Osteochondral Defects in the articular cartilage can result from trauma, arthritic conditions, chronic wear and tear. “Osteo” means bone and “chondral” refers to cartilage. Protect surgical ankle 2. The most common joints affected by osteochondritis dissecans are the knee, ankle and elbow, although it can also occur in other joints. Definition. Physicians can upload their anonymized problem case for expert advice. It is then matched to the surface area of the defect and impacted into place. 1, in a review of >580 osteochondral defects … Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondral defects in the ankle: why painful? 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. 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 ) The condition typically affects just one joint, however, some children can develop OCD in several joints. Because of excessive overlying fibrous tissue and synovium, the defect cannot be adequately visualized. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). 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. 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect … The broad term “osteochondral lesion of the talus” 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. In patients with an isolated ligamentous ankle injury, these symptoms usually resolve after functional treatment within 2–3 weeks. (OBQ12.74) A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. 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 strategies—namely, arthrodesis, osteochondral allograft, and total ankle replacement (TAR)—have been described for large OCDs of the ankle (). During loading, compressed cartilage … It is often associated with a traumatic injury such as a severe ankle sprain. 2015 Dec 18;6(11):944-53. doi: 10.5312/wjo.v6.i11.944. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. Editors: van Dijk, C. Niek, Kennedy, John G. 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. Information from your Foot and Ankle Osteochondral Defect Surgeon in Orange County with offices in Newport Beach and Irvine – Southern California. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Overall, more than 80% of the talus OCLs are of traumatic origin. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. 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. During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). Osteochondral Defects – OCD of Foot and Ankle, Talus, Metatarsal. 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. With disease progression, the fragment may detach, leading to degenerative osteoarthritis . 3-A) and heel-rise (Fig. Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. The graft is taken as a cylindrical plug of cartilage and subchondral bone. 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). Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. How is it caused? 6 The cause of OCLs of the talus has multiple facets. Trauma plays the most important role in the pathomechanism of talus OCLs. To make these surfaces slide more easily, there is also fluid in the joint that is created by the capsule of the joint. Osteochondral defects . The ankle is plantarflexed to visualize the osteochondral defect (OCD). OCDs usually develop after an inversion or high impact injury to the ankle, leading to a portion of the cartilage to be injured. Osteochondral lesion (OCL) describes an injury to the articular cartilage surface of bone within a joint. In most joints of the foot and ankle, this layer of cartilage is one to a few millimetres thick. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. 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. Ankle: Chondral/Osteochondral Defect Repair ... 1. Free Preview. A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. 3-B) views; the defect cannot be detected on the lateral view (Fig. 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. Immobilization of the ankle, medications, steroid injections and physical therapy are commonly tried but this often fails to relieve symptoms and surgery may be required. What causes it? Fig. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. Begin Range of Motion 4. In acute conditions, symptoms of osteochondral ankle defects are similar to those of acute ankle injuries. They may also be called osteochondritis dessicans or osteochondral fractures. In osteochondral autograft transplantation, cartilage is transferred from one part of the joint to another. This allows us to treat the bone defect without affecting the cartilage. 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). 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). [] Although majority may be associated with trauma, some may develop insidiously. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. 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]. When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. It may result in a defect that subsequently affects the subchondral bone and, in severe cases, may lead to formation of an osteochondral fragment. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Talar dome lesions are usually caused by an injury, such as an ankle sprain. The experts opinion can be of interest for other physicians who meet similar problems. Knee Surg. 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. If the fragment has come loose, it can also cause locking or instability symptoms. Through the years members of Ankle Platform have asked for treatment advise. 31. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for. We prefer to use the broader term osteochondral lesion to define a lesion of any origin … He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. 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. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). (Eds.) problems after ankle fracture. Sports Traumatol Arthrosc 18:570–580. “Osteo” means bone and “chondral” refers to cartilage. Control post operative pain/swelling Treatment: - Patient to be progressed to PWB (up to 30% body weight) if a small lesion (per MD’s recommendations). Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. If the cartilage does not heal properly following the injury, it softens and begins to break off. Tol et al. 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. Submissions are anonymized and transformed to cases which you can find in this section. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. Therefore a small anteromedial synovectomy is done using a 5.5 mm bonecutter shaver with the ankle in the dorsiflexed position. Talar Osteochondral Defects Diagnosis, Planning, Treatment, and Rehabilitation. Manage pain 3. INTRODUCTION. 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. However, it can be subdivided into a traumatic and nontraumatic cause. They include lateral or medial ankle pain, functio laesa and swelling. The ankle joint has a high congruency. Healthy cartilage tissue -- a graft -- is taken from an area of the bone that does not carry weight (non-weightbearing). Osteochondral defect or Cyst. 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