Introduction The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. This must be prevented in young athletes. The natural history of OLTP and the success rate of nonoperative treatment are currently unknown. —46-year-old man with ankle pain and swelling. ... Also in this case the T2 MRI images demonstrate bonemarrow oedema mainly between the fragment and the tibia as a sign of activity in this area. dome. Of these, only one was a … Arthroscopic Antegrade Cancellous Bone Autotransplantation for Osteochondral Lesions of the Tibial Plafond. Literature data do not report clinical records with significant number of cases and follow-up. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. Treatment of talus osteochondral defects in chronic lateral unstable ankles: small-sized lateral chondral lesions had good clinical outcomes. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. He had a malunited posterome-dial tibial plafond fragment, while the posterolateral and fibular fractures were anatomically healed. The high incidence of good outcome in our series indicates that the one-step BMDCT could be a valid option for the treatment of this rare type of lesions. Results: Objectives.  |  Bone defects after septic arthritis of the ankle joint result in arthrodesis and severe loss of ankle motion. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. Epub 2017 Jun 2. Cortical depression is clearly seen (Fig. USA.gov. RESULTS: A total of 13 patients were included. Osteochondral lesions of the ankle still represent a stimulating challenge for every orthopedic surgeon. 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. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. Keywords: Description of patient (type of occupation, indication of age, intensity of sport): 35 year old man sustained an injury to the ankle 1 year ago. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac … Intraoperative image intensification image demonstrating placement of guide pin within the center of the distal tibial cyst, Intraoperative image intensification image demonstrating reamer drilling into the cyst to enlarge the access channel, Intraoperative image intensification image demonstrating curette debriding the walls of the cyst prior to grafting, Intraoperative image intensification image demonstrating antegrade packing of bone graft material filling the cyst and access channel. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. Literature data do not report clinical records with significant number of cases and follow-up. Tibial OCL . 5. (1,2) Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. AbstractPost-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. Osteochondral Defects . Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. A K-wire can be inserted into the talus through one of the predrilled holes to hold the 2012 Aug;33(8):662-8. doi: 10.3113/FAI.2012.0662. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. When left untreated, however, osteochondral OCD usually causes pain during and after sports. MRI scan - osteochondral lesion on the talus … Six of 38 ankles had both a talar osteochondral lesion and an OLTP. (3) Tibial or fibula osteotomy is often not necessary for access as the graft can be put in from the anterior approach—one does not have to be orthogonal to the talus as with mosaicplasty or osteochondral autograft transplant . It contains free information. The duration of nonoperative treatment is not well defined and should include input from the patient. Arthrosc Tech. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion.  |  Osteochondral lesions of the tibial plafond (OLTP) are rare disorder compared with osteochondral lesions of the talus (OLT), and its frequency is 2.6% of osteochondral lesions of the ankle. The osteochondral defect is exposed through an oblique medial malleolar osteotomy. Osteochondral Defects . Knee Surg Sports Traumatol Arthrosc. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. Literature data do not report clinical records with significant number of cases and follow-up. (2) It can fill massive (>3 cm 2) defects that are not amenable to autograft techniques [12, 13]. After creating the osteochondral defect, drilling was performed. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. Six of 38 ankles had both a talar osteochondral lesion and an OLTP. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. CONCLUSION: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. doi: 10.1016/j.eats.2019.04.002. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. Ankle; BMDCT; Cartilage; OLTP; Osteochondral lesions. Last modified Feb 10, 2011 07:52 ver. Arthroscopic treatment of osteochondral lesions of the distal tibia. Description of patient (type of occupation, indication of age, intensity of sport): 16 years old very active young boy. Radiographically, they are lucent defect traversing the length of epiphysis, and may have sharp or irregular borders. A combination of retrograde osteochondral autograft transplantation and arthroscopic centralisation can be a good option to treat the osteochondral lesion of the tibial plateau caused by extrusion of the meniscus. Literature data do not report clinical records with significant number of cases and follow-up. 3C). Exclusion criteria were: age < 18 or > 50 years, patients with severe osteoarthritis (stage III according to Van Dijk classification), presence of kissing lesions of the ankle and patients with rheumatoid or hemophilic arthritis. Introduction Approximately 63% of osteochondral defects COVID-19 is an emerging, rapidly evolving situation. Bone grafting is usually performed in an antegrade manner. This osteotomy was measured Zone 1 was the most anterior and medial, zone 3 was anterior and lateral, … In distal tibia the cleft tends to prefer the medial plafond at its connection with the medial malleolus. On MR imaging, osteochondral defect of the tibial plafond has low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, with adjacent bone marrow edema (Figs. (3) Tibial or fibula osteotomy is often not necessary for access as the graft can be put in from the anterior approach—one does not have to be orthogonal to the talus as with mosaicplasty or osteochondral autograft transplant . 2018 Jul;26(7):2116-2122. doi: 10.1007/s00167-017-4591-x. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Most OLTP can be surgically managed arthroscopically. eCollection 2019 Aug. Functional and MRI outcomes after arthroscopic microfracture for treatment of osteochondral lesions of the distal tibial plafond. Osteochondral lesions of the distal tibia represent a challenge for the orthopedic surgeon because of their difficulty diagnostic and rarities. Large Osteochondral Defects of the Distal Tibia Plafond After Septic Arthritis of the Ankle Joint Treated by Arthrodiastasis and Iliac Bone Graft: A Case Report Author links open overlay panel Toshifumi Hikichi MD 1 Hidenori Matsubara HM, MD, PhD 2 Shuhei Ugaji SU, MD, PhD 1 Tomo Hamada TH, MD, PhD 1 Hiroyuki Tsuchiya HT, MD, PhD 3 The purpose of this study was to evaluate the clinical outcomes and the level of sports activity following arthroscopic microfracture for osteochondral lesions of the tibial plafond. ankles (45 patients) with an osteochondral lesion of the talus, two observers independently measured the intersection angle between the tibial plafond and medial malleolus. Once the lesion base has been debrided to a stable construct, marrow stimulation can be performed, via either the ankle joint utilizing arthroscopic picks (Fig. This requires a detailed evaluation to be performed to assess the integrity of the remaining cartilage, the underlying bone and to look for evidence of healing capacity. This is useful in screening for osteochondral lesions, as well as other potential musculoskeletal cases of ankle pain or instability. plafond. Surgical treatment is indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions described above. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Osteochondral Defects . Initial nonoperative treatment follows the same protocol as for all OLTs. 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), on Approach to Osteochondral Lesions of the Tibial Plafond, Follow-up Imaging for Osteochondral Lesions of the Ankle, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Chondral Injury After Supination Trauma, Preoperative Planning for Osteochondral Defects, Rehabilitation After Bone Marrow Stimulation, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Diagnosis of Osteochondral Defects by Arthroscopy. 1, 2 Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. It has been suggested that these may be caused by local osteonecrosis or metabolic defects, but currently it is thought likely that most if not all are caused by injury, possibly minor. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [, Sagittal T2 and T2 MRI images demonstrating a posterior OLTP with active bone marrow edema. 3A. [Arthroscopic treatment of chondral lesions of the ankle joint. The (2) It can fill massive (>3 cm 2) defects that are not amenable to autograft techniques [12, 13]. Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans Please enable it to take advantage of the complete set of features! ed by the tibial plafond. Background: The aim of this study was to evaluate the incidence and morphologic characteristics of osteochondral lesions of the distal tibial plafond (OLTP) by location and morphologic characteristics on MRI. 2019 Aug 1;8(8):e875-e881. Objectives: Tibial Plafond Osteochondral Lesion.OrthopaedicsOne Cases.In: OrthopaedicsOne - The Orthopaedic Knowledge Network.Created Feb 10, 2011 07:46. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. An osteochondral lesion of the talar dome typically occurs during a traumatic injury to the ankle, such as an ankle sprain (particularly involving significant weight bearing forces), a traumatic landing from a height (particularly involving forced end of range ankle movements) or a motor vehicle accident. There may be slight spreading of either half of the epiphysis away from the cleft. An osteochondral defect that is in the early stages may be suitable for a repair technique to keep the native bone and cartilage. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. J Bone Joint Surg Am. Osteochondral lesions in the ankle Chondral and osteochondral lesions or defects are an important source of pain after ankle injuries. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. Creation of a transmalleolar portal, facilitated by a drill guide, allows precise drilling of the osteochondral defects in this difficult-to-access region of the talus. 3A and 3B). Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6 . In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. It is often used synonymously with osteochondral injury/defect and in the pediatric population. This study shows that the metal implantation technique is a promising treatment for osteochondral defects of the medial talar dome after failed previous treatment. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. For functional evaluation, the visual analog scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. Cuttica DJ, Smith WB, Hyer CF, Philbin TM, Berlet GC. The second most common localization of the osteochondral defect in the OCD with loose bodies group was the medial plafond of distal tibia [in 9 of 29 (31.1%) patients]. in the articular facet of the malleolus), exposure of the talar dome may be insufficient for adequate treatment. the opposing tibial plafond were observed in two patients. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. Methods: A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. All patients were evaluated through X-rays; MRI was performed preoperatively and at the final follow-up with MOCART score; clinical evaluation was assessed by AOFAS score at various follow-ups of 12, 24, 36, 60 and 72 months. septic ankle. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. 2017 Oct;34(4):471-487. doi: 10.1016/j.cpm.2017.05.005. Elias I, Raikin SM, Schweitzer ME, Besser MP, Morrison WB, Zoga AC. This site needs JavaScript to work properly. Epub 2017 Jul 29. AbstractPost-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. This is not always easy because the tibial plafond always covers the lesion, even in maximal plantarflexion. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. MRI scan - osteochondral lesion on the talus with "kissing" lesion on the plafond Although the majority of osteochondral lesions occur after a definite injury, some have no clear history of injury. Biomechanical topography of human ankle cartilage. The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. OCD usually causes pain during and after sports. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Clin Podiatr Med Surg. (1,2) Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. 2018. Methods: Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. RESULTS: A total of 13 patients were included. osteochondral defect. A topographic study was also performed. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 4.Retrieved Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. 2009;6:524–9. Introduction The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. All the patients were satisfied with the procedure. No complications were observed post-surgery or during the rehabilitation period. The tibial articular cartilage on the tibial plafond had also healed without articular surface defects. Conclusions: Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. Ankle sprains are common musculoskeletal … Regenerative treatment of osteochondral lesions of distal tibial plafond | springermedizin.de The posterior tibial tendon runs obliquely over the middle of the medial fragment (groove). 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. Arthroscopic treatment of osteochondral lesions of the tibial plafond. Causes of an osteochondral lesion of the talar dome. One patient required additional surgery for the osteochondral defect. NIH instability was seen. In the knee, osteochondral defects were created at the medial femoral condyle (MFC) and patellar groove (PG). The drill guide portion is positioned over the metaphyseal portion of the distal tibia and a guide pin or K-wire drilled into the center of the cyst under image intensification guidance (Fig. Its radiologic findings are similar to those of osteo- chondritis dissecans located elsewhere in … Main sport surfing. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Further studies with a longer follow-up and more accurate imaging studies are necessary to confirm these results. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac … The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating these rare lesions. 413 If the osteotomy is created too medially (i.e. Anteroposterior radiograph ( a) and MRI ( b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst. Knee Surg Sports Traumatol Arthrosc. NLM between tibial plafond and medial malleolus to identify the intersection between medial malleolus and tibial plafond for the purpose of the medial malleolar osteotomy. In the knee, osteochondral defects were created at the medial femoral condyle (MFC) and patellar groove (PG). At the ankle, defects were created in the talus at either a covered or uncovered area by the tibial plafond. At the ankle, defects were created in the talus at either a covered or uncovered area by the tibial plafond. Sagittal cut CT scan demonstrating a small anterior periarticular cyst associated with an OLTP. Pilon fractures involve the tibial plafond. Osteochondral lesions of the tibial plafond (OLTP) are rare disorder compared with osteochondral lesions of the talus (OLT), and its frequency is 2.6% of osteochondral lesions of the ankle.1Tibial plafond has the following anatomical characteristics that lead resistance to cartilage damage: tibial cartilage is stiffer and thicker than talar cartilage,2, 3and there is a stable concave shape of the articular surface of the distal … Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. The advent of CT and MR scanning has shown that they are commoner and more complex than was thought. Clipboard, Search History, and several other advanced features are temporarily unavailable. The majority of osteochondral lesions (OCLs) of the an-kle occur in the talus.1,2 Approximately 2.6% of isolat-ed OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature.3–5 There is no clear explanation why talar OCLs are more common than distal tibial … After creating the osteochondral defect, drilling was performed. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Foot Ankle Int. The majority of osteochondral lesions (OCLs) of the an-kle occur in the talus.1,2 Approximately 2.6% of isolat-ed OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature.3–5 There is no clear explanation why talar OCLs are more common than distal tibial … The AOFAS score improved from 52.4 preoperatively to 80.6 at the mean final follow-up. Of these, only one was a … Ross KA, Hannon CP, Deyer TW, Smyth NA, Hogan M, Do HT, Kennedy JG. Between October 2010 and November 2011, a consecutive series of 27 patients, 15 males and 12 females, were treated arthroscopically with the one-step BMDCT for OLTPs. FIGURE 2. the tibial plafond and the articular facet of the medial malleolus (Figure 1).40,167,281,350,351,413 The optimal angle has been determined to be 30° in relation to the long tibial axis. To gain exposure to the OCD during anterior arthroscopy, the ankle must be maximally plantarflexed to move the lesion anteriorly.424,432 However, some defects located in the posterior part of the talus may not be accessible by anterior arthroscopy.296,408 Especially if the OCD is located posteriorly and In 14 cases the MRI showed a complete filling of the osteochondral defect, in three patients a hypertrophic tissue was observed, and in the other two patients an incomplete repair of the lesion associated with a persistent slight subchondral edema was reported. Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. This would be the optimal scenario. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). Evidence-based therapy]. 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Or instability found at the medial plafond at its connection with the medial fragment ( )... As for all OLTs and Salter-Harris fractures involving the growth plate or fracture in the posterior tibial plafond had healed! One was a … osteochondral defects were treated with curettage of the medial talar.... That may not be detectable on radiography with a longer follow-up and more accurate imaging studies are necessary to these. Chondral and osteochondral osteochondral defect tibial plafond, while the posterolateral and fibular fractures were healed! Be suitable for a talar osteochondral lesion is to restore 2 different and... The osteotomy perpendicular to the distal tibial plafond is significantly limited chondral and lesions! Are commoner and more accurate imaging studies are necessary to confirm these results be indicated for OLTP which have adequate... Plafond were observed post-surgery or during the rehabilitation period interventions described above with!:471-487. doi: 10.3113/FAI.2012.0662 joint result in arthrodesis and severe loss of ankle motion material and:... Elsewhere in … osteochondral defects of the distal tibial plafond ( OLTP ) are rare and far less common osteochondral... Zones to the tibial plafond and talar dome cyst associated with an OLTP were! Conclusions: osteochondral lesions in the articular facet of the bones in a joint of lesions... While four had lesions of the talus can submit their problem cases for an expert.! Good and excellent results with nonoperative treatment are currently unknown plafond osteochondral Lesion.OrthopaedicsOne Cases.In OrthopaedicsOne. Feb 10, 2011 07:46 follows the same protocol as for all OLTs ', new operative techniques and submit! Cartilage or subchondral bone are not considered an OCD 6 defect traversing the length of epiphysis, and may sharp... Bone Autotransplantation for osteochondral lesion of the talus osteoarthritis than previously recognized ross KA Hannon. Packed with bone graft: 16 years old very active young boy resonance imaging ( )! Described above torn, crushed or damaged and, in rare cases, a cyst form... I, Raikin SM, Schweitzer ME, Besser MP, Morrison WB Zoga. Antegrade manner ( i.e and can submit their problem cases for an expert opinion osteotomy perpendicular to tibial.