Osteochondral lesions of the talus (OCL) occur in the articular cartilage and subchondral bone of the talus and are commonly associated with . Anterior ankle pain can be a pain in the butt!! 2022 Jun 12;7(2):24730114221103263. doi: 10.1177/24730114221103263. #ankle #anklepain #anklearthritis #anklereplacement #anklereconstruction 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. Metrics. Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteo-chondral lesions of the talus: second-look arthroscopic evaluation. Open Open The demographic, clinical and radiological data of the patients were analyzed. Fresh osteochondral allograft transplantation (FOCAT) for definitive management of a 198 square millimeter osteochondral lesion of the talus (OLT): A case report. For smaller and less severe lesions, BMS techniques can initiate your bodys healing process to self-repair while avoiding any damage to healthy cartilage. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. anklearthritiscenters 69 Following BMS techniques, lesions may be too large for scar tissue to properly fill in the defect and bone grafting is required. CT and MRI pending. Ankle Arthroplasty. Feels as though his ankle wants to give out. If you need medical advice, use the ", Bulk Allograft Transplantation for Osteochondral Lesions of the Talus, Mosaicplasty for Osteochondral Lesions of the Talus. Imaging is necessary to confirm the diagnosis. Figures A and B are radiographs of the left ankle. American Orthopaedic Foot & Ankle Society, The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. Medial-sided lesions are more common (67%) than lateral-sided lesions. New cartilage like substitute was glued on top. Arthroscopy. Enjoy your weekend! Epub 2014 Oct 19. Thoughts? Talus fractures usually occur due to high-impact injuries such as car accidents. 0 Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Clipboard, Search History, and several other advanced features are temporarily unavailable. Feng SM, Chen J, Ma C, Migliorini F, Oliva F, Maffulli N. J Orthop Surg Res. Valgus Revision. Single Stage Stemmed Fixed Implant with a medial slide. May 24 What is OCD (Osteochondral Defect of Talus). In this procedure, the surgeon makes several small incisions around the ankle joint and inserts a narrow fiber optic scope (called an arthroscope) to examine the condition of the joint. These include a combination of chondral abrasion, subchondral drilling, and microfracture. 03 . #totaltalusarthroplasty #totaltalus #anklereplacement #anklesprain #anklebreaker #ankleavn #avascularnecrosis #deadtalus #aofas @aofas1 @acfas.foot.and.ankle.surgeons @restor3d Ankle Arthritis comes in various shapes and sizes. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Conservative treatment is indicated in Grade I, II and III injuries. What would you do?? Osteochondral lesions of the talus are an increasingly recognised pathology of the ankle joint and can lead to significant complications if not treated appropriately. Impaired function, limited range of motion, stiffness, catching, locking and . 0 Ankle valgus. We have developed a team of consultants that have expertise in a myriad of treatments for the thousands of ankle arthritis patients out there. View Osteochondral Allograft Transplantation for Focal Cartilage Defects of the Femoral Condyles. Phoenix Foot And Ankle Institute. Up to 75% of OLTs are caused by trauma, such as an ankle sprain or fracture. Tibial component was also loose. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. 11. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. This patient was over 13 years out and had no history of wounds or prev. 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. Jun 2 Tibial component was also loose. 2022 Feb 3;17(1):69. doi: 10.1186/s13018-022-02968-y. Foot Ankle Clin. AB - Background: Arthroscopic bone marrow stimulation (BMS) is considered the first-line treatment for osteochondral lesions of the talus (OLTs). Bookshelf Foot (Edinb). . Saw KY, Jee C, Ramlan A, Dawam A, Saw YC, Low SF. The ankle joint connects the leg with the foot, and is composed of three bones: tibia, fibula and talus. Get the latest news on COVID-19, the vaccine and care at Mass General. This site needs JavaScript to work properly. Oper Tech Orthop, 24: 230-237 She does not have RA or any other rheumatologic disorder. #anklereplacement #footarthritis #footfusion The etiology of osteochondral lesions of the talus is frequently attributed to ankle trauma but these lesions can also stem from alcohol abuse, chronic steroid use, endocrine abnormalities or genetics. Surgery to treat an osteochondral ankle lesion is a series of steps that usually starts with the least invasive technique, an arthroscope, as the last step of diagnosis before your surgeon progresses with whatever needs to be done to repair the top of your talus. Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. She would like to know her options. If OLTs are persistently symptomatic following an appropriate course of nonoperative treatment, various reparative and restorative surgical options may be considered on the basis of diameter, surface area, depth, and location of the lesion. Lesions greater than 1.29 cm2, cystic lesions, and lesions that have failed prior treatment are potential candidates for osteochondral autograft transplantation. Despite surgery going as well as possible, there is still a chance the pain will persist requiring additional treatment in the future. These injuries should undergo primary repair via internal fixation with bioabsorbable compression screws 3.0 mm or smaller using at least 2 points of fixation. Open All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. #lifeofasurgeon #podiatrylife #podiatrist #acfas #smithandnephew #medline #footandankleaurgery #surgeon #scottsdaleaz #footandankleresident Whats wrong with a simple ankle fusion? "Osteo" means bone and "chondral" refers to cartilage. Treatment usually requires surgery, and the recovery process can take months. The treatment options are numerous and constantly evolving, with no well-established evidence base to determine which, if any, are superior. If these measures have failed with multiple attempts or when the injury is severe, you may be a candidate for surgical repair. Focal medial shoulder talar osteochondral defect (OCD or OLT). These injuries range from mild bruising to more severe damage such as blistering of the cartilage layers, cyst-like lesions within the bone, or fracture of the cartilage and bone layers. OCLs most commonly occur in two areas of the talus: Many patients with talar OLTs are asymptomatic (no pain or swelling). The common mechanisms for an osteochondral lesion of the talar dome include a plantarflexion-inversion or dorsiflexion-inversion injury to the ankle. 35 anklearthritiscenters Feels as though his ankle wants to give out. Congruent Valgus. Come experience the difference! 0 View The type of surgery depends on the size of the defect and the extent of bone and cartilage loss. Osteochondral lesions are commonly the result of excessive force going through the knee. Talar component stable. Bookshelf J Bone Joint Surg Am 2013; 95 (11) 1045-1054 The main disadvantage of this procedure is the prolonged recovery time and increased complication rate, compared to arthroscopic debridement, Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. Laboratory and clinical work continue in this area, Surgery to address ankle instability, such as a Brostrom Lateral ligament repair or a lateral ligament tendon reconstruction, Calcaneal osteotomy to address significant hindfoot alignment abnormalities (usually hindfoot varus treated with a lateralizing calcaneal osteotomy). Physical examination elicits pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal. #totaltalusarthroplasty #totaltalus #anklereplacement #anklesprain #anklebreaker #ankleavn #avascularnecrosis #deadtalus #aofas @aofas1 @acfas.foot.and.ankle.surgeons @restor3d. infection. MRI is indicated if pain and symptoms prolongs for >8 weeks and used for assessment of peroneal tendon and osteochondral injuries. Patient over a year and a half out. Depending on the characteristics and location of the OLT, surgery may done arthroscopically or through a larger incision. Up and Down arrows will open main level menus and toggle through sub tier links. Ankle Lacer) to decrease stress can also be utilized, Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. Particulated juvenile cartilage is a restorative technique that employs cartilage allograft from juvenile donors. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area. 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. A complaint = Left Heel Pain. 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