For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. The experts opinion can be of interest for other physicians who meet similar problems. 2015 Dec 18;6(11):944-53. doi: 10.5312/wjo.v6.i11.944. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. Manage pain 3. Osteochondral defect or Cyst. 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). The broad term âosteochondral lesion of the talusâ describes an injury or abnormality of the talar articular cartilage and adjacent bone.1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. Editors: van Dijk, C. Niek, Kennedy, John G. During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). The graft is taken as a cylindrical plug of cartilage and subchondral bone. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. If the fragment has come loose, it can also cause locking or instability symptoms. Osteochondral lesion (OCL) describes an injury to the articular cartilage surface of bone within a joint. Ankle: Chondral/Osteochondral Defect Repair ... 1. 3-C). A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. Overall, more than 80% of the talus OCLs are of traumatic origin. Free Preview. With disease progression, the fragment may detach, leading to degenerative osteoarthritis . Osteochondral defects in the ankle: why painful? It is often associated with a traumatic injury such as a severe ankle sprain. Information from your Foot and Ankle Osteochondral Defect Surgeon in Orange County with offices in Newport Beach and Irvine â Southern California. The ankle is plantarflexed to visualize the osteochondral defect (OCD). Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). (OBQ12.74) A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. Submissions are anonymized and transformed to cases which you can find in this section. An osteochondral defect (OCD) of the ankle joint can lead to localised pain, swelling and stiffness in the ankle with difficulty weight bearing and mobilising. OCDs usually develop after an inversion or high impact injury to the ankle, leading to a portion of the cartilage to be injured. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. Osteochondral defects and loose bodies are common causes of mechanical symptoms in the ankle. Talar Osteochondral Defects Diagnosis, Planning, Treatment, and Rehabilitation. It is then matched to the surface area of the defect and impacted into place. Begin Range of Motion 4. This type of injury can be due to a severe ankle sprain that causes bone and cartilage to become loose, resulting in ongoing ankle pain. In most joints of the foot and ankle, this layer of cartilage is one to a few millimetres thick. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. They include lateral or medial ankle pain, functio laesa and swelling. Many synonyms for OCLs of the ankle have been used, such as osteocartilaginous bodies, joint mice, intra-articular fragmentary fractures, transchondral fractures, and osteochondral defects, with the acronym OCD being used interchangeably to refer to osteochondral defect or osteochondritis dissecans. Definition. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ⦠Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities World J Orthop. In acute conditions, symptoms of osteochondral ankle defects are similar to those of acute ankle injuries. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. It may result in a defect that subsequently affects the subchondral bone and, in severe cases, may lead to formation of an osteochondral fragment. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). problems after ankle fracture. Protect surgical ankle 2. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. In patients with an isolated ligamentous ankle injury, these symptoms usually resolve after functional treatment within 2â3 weeks. Joint preservation is challenging in cases with large osteochondral defects (OCDs) of the tibia plafond after trauma or septic arthritis of the ankle joint (1,2), and it is particularly necessary among young individuals or athletes.Several treatment strategiesânamely, arthrodesis, osteochondral allograft, and total ankle replacement (TAR)âhave been described for large OCDs of the ankle (). [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. 1, in a review of >580 osteochondral defects ⦠Through the years members of Ankle Platform have asked for treatment advise. However, it can be subdivided into a traumatic and nontraumatic cause. 3-A) and heel-rise (Fig. âOsteoâ means bone and âchondralâ refers to cartilage. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. Therefore a small anteromedial synovectomy is done using a 5.5 mm bonecutter shaver with the ankle in the dorsiflexed position. Tol et al. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. Osteochondral Defects â OCD of Foot and Ankle, Talus, Metatarsal. Trauma plays the most important role in the pathomechanism of talus OCLs. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect ⦠We prefer to use the broader term osteochondral lesion to define a lesion of any origin ⦠Clinical Relevance: The location of peak stress in the ankle joint becomes closer to the rim of the defect in OLTs at a threshold of 10 mm and greater in diameter. 3-B) views; the defect cannot be detected on the lateral view (Fig. How is it caused? Non-operative measures such as mobilisation, a heel lift and steroid injections are reasonable non-operative techniques to try before surgical referral, but pain from mechanical symptoms is often resistant to non-operative measures. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. These data may have implications toward OLT size thresholds for surgical decision making in symptomatic lesions (ie, primary osteochondral transplantation procedure vs curettage and debridement). [] Although majority may be associated with trauma, some may develop insidiously. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Sports Traumatol Arthrosc 18:570â580. The condition typically affects just one joint, however, some children can develop OCD in several joints. 6 The cause of OCLs of the talus has multiple facets. INTRODUCTION. (Eds.) 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. During loading, compressed cartilage ⦠Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. In osteochondral autograft transplantation, cartilage is transferred from one part of the joint to another. 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). 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. They may also be called osteochondritis dessicans or osteochondral fractures. To make these surfaces slide more easily, there is also fluid in the joint that is created by the capsule of the joint. What causes it? Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. Because of excessive overlying fibrous tissue and synovium, the defect cannot be adequately visualized. Keywords Osteochondral defect Cartilage Ankle joint Subchondral cyst Natural history Pain Introduction An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 46, 47, 50]. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondral defects . 31. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for. Physicians can upload their anonymized problem case for expert advice. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. Healthy cartilage tissue -- a graft -- is taken from an area of the bone that does not carry weight (non-weightbearing). Talar dome lesions are usually caused by an injury, such as an ankle sprain. This allows us to treat the bone defect without affecting the cartilage. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. The ankle joint has a high congruency. Knee Surg. âOsteoâ means bone and âchondralâ refers to cartilage. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. 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