30 What is the next appropriate step in the management of this patient? 1, in a review of >580 osteochondral defects of the talus, reported that trauma was implicated as the cause in 76% of the cases. Results: 2021 Mar;46:101639. doi: 10.1016/j.foot.2019.09.001. The term osteochondritis dissecans was originally applied to lesions of the talar dome of the ankle by Kappis ( 1) in 1922 referring to abnormalities of the articular cartilage and underlying subchondral bone which can result in fragment separation and loose body formation. MeSH Osteochondrogenesis with Autologous Peripheral Blood Stem Cells for Osteochondral Lesions of the Talus: Report of Five Cases. Learn about the many ways you can get involved and support Mass General. Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. Diagnosis Foot Ankle Orthop. Open Accessibility Often, there may be several treatment options. Edema is present in the bed of the defect (asterisk). Our Nurse Practitioners and Physician Assistants practice medicine with physician supervision and are licensed by the State of Massachusetts. @jamescottom @drjeffmcalister Causes: Talar dome lesions are usually caused by an injury, such as an ankle sprain. (OBQ12.74) FOIA #anklearthritis #anklefusion #hindfoot varus #anklepain #footandanklesurgeon #acfas Medial talar dislocation over 20 years ago. She has pain with every step. This 65 year old female had a few ankle sprains over the course of her lifetime. Depending on the characteristics and location of the OLT, surgery may done arthroscopically or through a larger incision. It is important to elevate the ankle elevated above your heart level and to ice around your knee to reduce swelling. An osteochondral lesion of the talus occurs when an ankle sprain or injury damages the cartilage and the bottom bone of the ankle joint, known as the talus. They can also occur from chronic, repetitive micro trauma. Valgus Revision. Ankle Lacer) to decrease stress can also be utilized, Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. Come see if your ankle replacement is intact and functioning well!! "Osteo" means bone and "chondral" refers to cartilage. Tibial component was also loose. #ankle #anklepain #anklearthritis #anklereplacement #anklereconstruction OLTs usually occur after an injury to the ankle, either a single traumatic injury or as a result of repeated trauma. The affected bone and its covering of cartilage may stay in place and not cause any symptoms, or a fragment may gradually loosen and cause pain. This young 40 year old patient had little options for this size of OCD lesion and he is only six weeks out but off of narcotics and only on Advil. A small subset of symptomatic osteochondral lesions of the talus involve subchondral pathology with intact overlying articular cartilage; in these cases, retrograde drilling into the cystic lesion can be employed to induce underlying bony healing. Focal medial shoulder talar osteochondral defect (OCD or OLT). Accessibility 29 Copyright 2021 Elsevier Masson SAS. View #anklepain #talarocd #talarcyst #acfas #anklearthritis, Another ankle arthritis center special. All shapes and sizes. Dr. McAlister presented his cases at @acfas.foot.and.ankle.surgeons in @vegas this past week. You may feel pain primarily at the lateral (outside) or medial (inside) point of the ankle joint. Despite surgery going as well as possible, there is still a chance the pain will persist requiring additional treatment in the future. J Bone Joint Surg Am 2013; 95 (11) 1045-1054 anklearthritiscenters An option that our advanced technologies are able to provide patients. Tol et al. ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT, ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT, possible repeitive microtrauma creates ischemic environment and loss of integrity of subchondral bone, leads to softening and disruption of overlying cartilage, among the thickest in the body (implications for osteochondral autografting), maintains tensile strength longer than femoral head with aging process, deltoid artery supplies majority of talar body and dome, ankle is a highly congruent mortise joint, oriented 15 degrees externally from midsagittal line of ankle, talus articulates with the medial malleolus medially, tibial plafond superiorly, posterior malleolus posteriorly, and fibula laterally, Berndt and Harty Radiographic Classification, Complete fragment detachment but not displaced, Cystic lesion within dome of talus with an intact roof on all view, Cystic lesion communication to talar dome surface, Open articular surface lesion with the overlying nondisplaced fragment, Cartilage injury with underlying fracture and surrounding bony edema, mechanical symptoms such as catching or locking, often limited secondary to pain or effusion, evaluate for ligamentous laxity or insufficiency, suspicion for OLT in setting of equivocal radiographs, helpful in evaluating subchondral bone and cysts, less reliable in purely cartilaginous lesions of nondisplaced OLTs, provides fine detail of lesions for pre-operative planning, persistent pain following injury, ankle sprains that do not heal with time, variable edema patterns, may overestimate degree of injury, unstable lesions show fluid deep to subchondral bone, predicts stability of lesion with 92% sensitivity, nondisplaced fragment with incomplete fracture, osteochondral grafting (osteochondral autograft transplantation, autologous chondrocyte implantation, bulk allograft), size > 1 cm and displaced lesions, shoulder lesions, salvage for failed marrow stimulation or drilling, period of immobilization in cast or boot for 6 weeks, followed by progressive weight bearing with physical therapy emphasizing peroneal strengthening, range of motion, and proprioceptive training, debridement of unstable cartilage flaps to create stable and contained defect using curettes or shaver, loose bodies and cartilage removed using shaver or grasper, microfracture awl placed perpendicular to surface and tapped into subchondral bone 2-4 mm deep, inflow stopped to allow fat or blood to emanate from holes, indicating adequate penetration, Kirschner wire can be passed using anterior portals, or transmalleolar for central or posterior lesions, talus dorsiflexed and plantar flex to necessitate only 1 transosseous passing of wire, articular cartilage delamination and graft failure, 65-90% improvement in patient reported outcomes, fibrocartilage formation at site of lesion in 60% of patients on second-look arthroscopy, no correlation noted with patient outcomes, evaluate cartilaginous surface for softening, dimpling with probe seen, Kirschner wire drilled from sinus tarsi into defect, fluoroscopy often helpful to confirm location, if bone grafting indicated, cannulated drill placed over K wire, dictated by location of OLT and concomitant procedures required (i.e. #anklepain #talarocd #talarcyst #acfas #anklearthritis Another ankle arthritis center special. Go! Once the diagnosis has been confirmed, treatment may be surgical or non-surgical, depending on the nature of the OLT, presence of other injuries, and patient-specific factors. Ankle valgus. What is OCD (Osteochondral Defect of Talus). Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. View Physical exam usually reveals some swelling and localized pain along the front of the ankle (ankle joint line). The traditional method to repair an osteochondral lesion involves drilling tiny holes in the joint, deep into the bone marrow. #anklearthritis #totalanklereplacement #anklefusion #ttc #bka #anklereplacements #anklepain #ankle #foot #tibiafracture #necrosis #beentheredonethat #pain #footandanklesurgery This site needs JavaScript to work properly. Once your surgeon has assessed your healing, you may be prescribed crutches to begin partially weight-bearing. The holes stimulate the bone marrow to start generating new cartilage cells to fill in the holes and repair the lesion. Osteochondral allograft plugs are an option for larger contained lesions (>1.5 cm in diameter) and in patients with knee osteoarthritis (OA) and concern for donor site morbidity. Treatment can be nonoperative or operative depending on patient age, patient activity demands, lesion size, and stability of lesion. It was once thought that all OLTs progress and worsen with time, but this is no longer believed to be true. Before This young 40 year old patient had little options for this size of OCD lesion and he is only six weeks out but off of narcotics and only on Advil. 17 Patients may have an OLT that doesn't cause pain or limitations or a lesion that becomes painful but improves. Copyright 2007-2023. Nov 18 This site needs JavaScript to work properly. Depending on the recovery condition of conservative treatment, the surgeon can subsequently plan for surgical treatment. When the fragment is removed, a defect shaped like a small crater is left in the talar dome. Plain x-rays can be used to help diagnose an osteochondral lesion. The recovery period after an osteochondral lesion usually lasts six months to a year. This weekend will be filled with laughter and giggles with my two-year-old and five-year-old. To be true condition of conservative treatment, the vaccine and Care at Mass General.Learn more #. And localized pain along the front of the OLT, surgery may done or! Start generating new cartilage Cells to fill in the holes and repair the lesion many ways can. Worsen with time, but this is no longer believed to be.... 17 patients may have an OLT that does n't cause pain or limitations or a lesion that painful! Operative depending on patient age, patient activity demands, lesion size, and stability of lesion painful... 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