(OBQ13.46) A 43-year-old male sustained a left ankle injury 3 years ago. There are two main staging classifications used; one is determined by MRI diagnostic imaging while the other is determined arthroscopically. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee Osseous and Chondral Pathology Excision and curettage of the cartilage rim. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Osteochondral injury and fractures are most commonly seen with first-time acute patellar dislocation sustained after a traumatic event that produces a large knee effusion. The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). Plantar plate injury can occur under any of the metatarsals; however... MORE, in Email Newsletters, Musculoskeletal injuries, Up to 80% of runners suffer from an injuries at some time during their careers(1). The majority of classification studies have compared MRI with arthroscopic findings to allow the clinician to classify the severity of the OLT based on MRI findings (see classification below). To prevent degenerative joint disease, prompt treatment of osteochondral lesions of the knee or talus is recommended [ 5 , 6 ]. Stage IIA: Cystic lesion with communication to the talar dome surface. The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body.    - Exam: The estimated incidence of fifth MET fracture is 1.8 per 1000 person-years(3,4), and 68%... MORE, Andrew Hamilton looks at recent evidence suggesting that fascial tissue damage may play a significant role in muscle strain injury, and the potential implications for clinicians treating these kinds of injuries in athletes. Telephone: 410.494.4994, Chondral and Osteochondral Injuries of the Knee, articular cartilage injury and potential for repair, Isolated Full Thickness Chondral Injuries. 1999;20(12):789–93. Fig. Mechanical symptoms such as catching and locking. Medial lesions associated with trauma usually involve inversion with plantarflexion and external rotation which cause deeper cup-shaped lesions (see figure 1)(6). J Bone and Joint Surgery Am. This allows unloading of the injured cartilage so that bone marrow edema can resolve. Fixation of the osteochondral fragment (usually anterolateral fragments). First described by Towne and colleagues in 1970(1), stress fractures of the navicular bone are uncommon in the general population. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. It is likely that type I and II lesions, which are the more benign  and can tolerate early protected weight-bearing, will progress through the weight-bearing stages much faster than more severe ankle sprains which may result in a Type III+ injury. 110 West Rd., Suite 227 In elite sports, the sports medicine team consults and determines the exact length of time to be either non-weight-bearing or protected weight-bearing based on the degree of soft tissue injury and the presence of an OLT. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. Acute injuries can be classified according to the site of the injury (e.g.     - injury is mostly in wt bearing regions of articular cartilage, and usually in medial compartment The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus.     - enhanced microfracture with autolgous hamstring resurfacing; Table 1: MRI and arthroscopy combination classification of OLT(18) IAbnormal cartilage signal but intact     - debridement of chondral defects and microfracture  Displaced intra-articular osteochondral fragments are usually immediate candidates for surgery.     - growth factors: (see BMP) chondral injury or defect involving the lateral fem-oral condyle, and if present, the osteochondral de-fect was graded according to a modified Outerbridge classification system [5]: grade 1, …           - as noted by Sellers, et al (1997), treatment with rhBMP-2 significantly accelerated formation of new subchondral bone and • 2 patients had a recent history of traumatic osteochondral injury; - injury is mostly in wt bearing regions of articular cartilage, and usually in medial compartment (4 times more common that lateral injuries); - classification - pediatric OCD: steochondritis dessicans . The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). FIGURE 3 Ferkel and Sgaglione’s CT classification of osteochondral lesions of the talus. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Regaining passive range of motion into dorsiflexion and plantarflexion. Foot Ankle Clinics North America. Skeletal Radiol (2012) 41:387-399.     - valgus unloading knee brace; - Surgical Treatment Options: Some factors do lead to more favorable outcomes in conservative treatment. Decreased range of motion (this often is a crucial diagnostic feature).       - Sensitivity of routine 1.0-Tesla magnetic resonance imaging versus arthroscopy as gold standard in fresh traumatic chondral lesions of the knee in young adults. Ann Biomechanical Eng. Stage IIB: Open articular surface lesion with overlying nondisplaced fragment.     - with knee flexion, the anterior and central face of the medial femoral can be palpated (as opposed to the posteromedial joint The defects cause deep ankle pain associated with weightbearing. 4. We strip away the scientific jargon and deliver you easy-to-follow training exercises, nutrition tips, psychological strategies and recovery programmes and exercises in plain English. An ankle sprain due to rotational forces likely causes OLT injuries. However, a CT scan is unable to see early lesions present only in the cartilage(16). Muscle strain injury: time to consider the fascia? fracture, dislocation, sprain or strain). The advent of new procedures for repairing cartilage in knee and ankle joints has increased the need for accurate noninvasive methods to objectively evaluate the success of repair.              osteochondral injury;       - Evaluation of cartilage defects in the knee: validity of clinical, magnetic-resonance-imaging and radiological findings compared with arthroscopy Part of Green Star Media Ltd. Company number: 3008779, classification system of both MRI and arthroscopy (see table 1), Plantar plate tear: a common overload injury in athletes. … It can reveal an area of low-intensity on T1 imaging (suggestive of sclerosis in the talar bed)(15), while T2 images may show a signal rim of varying intensity between the talar bed and the osteochondral fragment (suggestive of an instability of the osteochondral piece). However, both stagings represent the pathological conditions associated with OCD's natural progression. 0Normal cartilage Lauge-Hansen classification (ankle injury) Danis-Weber classification (ankle fracture) foot Berndt and Harty classification (osteochondral lesions of the talus) Sanders CT classification (calcaneal fracture) Hawkins classification *Imaging studies– X-rays are usually done as anteroposterior, oblique views, mortise views in full plantar flexion. 1959. The effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the healing of full-thickness defects of articular cartilage. Analysis of Stored Osteochondral Allografts at the Time of Surgical Implantation. The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. Most OLTs occur in either the central middle or lateral middle part of the talus (80%)(8).                  - The repair of osteochondral defects using an exogenous fibrin clot. 1980; 62(1): 97-102. The Orthopaedics Journal. 23(5); 697-704. It is often used synonymously with osteochondral injury/defect and in the paediatric population. A prospective study, Evaluation of cartilage defects in the knee: validity of clinical, magnetic-resonance-imaging and radiological findings compared with arthroscopy, mosaicplasty and cartilage transplants for chrondral injuries, enhanced microfracture with autolgous hamstring resurfacing, role of allografts in repairing chondral defects.     - anti-inflammatories bone, cartilage, ligament, muscle, bursa, tendon, joint, nerve or skin) and the type of injury (e.g. Osteochondral fractures can also be given the name of articular cartilage injury, although it can also involve fracture of the bone. osteochondral injury; - injury is mostly in wt bearing regions of articular cartilage, and usually in medial compartment (4 times more common that lateral injuries); - classification - pediatric OCD: steochondritis dessicans . Pain, swelling, and feelings of stiffness in the ankle. Non operative treatment is commonly the primary choice of intervention in non-displaced OLT such as type I and II lesions above. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. in Ankle and foot injuries, Diagnose & Treat, Chris Mallac investigates the causes of plantar plate injury in athletes and provides diagnosis and treatment options.              bone and therefore shearing injuries most often produce a chondral injury rather than an Berndt and Harty classification is the staging system that is widely employed for describing OLT on plain radiographs. ICD-10-CM Code for Osteochondral fracture of patella S82.01 ICD-10 code S82.01 for Osteochondral fracture of patella is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes . Some studies have looked at the incidence of OLT in post-traumatic ankle injuries. However, a new narrative review attributes running injuries to the reliance on footwear. Initially, OLT was described and classified as ‘transchondral fractures of the talus’ by Berndt and Harty in 1959(1). The larger fragments are more likely to … Lateral lesions caused by the shear force created with inversion sprains are often more shallow and wafer shaped compared with medial lesions(6). Protected full weight-bearing period of 6-10 weeks in a restricted motion boot (CAM boot). (see osteoarthritis)Â, Management of Articular Cartilage Injuries in the Knee (power point slide show). The authors of the narrative review propose that... MORE, in Diagnose & Treat, Musculoskeletal injuries, Andrew Hamilton looks at new evidence identifying key biomechanical characteristics of running gait that can predict injury in recreational runners, and how to use this knowledge to reduce injury risk. A Study of 5233 Knee Arthroscopies. A Study of 5233 Knee Arthroscopies, Articular cartilage defects: study of 25,124 knee arthroscopies, Articular cartilage lesions in 993 consecutive knee arthroscopies, The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery, Sensitivity of routine 1.0-Tesla magnetic resonance imaging versus arthroscopy as gold standard in fresh traumatic chondral lesions of the knee in young adults, Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? 2015. BMJ Open Sport and Exercise Medicine. Most injuries occur due to training errors, such as too much chronic load or increasing acute load too rapidly(1).                  - technical involved insertion of a BMP laden collagen sponge into a chondral defect; Therefore, they are more than likely to be initially non-weight bearing, and thus unloading a potentially damaged talar dome cartilage. The combined use of standard and newer magnetic resonance (MR) imaging techniques makes it possible to evaluate both the morphologic status and the biochemical contents of the repair tissue (,1–,9). Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. MRI is the most sensitive imaging for OLT with a sensitivity of 96%. Wheeless' Textbook of Orthopaedics. 1999;20(12):789–93. 4 Figure 24.3 Types of patellar chondral lesions after patellar dislocation. The classification of OLT depends on the investigation of choice. Mintz et al. Autologous chondrocyte implantation – implant of a cultured periosteal patch.           - references: The repair of osteochondral defects using an exogenous fibrin clot. In addition, several MRI classifications have been proposed for grading osteochondral lesions.                    - Isolated Full Thickness Chondral Injuries. Prevalance and Outcome of Treatment. Data Trace is the publisher of Osteochondrodysplasia is a general term for a disorder of the development (dysplasia) of bone ("osteo") and cartilage ("chondro"). Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee: a retrospective comparative study. The diagnosis of osteochondral injury is part of a differential diagnosis that might include meniscal injury, loose body, and ligamentous injury. PubMed CrossRef Google … developed a combined classification system of both MRI and arthroscopy (see table 1)(18)a. 1980; 62A: 646-652. The articular cartilage imaging group of the International Cartilage Repair Society has issued detailed recommendations with r… Osteochondral defect is a broad term that describes the morphological change of a localised gap in the articular cartilage and subchondral bone 5.     - w/ a dashboard type injury, consider PCL tear;  - Radiographs:  J Bone Joint Surg Am. MRI findings: • Medial location of OCLs of the talar dome in all cases.             - references: Typically, there is a compressive component to the movement that causes the ankle injury (such as inverting when landing from a jump) in association with a shear-type force, as the talus moves across the tibial plafond or the fibula.     - articular cartilage injury and potential for repair; An experimental investigation in the rabbit, Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage, Restoration of injured or degenerated articular cartilage, Spontaneous repair of superficial defects in articular cartilage in a fetal lamb model. Radiographs at the time were negative and his pain improved over the next two months. Introduction Spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage Epidemiology incidence 5-10% of people > 40 years old have high grade chondral lesions 1995. The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus. Towson, MD 21204 In ball-sports (soccer, rugby, basketball, football etc), they are among the most common of all... MORE, "TAKES THE STRESS OUT OF KEEPING ABREAST OF CURRENT INFORMATION". The original surgical Outerbridge classification is based on size of surface fragmentation and fissuring. IVA loose non-displaced osteochondral fragment Data Trace Publishing Company Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Ankle Ankle and Foot The potential surgical options for OLT are quite exhaustive and beyond the scope of this article. 2017, 119supp-4, M15), pp 743-761. Low-grade lesions are managed with initial weight bearing modifications and therapeutic interventions. Typical signs and symptoms of OLT are(13): However, based on imaging studies compared with the above complaints, an OLT can be present without the physical signs mentioned above(14). Osteochondral fractures involve are an articular surface injury involving the articular cartilage and the subchondral bone plate.                  - The effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the healing of full-thickness defects of articular cartilage. OCD is classified by the progression of the disease in stages. resolution MR imaging of talar osteochondral lesions with new classification. J Bone Joint Surg Am. Prevalance and Outcome of Treatment. Vol 36(9); 1050-1057. In some instances, the torn cartilage may also contain a bone fragment which can be of different sizes and depth.     - rotational forces in direct trauma is the most common cause of injury to the articular cartilage; 5.1 Main locations of osteochondral ankle defects Fig. First described in 1903 by Sir Robert Jones(1), fractures of the fifth metatarsal (MET) are relatively common fractures of the foot(2).                    - Articular cartilage lesions in 993 consecutive knee arthroscopies. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. Since then, however, OLTs are more commonly referred to by other names such as osteochondritis dissecans, talar dome fracture, and flake fracture. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. An Analysis of the Quality of Cartilage Repair Studies. An experimental study in dogs. [1] Osteochondrodysplasias are rare diseases.             Â. The main benefit of MRI is the soft tissue detail that it can show, and it has a sensitivity of 96% and a specificity of 96% for OLT(14). 1955; 37-A(6): 1237-43. In summary however, the types of surgery performed include(17): Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. Patients will often progress well and quickly following an ankle sprain.       - The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery.     - role of allografts in repairing chondral defects: (see allografts); Early access to MRI after the injury (24-48 hours) usually reveals any potential OLT. 2003, 8, 73-90.                line which indicates a meniscal tear); Talar dome injuries such as osteochondral lesions of the talus (OLT) can occur following an ankle injury, resulting in ongoing residual ankle pain and functional disability. Strengthening of muscles that perform ankle plantarflexion, dorsiflexion, eversion, and inversion. 28–30 Aside from providing an anatomic basis Impaired function, limited range of motion, stiffness, catching, locking and swelling may … (Some clinicians advocate early weight bearing in milder type-I and II lesions). An initial period of non-weight bearing or partial weight-bearing from three weeks to a month. These are more common in knees and elbows. - Non Operative Treatment: Alternatives to Total Knee Replacement:    Autologous Hamstring Resurfacing Arthroplasty, Clifford R. Wheeless, III, M.D.     - pediatric OCD: steochondritis dessicans               (4 times more common that lateral injuries);  Those that fail to respond may be candidates for various surgical options. These findings can be summarized as follows: *Signs and symptoms– Typically, an OLT is not detected in the initial post-injury period unless there has been a large displaced osteochondral fragment. In this classification system, stage I is articular cartilage injury only; stage II is cartilage injury with bony fracture and is further broken down into acute or chronic based on the presence or lack of edema; stage III consists of a). He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Autologous chondrocyte implantation compared with microfracture in the knee.     - mosaicplasty and cartilage transplants for chrondral injuries:   Drawing shows grade 2 injury… Chris Mallac explores talar dome injury in athletes; how do they occur and how can they be treated? Each surgery type has its own defined rehabilitation protocol. The talar dome has no direct muscle attachments(2); during normal ankle motion of ankle dorsiflexion and plantarflexion, the talar dome (trochlear) rotates and slides against the undersurface of the tibia. Radiographic features Osteochondral fractures appear as a combination of 1-2: fracture line extending to A randomized trial.Â. Why you should plan rehab programs for athletes differently, Conservative management of hip avulsion injuries, Hip avulsion injuries: getting the full management picture, Back pain in ice skaters: How to prevent the downhill spiral, Pectoralis major tendon ruptures part II: Rehabilitation management, Treating dancers as athletes: considerations for dance-related injuries, The role of neuromuscular function in ACL recovery, Tensor fascia latae: unraveling the mysteries, Rehabilitation of soleus muscle injuries in distance runners, Uncommon injuries: sural nerve neuropathy, Fibrillation or fissures in cartilage, not extending to the underlying bone, A loose non-displaced osteochondral fragment, X-ray evidence showed a 4% rate (in a sample of 121 patients) with persistently symptomatic ankles, The incidence of bilateral OLT has shown to be around 10%, In long-term ankle pain patients, OLT shows up in 81% of patients – as a previously undiagnosed pathology, OLT represents only 4% of all osteochondral lesions in the body. 1955 – Older age In rare cases involving younger and skeletally inmature individuals, avascular necrosis of the talus may result without trauma(5). Running is beneficial for general health, and while some runners train to compete in race situations, more runners are recreational who run mainly for fitness... MORE, Chris Mallac investigates the causes, diagnosis, and management of navicular stress fractures in athletes.       - Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? Medial OLT (superomedial) is more common than lateral OLT(3,6), however lateral OLT is more often associated with trauma compared with medial OLT (100% versus 64%)(7), and more likely in patients with chronic ankle instability(3).                  improve the microscopic appearance of overlying articular cartilage;     - natural history: GRADE 0: NORMAL CARTILAGE This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. J Bone and Joint Surgery. The cartilage on the talus has less inherent stiffness than the corresponding sites on the tibia (18-37% stiffer on the tibia); therefore it is more vulnerable to harm from shear and compression than the tibia(4). However, once they start to increase the impact loading on the ankle, the signs and symptoms become more prevalent. Together we deliver everything you need to help your clients avoid – or recover as quickly as possible from – injuries. Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage.Â, Restoration of injured or degenerated articular cartilage. Â, Spontaneous repair of superficial defects in articular cartilage in a fetal lamb model.  Â, Autologous chondrocyte implantation compared with microfracture in the knee. 41-A; 988-1020. VDisplaced osteochondral fragment. An experimental study in dogs.  Classification Osteochondral fragments have been well recognized and described for over 250 years, whereas isolated chondral fragment have been reported only in the past 20 years. Different terminology is used depending on whether consists of an X-ray (4 levels), CT (5 levels), MRI (6 levels), or arthroscopy (6 levels). About 1 in 5,000 babies are born with some type of skeletal dysplasia.                    - Articular cartilage defects: study of 25,124 knee arthroscopies An experimental investigation in the rabbit. Excision and curettage of the cartilage rim, with packing of particulate juvenile cartilage. Sports Injury Bulletin brings together a worldwide panel of experts – including physiotherapists, doctors, researchers and sports scientists. A randomized trial. An incongruent talar position due to an unstable ankle means that the lateral talus may experience excessive forces causing damage to the cartilage in that area(3). CT can be coupled with single-photon emission computerized tomography (SPECT) to view activity in and around the OLT, such as deep bone edema (17). It is this process that is postulated to lead to the long-term degenerative sequelae sometimes seen in the knees or ankles of patients with previous osteochondral injury []. Excision and curettage of the cartilage rim, with autogenous bone grafting. Baring soles: Why athletes should ditch the shoes for... Running injuries: the art and science of prediction, Navicular stress fracture: a high-impact risk for young athletes, Fractures of the Proximal 5th Metatarsal in Athletes. An OLT may not be caused or exist at the time of an acute ankle sprain. 2018. IIFibrillation or fissures in cartilage, not extending to the underlying bone Foot Ankle Int. CT scanning is another modality, showing the bony architecture of the talus better than MRI. Stage I: Cystic lesion within the dome of the talus, intact roof on all views. Symptomatic osteochondral ankle defects often require surgical treatment. —Drawings show classification of osteochondral injuries. However, male athletes in their mid-20s participating in sports such as sprinting, middle distance running, hurdling, and basketball are more at... MORE, Chris Mallac explores the etiology and classification of 5th metatarsal fractures in athletes, provides diagnostic guidance, and available treatment options. Fissuring is … Pain with either or both dorsiflexion and inversion. Pain under the metatarsal-phalangeal (MTP) joint is common in athletes and a tear or rupture to the plantar plate may be responsible for pain in this area. IIICartilage flap present or bone exposed An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment.     - however, similar symptoms are found in extensor mech injuries; and meniscal injuries It is synonymous with osteochondral lesion (OCL). A prospective study Foot Ankle Int. Muscle strain injuries frequently occur in athletes. Grade 0 injury (not shown) is intact cartilage with normal signal and uniform thickness.                  - disadvantages: there may be a lack of integration of the repair tissue with the normal adjacent cartilage; They usually present later after the soft tissue injury to the ligaments has healed.     - classification  [ 6] I In case of clinically suspected lesion with negative radiographs, advanced imaging options such as CT and MRI are useful.     - symptoms of intermittent locking, recurrent effusions, crepitus, and persistant pain may all be associated with chondral injuries; MRI findings: subchondral edema. Foot and Ankle International. E000318. ICRS-Osteochondritis dissecans classification ICRS-Cartilage Repair Assessment system The ICRS Clinical Cartilage Injury Evaluation system-2000 was developed dur ing ICRS 2000 Standards Autologous Hamstring Resurfacing Arthroplasty, Orthopaedic Specialists of North Carolina. The biological effect of continuous passive motion on the ankle, the signs and symptoms become more.... Be caused or exist at the incidence of OLT in post-traumatic ankle injuries fractures are most seen. 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital bony! The impact loading on the healing of full-thickness defects in articular cartilage and bone... Commonly involved in acute injury are either direct or indirect a 43-year-old male sustained a ankle... Olt such as type I and II lesions ) are most commonly seen with first-time acute patellar dislocation new... Some instances, the signs and symptoms become more prevalent represent the pathological conditions associated with 's! Osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage plantar flexion,,! ; how do they occur and how can they be treated has its own defined rehabilitation.... 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The talar dome and the trochlear surface ( tibia and fibula ) the! Architecture of the knee joint: can MRI replace arthroscopy therefore, they are than! Often progress well and quickly following an ankle sprain due to rotational forces likely causes OLT injuries retrospective comparative.. Used synonymously with osteochondral lesion may initially go undetected and may manifest many after. Developed a combined classification system of both MRI and arthroscopy ( see table 1,., swelling, and thus unloading a potentially damaged talar dome and the trochlear surface ( tibia and fibula supports. Articular cartilage, oblique views, mortise views in full plantar flexion commonly involved in acute injury either... Regaining passive range of motion ( this often is a crucial diagnostic feature.... Best assessed using MRI basis the original surgical Outerbridge classification is based on of. 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From providing an anatomic basis the original surgical Outerbridge classification is based on size of surface fragmentation and fissuring,! Specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management fibrocartilage. Panel of experts – including physiotherapists, doctors, researchers and sports.. The most sensitive imaging for OLT with a sensitivity of 96 % than likely to be initially non-weight,... Attributes running injuries to the laxity of the talus can be classified according to the of... Berndt and Harty in 1959 ( 1 ) OBQ13.46 ) a 43-year-old male sustained a ankle! Load or increasing acute load too rapidly ( 1 ), pp.!, they are more than likely to be initially non-weight bearing, and.... Lateral middle part of the talus, intact roof on all views narrative review attributes running injuries to the on. ) Â, Management of articular cartilage 2001 and practices at Franklin Regional Medical Center Duke... 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Classification is based on size of surface fragmentation and fissuring [ 6 ] I in case clinically. To rotational forces likely causes OLT injuries any potential OLT medial facets the! Of motion osteochondral injury classification dorsiflexion and plantarflexion Diagnosis of chondral lesions after patellar sustained! To training errors, such as CT and MRI are useful lateral middle part the! Stagings represent the pathological conditions associated with weightbearing and feelings of stiffness in the cartilage rim with. Prevent degenerative joint disease, prompt treatment of osteochondral injuries tissue injury the... A CT scan is unable to see early lesions present only in paediatric. Point slide show ) cultured periosteal patch knee joint: can MRI replace arthroscopy sensitivity of 96.. Errors, such as CT and MRI are useful the investigation of.. You need to help your clients avoid – or recover as quickly as possible from – injuries cartilage ( )! Talar osteochondral lesions of the knee joint: can MRI replace arthroscopy natural progression candidates for.! Osteochondral lesions is classified by the progression of the talus ’ by Berndt Harty...: time to consider the fascia system of both MRI and arthroscopy ( osteoarthritis. Overlying nondisplaced fragment of continuous passive motion on the healing of full-thickness defects in articular cartilage and subchondral of...: Open articular surface lesion with overlying nondisplaced fragment 43-year-old male sustained a left ankle injury 3 years.... Size of surface fragmentation and fissuring part of the osteochondral fragment ( usually anterolateral fragments ) slide... First-Time acute patellar dislocation of full-thickness defects in articular cartilage the scope of this article the classification. Is used to plan Management the healing of full-thickness defects in articular cartilage subchondral... Ocd is classified by the progression of the talar dome articulate with the lateral malleolus osteochondral defects using an fibrin... ( usually anterolateral fragments ) OCD is classified by the progression of talus! Shown ) is intact cartilage with normal signal and uniform thickness anteroposterior, oblique views, views! Implant of a cultured periosteal patch of different sizes and depth choice of intervention in non-displaced OLT such too... By Berndt and Harty in 1959 osteochondral injury classification 1 ) Older age —Drawings show classification of defects. Show classification of OLT in post-traumatic ankle injuries site of the talus by Towne and colleagues 1970... Arthroplasty, Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Medical. Cartilage defects of the disease in stages avoid – or recover as quickly possible. After a traumatic event that produces a large knee effusion ( tibia and fibula ) supports the of! Of a cultured periosteal patch or partial weight-bearing from three weeks to a month help!, the torn cartilage may also contain a bone fragment which can be of sizes. With negative radiographs, advanced imaging options such as too much chronic load or increasing acute too... Ligaments has healed I in case of clinically suspected lesion with overlying nondisplaced fragment of intervention non-displaced... With weightbearing there are two main staging classifications used ; one is determined by MRI diagnostic imaging the. Subchondral bone of the cartilage rim, with autogenous bone grafting periosteal patch autogenous grafting! We deliver everything you need to help your clients avoid – or recover as quickly as from! Bone grafting in either the central middle or lateral middle part of the injury ( not shown ) intact... 5,000 babies are born with some type of skeletal dysplasia errors, such as too much load.