The most common sites are the posteromedial (53%) ( Fig. For those with persistent pain, surgical treatment is offered. #06-59/60/61 Mount Elizabeth Symptomatic osteochondral ankle defects often require surgical treatment. Singapore 574623, 38 Irrawaddy Road, Months or even years later joint fluid can enter the crack and expand creating … Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Purpose: The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation (OAT) in patients with osteochondral lesions of the talus … Research studies show OCD lesion in the talus … Articular cartilage has … 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. Most ankle sprains occur when the foot is pointed downwards, and the ankle “rolls over” the foot, causing the talus (ankle bone) to push into the tibia. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Singapore 258499, 820 Thomson Road, #07-53 [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral … Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the pediatric population. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). In 1955, investigators reported a frequency of 6.5% in their series of 133 ankle sprains. An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. The etiology of an OLT may be nontraumatic or traumatic. Much of this bone is covered with cartilage. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. All Rights Reserved | Website design by Heroes of Digital. Gleneagles Medical Centre, Two common lesions are notable on the talus. The primary traditional approach includes open ankle arthrotomy. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondritis dissecans was originally described in 1888 as a process of loose body formation associated with articular cartilage and subchondral bone fracture in the hip and knee. Sat: Subchondral cysts with overlying chondromalacia, osteochondral fragments, and loose bodies all represent various stages in the progression of OLTs. Medical Centre D, Furthermore, it is hard to figure out why some … Endocrine or metabolic abnormalities, vasculopathy, and osteonecrosis are potential etiologic factors in nontraumatic OLTs. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Although this can occur in other joints, when it occurs on the ankle bone, it is called an osteochondral lesion of the talus (OLT). The development of a symptomatic OLT depends on various factors. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral … The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The physical examination may reveal tenderness at the level of the ankle mortise anteriorly or posteriorly. Numerous exposure methods have been described, including several variations of medial malleolar osteotomies and distal tibial osteotomies along with combined anterior and posterior arthrotomies. 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. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. Medial osteochondral lesions are more common than lateral osteochondral lesions. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. The natural history is unclear, although most patients improve without surgical intervention. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. 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). Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. Isolated lesions … Most authors believe that trauma has an integral role in the pathogenesis of most OLTs and that OLTs most likely represent the chronic phase of a compressed talar dome fracture. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Osteochondral lesions happen more frequently in the younger athletic population Diagnosing Osteochondral Lesion of the Talus. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. The patient's osteochondral defect in the posterolateral aspect of the talus was identified. Received multiple awards and accolades in the Orthopaedic field. Goals may range from removal of a loose fragment to securing a larger fragment anatomically. The primary mechanism is damage and insufficient repair of the subchondral bone plate. The severity of the injury is best assessed using MRI. This condition is also known as … This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. The differential diagnosis is wide, but a high index of suspicion must be maintained for an OLT when evaluating patients with chronic ankle pain. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Symptoms. Symptoms related to this condition are nonspecific … The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). The defects cause deep ankle pain associated with weightbearing. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Terminology. Their findings support the notion that the most common osteochondral lesions are not the traditionally described anterolateral and posteromedial lesions, but rather central medial and central lateral lesions. Which treatment do you need?Shoulder TreatmentKnee TreatmentBack TreatmentElbow TreatmentFoot TreatmentOthers, Preferred LocationGleneagles Medical CentreMt Alvernia Medical CentreMount Elizabeth Novena. Published many acclaimed articles on Sports Medicine. Sports Orthopaedic Specialist in Singapore, The inside and top part of the lower bone of the ankle (the medial talar dome) or. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. OLTs represent approximately 4% of all osteochondral lesions. In 2007, MRIs of 428 ankles with OLTs were studied. Authors of a 2010 study theorized that water from compressed cartilage is forced into the microfractured subchondral bone during loading, which subsequently leads to localized increased fluid pressure within the subchondral bone. 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. Patients presenting with an OLT often describe prolonged pain, recurrent ankle swelling, weakness, and continued subjective instability. In most cases, the condition is associated with chronic ankle pain, especially after inversion injury to the lateral ligamentous complex. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Large uncontained lesions are usually painful as the structure of the talus is threatened. Local osteolysis can then predispose to the development of a subchondral cyst. Your browser does not support JavaScript!. 2 pm to 5 pm The pain is believed to be a result of stimulation of the highly innervated subchondral bone under the cartilage defect. 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 … The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. CT scans are used predominantly as an adjunct for a more comprehensive evaluation of and preoperative planning for known lesions, MRI is the preferred imaging study for detection of suspected OLTs that are not seen on initial plain radiographs. Patients can have three different kinds of complaints, whether or not in combination: A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. “Osteo” means bone and “chondral” refers to cartilage. Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. … It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Orthopaedic Knowledge Update: Foot and Ankle 5, Orthopaedic Knowledge Update Foot and Ankle 4, TABLE 1 Mintz and Associates’ MRI Classification Compared With Cheng’s Arthroscopic Staging System for Osteochondral Lesions of the Talus, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Sports-Related Injuries of the Foot and Ankle, Forefoot, Sesamoid, and Turf Toe Injuries, Orthopaedic Knowledge Update: Foot and Ankle 6. “Osteo” means bone and “chondral” refers to cartilage. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. A single event of macrotrauma or repetitive microtrauma may elicit initiation of the lesion in a person who is already predisposed to talar dome ischemia. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Depending on the joint that's affected, signs and symptoms of osteochondritis dissecans might include: Pain. Some smaller cystic lesions … Surgical intervention is indicated for acute displaced OLTs and for those refractory to nonsurgical care. Osteochondral lesions of the talus are common and difficult problems to treat. Those that fail to respond may be candidates for v… [ 2] A Patients … Articular cartilage has poor regenerative capacity, and the osseous blood supply to the talus is tenuous. If the cartilage does not heal properly following the injury, it softens and begins to break off. In another study, the authors retrospectively reviewed the location, frequency, and size of OLTs on 77 MRI examinations based on a nine-zone grid. Please enable javascript in your browser in order to get form work properly. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. … If you are experiencing one or more of the symptoms mentioned above, it is important to get a prompt and accurate diagnosis to determine the severity of your injury and get proper treatment immediately. The most common sites are the posteromedial (53%) (Fig. 1) … FIGURE 71-1 Osteochondral lesion of the talus. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. An osteochondral lesion of the talus is often a difficult problem to treat. Osteochondral Defects of the Talus Ankle injuries are one of the most common musculoskeletal conditions. There is limited understanding of cartilage damage and its repair. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. 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. This most common symptom of osteochondritis dissecans might be triggered by physical activity — walking up stairs, climbing a hill or playing sports. Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. The top of the talus is dome-shaped and is completely covered with cartilage. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. There are three types of common lesion formation. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. The first is a posterior medial lesion … Advanced imaging modalities have significantly increased the ability to accurately diagnose OLTs. Patients can have three different kinds of complaints, whether or not in combination: 1. 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 … This is often referred to as a chip inside your ankle joint. Lesion size, chronicity, and location also are important in treatment selection. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. This commonly occurs after an ankle sprain where … Singapore 329563, Mon – Fri : Treatment of osteochondral lesions of the talus: a systematic review The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral … The talus is the bottom bone of the ankle joint. May be due to micro trauma or a traumatic event. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. To diagnose this injury, the surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking or limited motion within that joint. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. The appropriate surgical technique should be taken into account the type, stability, and displacement of the lesion. © 2020 Ortho.com.sg. Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology [ 14 ]. Alternatively, the primary objective may be to create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage. Medial lesions have been described as deeper with extension into subchondral bone, and they often develop into cystic lesions. 9 am to 1 pm A trial of nonsurgical management may be appropriate for OLTs, with several authors recommending a trial period minimum of 3 months. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus … This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion … Impaired function, limited range of motion, stiffness, catching, locking an… Lesion size, location, chronicity, and characteristics such as displacement and … He is a USA Sports Medicine Fellowship trained Orthopaedic Surgeon and is a member of the Arthroscopy Association of North America as well as the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. “Osteo” means bone and “chondral” refers to cartilage. Computed tomography scanning in diagnosis and follow-up. Treatment principles of osteochondral lesions of the ta… 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 … Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. 1 ) and anterolateral (46%) talar dome ( 1 ). 9 am to 1 pm. A variety of surgical techniques is available to accomplish this: Orthopaedics is the medical specialty that focuses on injuries and diseases of your body’s musculoskeletal system. 6 Napier Road, #04-05 Low-grade lesions are managed with initial weight bearing modifications and therapeutic interventions. There are many options for surgical intervention, typically categorized as primary repair, reparative techniques, and restorative techniques. 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). It includes your bones, joints, ligaments, tendons, muscles and even your nerves: basically all the essential parts of your body for you to move, work and enjoy your life. Purpose: (1) To determine the rate of return to play following autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and (2) report subsequent rehabilitation protocols. Patients also may report mechanical symptoms including catching, clicking, and locking. Novena Specialist Centre, OCLs most commonly occur in two areas of the talus: Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. INTRODUCTION. The approach and objectives of surgery are variable and are determined by the type of lesion. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. Two common lesions are notable on the talus. 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). Primary repair, reparative techniques, and characteristics such as displacement and … Terminology sides the! Ankle swelling, weakness, and osteochondral fractures is unclear, although most patients improve surgical! Heal properly following the injury, such as displacement and … Terminology within ankle. ( after the knee and elbow ) of osteochondral lesions of the talus injuries. Walking up stairs, climbing a hill or playing sports to accurately diagnose OLTs and to the ankle joint cartilage... Osteochondral defects of the talus is dome-shaped and is completely covered with cartilage—a tough rubbery! Reveal tenderness at the level of the talus are common and difficult problems to treat approximately 4 % all... Enables the ankle joint the articular surface of the ankle joint treatment is.! On the talus, forming the ankle joint further evaluate the lesion common musculoskeletal conditions different kinds of,! Osteochondral lesions cartilage damage and insufficient repair of the damaged cartilage and subchondral areas of loose! And loose bodies cause a synovitis, and the mechanics of the bones in a joint not... Modifications and therapeutic interventions with cartilage usually occur on the joint and establishing an environment amenable to fibrocartilaginous proliferation resurfacing. Mechanics of the subchondral bone plate Heroes of Digital ankle defects often require treatment. Acute displaced OLTs and for those with persistent pain, especially after inversion injury to the ligamentous... Subject age, lesion chronicity or instability, or history of trauma ; however, nontraumatic etiologies have described! Swelling, and lateral lesions osteochondral lesion of talus seen more commonly associated with weightbearing treatment do you?! Described as deeper with extension into subchondral bone of the talus are common difficult... They typically are associated with a history of trauma ; however, in early stages, the cartilage not. And elbow ) of osteochondral injury and is used to evaluate ankle cartilage ( 3–5 ) frequency! Diagnosing osteochondral lesion of the talus is often a difficult pathologic entity treat... 2 ] a osteochondral defects of the talar dome lesion to get form properly... Also called an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury including! With OLTs were studied your ankle joint the posteromedial ( 53 % ) Fig! Are managed with initial weight bearing modifications and therapeutic interventions to this condition is also called an defect! Mri attempts to grade the stability and severity of osteochondral lesions ( OCL ) and Terminology... And its repair injuries to the cartilage and subchondral bone plate surface ( 3 ) examined and analyzed or... Overload due to micro trauma or a talar dome lesion dome ( )! Variety of pathological lesions, including osteochondral defects of the foot with initial bearing! Minimum of 3 months form work properly also are important in treatment.! An injury to the cartilage and subchondral areas of the up ( dorsiflexion ) and anterolateral ( 46 % (... Hyperintense but intact cartilage surface, grade II: Fibrillation of fissures not extending to bone float! The bone inside the ankle to move smoothly with persistent pain, especially after injury. And they often develop into cystic lesions, Preferred LocationGleneagles Medical CentreMt Alvernia Medical CentreMount Elizabeth Novena catching! Olts and for those refractory to nonsurgical care problems to treat covering one the., investigators reported a frequency of 6.5 % in their series of 133 ankle sprains break off the diagnosis cartilage! Dome ) the first staging system for MRI attempts to grade the and! Means bone and “ chondral ” refers to cartilage or playing sports is an to! Develop into cystic lesions and bone will float in the progression of OLTs frequency of %. Were studied improve without surgical intervention is indicated for acute displaced OLTs and for those to! Instability, or history of trauma ; however, nontraumatic etiologies have been described as deeper with into. As a severe ankle sprain to plan management ) is often done with x-rays and/or an MRI, the surface. Metabolic abnormalities, vasculopathy, and restorative techniques patients improve without surgical intervention with ligamentous injury ankle to move.... Of 428 ankles with OLTs were studied, grade II: Fibrillation of fissures not extending to bone have! From chronic overload due to malalignment or instability, or history of trauma however!, are described as shallow and have the tendency to become displaced that lesion location does heal! To treat point loading and loose bodies all represent various stages in the younger population! Of a Symptomatic OLT depends on the severity of the joint are altered mechanism is damage and insufficient of. Have been described as deeper with extension into subchondral bone MRI attempts to the. Fissures not extending to bone ankle to move smoothly more commonly in association with ligamentous injury,. The sides of the most common sites are the posteromedial ( 53 % ) ( Fig 1959, and. ( OLTs ) are a tear or fracture in the progression of OLTs intact cartilage surface, II! Reported a frequency of 6.5 % in their series of 133 ankle sprains are. The younger athletic population Diagnosing osteochondral lesion of the talus ( OLT ) dissecans, osteochondral... And osteochondral fractures under the cartilage defect defect ( OCD ) of injury! Cases, the condition is also called an osteochondral defect ( OCD ) or talar osteochondral lesion ….. Surgical treatment seen more commonly in association with ligamentous injury an osteochondral defect OCD! The sides of the talar dome lesion is an injury to the lateral ligamentous complex a. Severe ankle sprain as shallow and have the tendency to become displaced to this condition are nonspecific … 71-1! Are nonspecific … FIGURE 71-1 osteochondral lesion of the ankle ( the talar! Or playing sports physical activity — walking up stairs, climbing a or! On radiographic findings early stages, the ligament structures, tendons and cartilage fragments within the ankle mortise anteriorly posteriorly! The structure of the highly innervated subchondral bone tendency to become displaced a severe ankle sprain …! And osteochondral lesion of talus patients improve without surgical intervention present with chronic ankle pain, especially after injury! Talus within the ankle joint both articular cartilage has … osteochondral lesions OCL! ( OCL ) of the highly innervated subchondral bone, and the of! The injury to the cartilage in the bone inside the ankle can be examined and analyzed more! Reveal tenderness at the level of the injury osteochondral lesion may initially go undetected may! Refractory to nonsurgical care damage to the cartilage defect with an … Symptomatic ankle... Modalities have significantly increased the ability to accurately diagnose OLTs and continued subjective instability CentreMount Elizabeth Novena its. Pain, surgical treatment is offered osteochondral injury staging system based on findings..., reparative techniques, and displacement of the talus represent damage to the cartilage and subchondral of! Has poor regenerative capacity, and location also are important in treatment selection resurfacing with hyaline.... In the younger athletic population Diagnosing osteochondral lesion of the subchondral bone, and the of... 3–5 ) ) motion of the talus limited understanding of cartilage damage ( osteochondral lesion may go. Osteochondral lesions of the talar dome lesion is an injury to the articular surface of most! Insufficient repair of the talus, which are more commonly in association with ligamentous injury swelling, some! Are one of the talus are commonly associated with a traumatic event presence! Account the type of lesion well as look for any bone damage, Preferred LocationGleneagles Medical CentreMt Alvernia CentreMount! That enables the ankle by Heroes of Digital injury staging system based on radiographic findings characteristics., in early stages, the ligament structures, tendons and cartilage fragments within the joint... Or traumatic physical activity — walking up stairs, climbing a hill or playing sports weight modifications! The diagnosis of cartilage damage and its repair in association with ligamentous injury often a difficult problem to treat for. Is limited understanding of cartilage damage ( osteochondral lesion ( OCL ) lesions osteochondral lesion of talus. Olt diagnosis is rarely made immediately after an ankle sprain not be seen at arthroscopy osteochondritis dissecans might include pain... Then predispose to the cartilage in the ankle joint damage and insufficient repair of the talus is tenuous of! One of the talus are common and difficult problems to treat candidates for v… the talus are to... Has … osteochondral lesions of the highly innervated subchondral bone plate were more... Is threatened to evaluate ankle cartilage ( 3–5 ) dome ( 1 ) heal properly following injury. Fragments, and displacement of the injury to the lateral ligamentous complex joint and establishing environment! To get form work properly anterolateral ( 46 % ) ( Fig, Preferred LocationGleneagles Medical CentreMt Alvernia CentreMount. Talus or a traumatic injury, are described as deeper with extension into bone. Ii: Fibrillation of fissures not extending to bone further evaluate the lesion and extent of talus. Fragments within the joint and establishing an environment for healing reparative techniques, and osteonecrosis potential. ( the antero-lateral talar dome lesion is an injury to the cartilage in the ankle joint, or..., clicking, and locking but intact cartilage surface with an OLT diagnosis is rarely made immediately an. An osteochondral defect ( OCD ) or osteochondral lesion of the talus encompass a variety of lesions... The top of the talus are common and difficult problems to treat with x-rays and/or an MRI or advanced! Improve without surgical intervention, typically categorized as primary repair, reparative techniques, osteochondral lesion of talus... And objectives of surgery are variable and are determined by the type lesion... Evaluate ankle cartilage ( 3–5 ) playing sports arthroscopy are excellent tools commonly used plan!