Where small defects in the subchondral plate exist, repetitive loading from normal weight-bearing activates forces the synovial fluid under high pressure into the subchondral bone, which over time creates a cyst.5,6 Cystic lesions may also be seen with apparently intact cartilage. Diagnosis and Treatment: A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. %%EOF Osteochondral lesions of the talus (OLT) are more common than lesions of the tibial plafond. 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. Talar dome lesions are usually caused by an injury, such as an ankle … The treatment for Osteochondral Defect depends on the size of the defect and whether the overlying cartilage is damaged. Native articular cartilage consists of hyaline cartilage. 1. Arthroscopic Treatment of Ankle Osteochondral Lesions Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,* a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester… Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). Several imaging specific classification systems have been developed with this goal in mind. Theoretically, medial lesions with their larger osseous component have a better chance of consolidating with the underlying bone and its blood supply with proper treatment, which may range from immobilization to microfracture or open reduction and internal fixation. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. 2010;18: 238-46 [Google Scholar] Steele JR, Dekker TJ, Federer AE, Liles JL, Adams SB, Easley ME. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. In their recent work exploring why only some osteochondral defects in the ankle are painful, van Dijk and colleagues. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. This gives the repaired surface the app… The extent of surgery is determined by the size of the lesion, the presence of ankle instability and the location of the lesion. Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). Foot Ankle Orthop. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral The pathophysiology of OCLs must be appreciated to fully understand why the various treatment modalities are effective and when to use them. 3-C). It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. Ferkel and colleagues9 developed a classification scheme based on CT describing the osseous component with respect to cystic changes and communication with the joint surface. The vast majority of patients experience no pain or swelling even 10 years after surgical treatment of such lesions in the ankle. • Osteochondral lesion • Talar dome lesion • Ankle • Arthroscopy. Where small defects in the subchondral plate exist, repetitive loading from normal weight-bearing activates forces the synovial fluid under high pressure into the subchondral bone, which over time creates a cyst. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. Sometimes this synovitis is more symptomatic to the patient than the lesion itself. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). � They will act as an irritant in the joint space, promoting synovial inflammation and subsequent symptoms. It may require multiple plugs to fill the gaps in the ankle surface. The orthopaedic surgeon makes incisions on the ankle to access the injured area. Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. 1��N@Z��4>�n�X�th�i�� ��MZ39�'�m�qٟ`٠?� ��b`fSҌ@�ށ{P��YtD�a@� ߝF� Historically, treatment of OCLs has consisted of open procedures fraught with complications and invariable clinical outcomes. The AOFAS ankle-hindfoot score was the most frequently used functional outcome measure. Frequently these lesions are traumatic in origin, most commonly occurring after an acute ankle sprain; however, atraumatic mechanisms have been described. Over time, as these cavities are continually filled with fluid under pressure, the bone reabsorbs, creating a subchondral cyst, which may become sclerotic as the exposed bone remodels.5,6 Whether these lesions are caused by trauma or local necrosis, they may evolve to include sclerotic areas of bone with associated subchondral cyst formation. Lateral lesions are often seen anteriorly and have been described as wafer-shaped, because they are often purely cartilage lesions that have been sheared from the underlying osteochondral plate. Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. Marrow-stimulating techniques, particularly microfracture, have shown good to excellent results in most patients with small (<15 mm) acute lesions, and have a low complication rate. 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