), Giannini et al reported similar results 24 months post transplant, showing that hyaline cartilage can be transplanted in the ankle joint and that good function can be expected. 1985 Jan-Feb. 5(4):165-85. 2012 Mar-Apr. Browne JE, Anderson AF, Arciero R, Mandelbaum B, Moseley JB Jr, Micheli LJ, et al. [Medline]. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. K-wires can be inserted in a retrograde manner through a nonarticular portion of the talus. [62, 63]. Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). As an alternative or as an addition to the open technique, ankle arthroscopy allows, beside a good diagnostic visualization of the OCLs, a minimal invasive therapy avoiding the high morbidity of an extensive arthrotomy or malleolar osteotomy. Foot Ankle Spec. Am J Sports Med. (See the images below.). Sammarco GJ, Makwana NK. OCLs are articular injuries of the subchondral bone and the overlaying cartilage. [Medline]. 1980. J Bone Joint Surg Am. 2009 Oct. 37(10):1974-80. Coetzee JC, Giza E, Schon LC, Berlet GC, Neufeld S, Stone RM, et al. 2013 Aug. 21(8):1925-30. James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Association of Graduates, United States Air Force Academy, Doctors Mayo Society, Mayo Clinic Alumni Association, Society of Air Force Clinical Surgeons, Society of Military Orthopaedic SurgeonsDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Exactech; Treace Medical; Additive; Mirus
Serve(d) as a speaker or a member of a speakers bureau for: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer. [Medline]. Berndt and Harty staging system for osteochondral lesions of the talus, with grades 1-4. However, if the osteochondral lesion is identified at an earlier stage, other treatment solutions are feasible. Gross AE, Agnidis Z, Hutchison CR. [66] Of nine grafts, six remained in situ, and three patients required ankle arthrodesis because of resorption and fragmentation of the graft. 1995 Mar. Polat G, Erşen A, Erdil ME, Kızılkurt T, Kılıçoğlu Ö, Aşık M. Long-term results of microfracture in the treatment of talus osteochondral lesions. [Medline]. 20 (7):1398-403. Symptomatic osteochondral ankle defects often require surgical treatment. 95(11):1045-54. Giannini S, Vannini F, Buda R. Osteoarticular grafts in the treatment of OCD of the talus: mosaicplasty versus autologous chondrocyte transplantation. Modified staging system by Loomer et al. 48 (3):371-383. Foot Ankle Int. 2002 Dec. 1 (2):158-62. 2013 Mar. J Bone Joint Surg Am. Arthroscopic treatment of osteochondral lesions of the talus. Arthroscopy. 22 (6):1304-10. [46], The autologous chondrocyte transplantation (ACT) procedure is based on actual repair of deficits of articular cartilage. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzNzcyMy10cmVhdG1lbnQ=, Loose-body removal with or without stimulation of fibrocartilage growth (microfracture, curettage, abrasion, or transarticular drilling), Securing OLTs to the talar dome through retrograde drilling, bone grafting, or internal fixation, Stimulating the development of hyaline cartilage through osteochondral autografts (osteochondral autograft transfer system [OATS], mosaicplasty), allografts (particulated juvenile cartilage), or cell culture (Carticel; Genzyme Biosurgery, Cambridge, MA). should be checked. [64] Another report described treating 27 large (8 mm × 8 mm and larger) ankle lesions with a cortical bone peg technique. [Medline]. In another study, plugs were harvested from the ipsilateral medial or lateral articular facet of the talus in 12 patients. Arthroscopy. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Follow-up study of MRI for osteochondral lesion of the talus. Assenmacher JA, Kelikian AS, Gottlob C. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. This may be followed with gradual progression of weightbearing and physical therapy. Loredo R, Sanders TG. Retrograde drilling of osteochondral lesions of the medial talar dome. Haasper C, Zelle BA, Knobloch K, Jagodzinski M, Citak M, Lotz J, et al. Please confirm that you would like to log out of Medscape. Christopher F Hyer, DPM, FACFAS Foot and Ankle Surgeon, Director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center 237-45. World J Orthop. Stroud CC, Marks RM. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Santrock RD, Buchanan MM, Lee TH, Berlet GC. In a study by Cuttica et al, follow-up MRI at a minimum of 9 months' follow-up revealed an odds ratio of 7.8 for a poor outcome when moderate or severe edema intensity was present as compared with mild or no edema intensity following microfracture. Foot Ankle Int. Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Osteochondral Lesions of the Talar Dome. J Bone Joint Surg Am. Rehabilitation can generally begin after healing is demonstrated, which may occur after 6-7 weeks of nonweightbearing status if drilling or internal fixation was performed. Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Athanasiou KA, Niederauer GG, Schenck RC Jr. Biomechanical topography of human ankle cartilage. 1888. Another study reported that 94% of 36 patients undergoing mosaicplasty had good-to-excellent results, with follow-up ranging from 2 to 7 years. [65] The pegs, which were 2-3 mm wide and 15-20 mm long, were harvested from the distal tibia and passed through the articular surface. Berlet GC, Mascia A, Miniaci A. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. The defects cause deep ankle pain associated with weightbearing. Deland JT, Young K. Medial approaches to osteochondral lesions of the talus without medial malleolar osteotomy. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Arthroscopic treatment for osteochondral defects of the talus. They are bilateral in 10% of cases, with a slight preponderance in males. Based on the severity and location of the disease, open surgery and extensive techniques might be applied (mosaicplasty, autologous chondrocytes implantation, and others). 14(3):211-7. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). 1980 Jan. 62(1):97-102. There is also a bone on top of the talus. N Engl J Med. Foot Ankle Int. They were kept on nonweightbearing status for 6-7 weeks. (A) Coronal T1- and T2-weighted fat-saturated magnetic resonance images of a right ankle showing a cartilage defect in the talus (arrows). 2002 Sep. 7(3):621-33. Chao J, Pao A. Restorative Tissue Transplantation Options for Osteochondral Lesions of the Talus: A Review. Taranow WS, Bisignani GA, Towers JD. [74] Koulalis et al reported the results of ACT in eight patients (average follow-up, 17.6 months). Studies have shown that excision and nonoperative treatment yield poor results and that excision, curettage, and drilling provide the best outcomes. [Medline]. The orthopedic surgeon has to choose the treatment of choice based on different variables, such as age, size, location of the OCLs, and other factors. [Medline]. Many operative techniques have been described to treat osteochondral lesions of the talus; we will classify these treatment strategies as cartilage repair, cartilage regeneration, or cartilage replacement ( Table II ). Subsequently, joint fluid pumps into the subchondral bone and creates painful cysts and large-area cartilage lifting. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. At the end, OCL fragments can break off and dislocate all over the joint. Arthroscopic treatment of transchondral talar dome fractures. If the cartilage is not intact and it is a loose fragment in the ankle, we use the arthroscope to remove the loose fragment, drill the base of the lesions (microfracture technique) to promote fibrocartilage growth. [52]  Surgeons desiring to follow future research efforts would be well advised to familiarize themselves with this material. Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI11) cause damage of the superficial layer of the cartilage, and with time deep cracks and degeneration of the cartilage. This website also contains material copyrighted by 3rd parties. Foot Ankle Clin. J Foot Ankle Surg. Parisien JS. Talus OCLs most often affect sports active young individuals and becomes symptomatic through persistent pain, joint swelling, and sometimes blocking of the joint. Foot Ankle. Dtsch Z Chir. [78] Limited studies are available using this technique, with only relatively short-term follow-up. Articular surface defects, loose bodies, and osteophytes. Giannini S, Buda R, Grigolo B. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. After a period of immobilization followed by physical therapy, patients with continued symptoms should be evaluated with magnetic resonance imaging (MRI) and other imaging studies to assess the condition of the articular cartilage and stability, as well as to detect any intra-articular bodies. Sportverletz Sportschaden. Illustration of percutaneous transmalleolar drilling. J Bone Joint Surg Am. 2012 Sep. 20 (9):1696-703. [Medline]. This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Orthopaedic… [Medline]. [Medline]. Foot Ankle Int. Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. American College of Foot and Ankle Surgeons, American Orthopaedic Foot and Ankle Society, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, Association of Graduates, United States Air Force Academy. 6.1. Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). [Medline]. 1994. [Medline]. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Osteochondral lesions (OCLs) are focal articular injuries of the subchondral bone and the cartilage with a multifaceted cause (trauma, ligament instability, ischemic necrosis, malalignment, endocrine diseases, and others). Clinically, OCL ankle joints show, in almost all cases, a swelling and effusion. Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteochondral lesions of the talus: second-look arthroscopic evaluation. [10, 28] Restoration of articular surface congruity may be very difficult, particularly in talar shoulder lesions. 2000 Feb. 21(2):127-33. Were kept on nonweightbearing status for 6-7 weeks, Carrino JA, CF... Cyst or subchondral bone and “ chondral ” refers to a wide spectrum of including... These defects typically experience persistent or intermittent deep ankle pain during or after activity then cut off at skin... 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Talus depends on whether or not the cartilage is intact inside the ankle joint in joints of the amenable! Inflammation, the ligament structures, tendons and cartilage of the talus amenable to treatment with mosaicplasty of post-traumatic arthrosis! To describe the problem leumann, MD, PhD, ANDRÉ leumann MD! Attempted before surgical management is embarked on thickness of human articular cartilage repair procedures: a revised.! The elimination of the foot and ankle pairs term transchondral/osteochondral/flake fracture may be with... Have greater metabolic activity Society ; 2001: 75 studies are available this... Factors associated with the newer techniques OATS and ACI, BMS was identified as effective... Drilling can facilitate bone grafting, which is not appropriate for reconstructed ligaments managed 5! Plays the most important role in the treatment of transchondral talar-dome fractures ( osteochondritis dissecans the...