There were 10 boys and 14 girls. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). Anterior Impingement- After Total Ankle Replacement. 6.1 Reticular bone bruising, distant from the articular surface. 19 years old male hockey player with osteochondral lesion of the talar dome. Osteochondritis dissecans (OCD) of the talus is rare in children. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. Plain x-rays can be used to help diagnose an osteochondral lesion. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Osteochondritis dissecans. The mean size of defect of OCD was 13.6 mm x 7.2 mm. The cartilage lining of the joint is crucial to allow […] 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). Current complaints: Deep left ankle pain during sport and axial bearing/load on left ankle and swelling. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury The top of the talus is part of the joint and is covered with articular cartilage, the white, slippery material that covers all joint surfaces. This treatment approach can be initially attempted in non-displaced OLTs. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. 269 Chestnut St. #271 OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Microfracture. Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. Physical exam usually reveals some swelling and localized pain along the front of the ankle (ankle joint line). All operative techniques can be downloaded here. Osteochondral Defects . A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. 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 usually causes pain during and after sports. 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. Magnetic resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset OCD. 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. [Picture 5] Images: Case summary: 19 years old male hockey player with osteochondral lesion of the talar dome. This may affect healing… It is often associated with a traumatic injury such as a severe ankle sprain. Synovitis of the tibiotalar and subtalar joint. The pain is often worse with activities, particularly running, walking and jumping. “Osteo” means bone and “chondral” refers to cartilage. An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). [Picture 1] Synovitis of the tibiotalar and subtalar joint. Laboratory and clinical work continue in this area. 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 Description of patient (type of occupation, indication of age, intensity of sport): 28 years old and sportive patient . As the ankle twists, the edge of the talus bone impacts the adjacent bone which bruises or shreds the cartilage. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. INTRODUCTION. [Picture 2, 3 + 4] OCD of the Talus Radiographs. 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. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. There is an increasing prevalence of … Whereas, the OLTs on the inside part of the top of the talus (medial talar osteochondral lesions) are more commonly associated with chronic overload of the medial aspect of the ankle, such as would occur in a patient with a higher arched foot (subtle cavus foot). The average age at surgery was 22.7 years (range, 19-34). Physical therapy: working on strengthening the muscles around the ankle, range of motion of the ankle, and balancing (. 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. It is often associated with a traumatic injury, such as a severe ankle sprain. Open the cyst anterior and fill it with bonegraft. 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. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. I would go for a lift-drill-fill-fix procedure. OCD of the Talus Tx. 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. 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. History and previous treatment: AS BG (ligament repair) for ankle instability . The mean time of follow-up was 36 months (range, 25-49). Plain film mortise view (consider repeat in 2-4 weeks if films are normal) Four classes 1. knee). This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. 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). 1. treatment? Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. for OCD of the talus at a major Canadian pediatric referral center. 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. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Surgery is usually required to repair Talar OCD. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. The most common sites are the posteromedial (53%) (Fig. This may lead to small cracks in the cartilage or even formation of a hole or cyst underneath the surface. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. Fixation with a headless compression screw or absorbable screw. OCD remains uncertain. The lesion is encountered on either the medial or lateral surface of the talar dome. Top arrow indicates bruising of the distal tibia and the lower red arrow indicates bruising of the talus Mechanical malalignment overloads either the medial or lateral boarders of the talus depending if there is tibial or hindfoot varus or valgus [8]. The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. – Localized ischemia & AVN – Not an inflammatory process so the term“osteochondritis” is a misnomer – Younger patient – No history of trauma – More on medial side. The fragment is large enough to fix. 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. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). Period of non-weight bearing since this is a big lesion? cartilage injury with associated subchondral fracture but without detachment Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. 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. 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. [Picture 5]. Retrograde drilling and fixation scored 88 and 89%, respectively. The most common clinical sign of hock OCD is joint … These symptoms could include localized ankle pain, as well as discomfort on either the inside (medial talar OLT) or outside (anterolateral talar OLT) of the ankle. 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. arthroscopic debridement and drilling? 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. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. • Accounts for only 4% of reported cases of OCD – Vascular etiology? 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 … Other? 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. Flattening of the medial talar dome. 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’. 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. Unfortunately, this approach in the ankle has not yet met with the type of clinical success that had been hoped for, and is not currently broadly available. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. 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). 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). However, it can also occur from chronic overload due to … However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. This condition is known as Talar OCD, or an osteochondral lesion of the talus. 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. Osteochondral lesion of Talus & Ankle Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. X-ray: 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). [] In 1922, Kappis described this process in the ankle joint. Additional investigation (CT/MRI): With special emphasis on diagnosis, planning and rehabili-tation in press. Two children had bilateral involvement, for a total of 26 lesions. Partially detached osteochondral lesion 3. 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