome measures Chapter 15 Outcome measures Talar OCD. The talus sits inside the joint and allows the up and down motion of the ankle. [Picture 5]. Two children had bilateral involvement, for a total of 26 lesions. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Show Related Articles from PubMed. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. OLTs on the top outside part of the talus (Antero-lateral lesions) usually have a history of a traumatic injury with a twisting component, such as an ankle sprain. However, if the lesion is large enough, or the overlying cartilage is displaced, talar OLTs can be quite symptomatic. OCD occurs in a number of locations in the hock, including the intermediate ridge of the tibia (most common), the lateral trochlear ridge of the talus, the medial malleolus of the tibia, and the medial trochlear ridge of the talus. This can be done without a medial malleolar osteotomy. Treatment options for large talar osteochondral lesions (greater than 1.5 cm) or those that fail to adequately respond to microfracture, have broadened over the last decade, with most procedures directly aimed at hyaline-like cartilage restoration. 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). OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. dissecans (OCD) of talus • “Osteochondrosis”?? The mean size of defect of OCD was 13.6 mm x 7.2 mm. Where does OCD develop? OCD of the Talus Tx. Osteochondritis dissecans. Autologous chondrocyte transplantation (ACI): There has been an attempt to harvest a patient’s own healthy cartilage, grow the cells in a lab, and then reimplant these cells back into the area where the cartilage has been lost. X-ray: In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. – Localized ischemia & AVN – Not an inflammatory process so the term“osteochondritis” is a misnomer – Younger patient – No history of trauma – More on medial side. [Picture 2, 3 + 4] Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. Cartilage repair techniques. All operative techniques can be downloaded here. Synovitis of the tibiotalar and subtalar joint. San Francisco CA 94123, Osteochondral Autologous Autograft Transfer, The inside and top part of the lower bone of the ankle (the medial talar dome) or. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. [Picture 1] There is an increasing prevalence of … An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). 1. treatment? Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. OCD medial Talus . This may lead to small cracks in the cartilage or even formation of a hole or cyst underneath the surface. OCD usually causes pain during and after sports. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. The mean time of follow-up was 36 months (range, 25-49). Osteochondritis dissecans (OCD) of the ankle is a disorder of the talar or distal tibial subchondral bone and articular cartilage whose incidence in children is not clearly known. healing of osteochondral defects of the talus: an experimental goat study Osteoarthritis Cartilage 2013;21:1746-54. Areas of decreased density (i.e., darker areas) seen on the plain x-rays (Figure 2) can be indicative of this condition, although it is not uncommon for the plain x-rays to be read as normal. As the ankle twists, the edge of the talus bone impacts the adjacent bone which bruises or shreds the cartilage. They may also complain of mechanical symptoms, such as clicking and popping sounds caused by a loose fragment of cartilage and/or bone associated with the OLT. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. I would go for a lift-drill-fill-fix procedure. Did you know our resouces can be found in. Anterior Impingement- After Total Ankle Replacement. Retrograde drilling and fixation scored 88 and 89%, respectively. arthroscopic debridement and drilling? This prevents the need from harvesting bone and cartilage from another part of the body (ex. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). knee). Magnetic resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset OCD. The area where OCD occurs is located at the top of the talus. On the talus, this covering is about one-eighth of an inch thick. 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. 2. postoperative treatment regime? This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Osteochondral defects of the talus (OCD) are a well-established pathology within 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). This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The cartilage lining of the joint is crucial to allow […] Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Non-operative treatment can be successful for non-displaced talar OLTs, especially if the condition is recognized and treated early, and the lesion is relatively small. CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). The gold standard for diagnosis of talar OLTs is an MRI of the ankle (Figure 3A and 3B). OCD of the Talus Radiographs. lage OCD may have genetic risk factors that predispose them to developing the disease, although as per Zanon et al9 in ‘Osteochondritis Dissecans of the Talus’, ‘there are no ongoing studies to identify such genes’. The fragment is large enough to fix. It is often associated with a traumatic injury, such as a severe ankle sprain. Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Th… OCD Lesions of Talus Introduction The ankle joint of made up of 3 bones; the tibia (including the medial malleolus), the fibula (including the lateral malleolus) and the talus. During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for … Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. While initial symptoms may be similar to a sprained ankle, persistent pain, swelling, and a catching sensation while using the ankle may indicate this more serious condition. They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. 19 years old male hockey player with osteochondral lesion of the talar dome. If you want advise on a difficult case, you can upload it here. With special emphasis on diagnosis, planning and rehabili-tation in press. 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. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. cartilage injury with associated subchondral fracture but without detachment for OCD of the talus at a major Canadian pediatric referral center. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury The most common sites are the posteromedial (53%) (Fig. Small area of compression 2. Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4-6 weeks can help reduce stress on the OLT and allow healing. 1) and anterolateral (46%) talar dome (1). CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. OCLs most commonly occur in two areas of the talus (Figure 1A and 1B): Many patients with talar OLTs are asymptomatic (no pain or swelling). Osteochondral lesion of Talus & Ankle Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. OCD remains uncertain. The pain is often worse with activities, particularly running, walking and jumping. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). There are several non-operative management options for the treatment of osteochondral lesions, including: In younger patients, this condition has the potential to heal, making it possible to treat acute non-displaced talar OLTs with immobilization in a cast or CAM walker. It occurs when OCD develops in an articulating surface before closure of the growth plate.14 Owing to rarity of juvenile OCD of the talus, existing management guidelines are predominantly Completely detached , non-displaced fragment 4.Completely detached and displaced fragment Ct or MRI will give more information with a suspected lesion . 6.1 Reticular bone bruising, distant from the articular surface. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). The bone lesions on the lateral or outside portion of the talus are most often related to trauma. 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