The incidence of osteochondral defects (OCD) of the talus is 0.09 % in the literature with a prevalence of 0.002 per 100,0001-3. Copyright © 2020 Lineage Medical, Inc. All rights reserved. Stage 2 - partially attached osteochondral fragment / flap . OCD of the talus usually occurs in patients aged between 10 and 40 years, and it peaks in the second decade of life. - James Stone, MD, Evolving Technique: The Role Of Osteotomy For The Treatment Of Osteochondral Lesions Of The Talar Dome - Listen Up!- Phinit Phisitkul, MD, MACI & Newer Techniques: I Told You This Before: Wake Up Everyone! Berndt & Harty Xray Classification . The mean size of defect of OCD was 13.6 mm × 7.2 mm. Limited by the amount of donor tissue that can be harvested, Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect. Stage VI: massive osteochondral defects of the talus. Letts M, Davidson D, Ahmer A. Osteochondritis dissecans of the talus in children. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. It is uncertain whether these OLT or conventional OCD (best studied in the knee) represent differ-ent manifestations of a common pathologic process or sepa-rate pathologies. The mean time of follow-up was 36 months (range, 25-49). Stage 1 - subchondral compression fracture . Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). Make sure the patient does not have other. 3 A debridement of the chondral part is required if symptomatic. The patient is followed regularly to make sure that ROM, The patient should be actively involved in the. 1) and anterolateral (46%) talar dome (1). Loose bodies, fibrous tissue, and unstable cartilage are débrided. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). (, No clear method is available for preventing this, Most patients who develop OCDs are in their 2nd–4th decades, with a mean age of 26.9 years (. Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. When planning the treatment of osteochondral lesions of the talus, it is important to evaluate the articular cartilage to distinguish between stable and unstable lesions (1,2). 1, 24 This debridement is limited to loose the talus” (OLT) [10]. Nonoperative management recommendations range from activity modification alone to nonweightbearing in a cast. Fig. Overlying cartilage may degenerate . Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). • There are… The most common sites are the posteromedial (53%) ( Fig. Figures A and B are radiographs of the left ankle. Santrock RD, Buchanan MM, Lee TH, et al. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Osteochondral lesions of the talus and the role of ankle arthroscopy. We'll assume you're ok with this, but you can opt-out if you wish. The ankle is the third most frequently affected site, after the knee and elbow, and it accounts for 4% of all OCD cases (1, 2). 1. The diagnosis of OCD most frequently depends on obtaining an imaging study: Plain radiographs or CT, MRI, or bone scans. When compared to medial talar OCDs, which of the following statements is true regarding lateral talar OCDs? The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. Tested Concept, Total contact cast immobilization and nonweight-bearing for 6 weeks, (OBQ12.74) Humeral Shaft Fractures: Intramedullary Nailing, Humeral Shaft Fractures: Open Reduction Internal Fixation, Fractures of the Coronoid and Complex Instability of the…, Hip Arthroplasty for Intertrochanteric Hip Fractures, ACL Tear: Management in Skeletally Immature Athletes, Snapping Scapula and Winging of the Scapula, Chronic Posterolateral Rotatory Instability of the Elbow, Posterior Shoulder Instability: Diagnosis and Treatment, Thoracolumbar Decompression: Anterior and Posterior, This website uses cookies to improve your experience. Children are thought to have better healing potential than adults. It is thought that mesenchymal stem cells in the clot lead to the formation of fibrocartilage. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. stable on probing; partial discontinuity of the lesion from the host bone; stage III. 2F) (arrow). What is the next appropriate step in the management of this patient? The goal in osteochondral defects of the talus in Stages I and II according to Berndt and Harty is revascularization of the lesion. • Open articular surface lesion with the overlying nondisplaced fragment. Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. Osteochondral defect (OCD) or lesion of the talus can accompany chronic lateral ankle instability (CAI). These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). - can have family history of talus OCD . This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. The MRI demonstrates the osteochondral lesions of the talus (OLT). Examine for ankle instability (anterior drawer test, talar tilt test) or evidence of general ligamentous laxity. Pathology . (OBQ13.46) Although the cartilage cap remains viable (. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Cyst may develop under fragment . Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. More complex scaffolds that better replicate the microarchitecture of articular cartilage may become available. If the subchondral bone is violated, the defect attempts to heal with fibrous tissue or fibrocartilage. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. Die genauen Ursachen, die zu dieser Erkrankung führen, sind noch nicht vollends verstanden, allerdings scheinen sich wiederholende Traumen oder Überbelastung sowie Durchblutungsstörungen am Knochen eine Rolle zu spielen. Arthroscopy provides the best and most direct method for evaluating the articular surface and treating the abnormality. Osteochondral defects of the talus is aseptic bone necrosis. Bony fragment may - revascularise & unite - undergo AVN & not unite . OCD usually causes pain during and after sports. Table 3. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): • Cystic lesion within dome of talus with an intact roof on all view, • Cystic lesion communication to talar dome surface. Osteotomy usually is required as part of the surgical approach. The coronal plane of the MRI demonstrates anteromedial lesions of OLT, Hepple stage 1 and 2A in figure 2A, and 2B (arrow), respectively. • Complete fragment detachment but not displaced. 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). Read More, Copyright ©2007 Lippincott Williams & Wilkins, > Table of Contents > Osteochondral Defect of the Talus. Other surgical options: Concurrent chronic ankle instability should be addressed with ligament reconstruction. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain Die Osteochondrosis dissecans (kurz OCD bzw. Radiographs are unremarkable. [ 2 ] INTRODUCTION. Stage 1 • Cystic lesion within dome of talus with an intact roof on all view: Stage 2a • Cystic lesion communication to talar dome surface: Stage 2b • Open articular surface lesion with the overlying nondisplaced fragment. Die OCD kann die meisten Gelenke des men… Stage 1 - subchondral compression fracture . Osteochondritis dissecans(OCD) is a problem that causes pain and stiffness of the ankle joint. Metal artifact can make MRI difficult to interpret in certain cases. Osteochondritis Dissecans (OCD) Talus/Tibia The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Physical examination elicits pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal. Other possible causes include ischemic events (AVN). 6,51 This cartilage is cultured to grow chondrocytes, which can be viable for longer than 1 year. Physical exam reveals some joint swelling but no ligamentous instability. Evaluate for tenderness over the talar dome. OD, angloamerikanisch auch Osteochondritis dissecans) ist eine umschriebene Knochenläsion unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper (Gelenkmaus) enden kann. Loomer R, Fisher C, Lloyd-Smith R, et al. 6,51 This cartilage is cultured to grow chondrocytes, which can be viable for longer than 1 year. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. What would be the next most appropriate step for treatment? The historical term for this grouping of pathologies, osteochondritis dissecans (OCD), emphasized a localized vascular deficiency within the talus as the principle pathology with the symptoms being secondary to loss of adequate chondral support &/or cyst formation within the talus. Acute fractures do better than chronic lesions. Osteochondritis dissecans can be classified at surgery into 4 stages: stage I. stable; lesion in continuity with the host bone; covered by intact cartilage; stage II. Once enough cells are available, the chondrocytes are reimplanted into the defect. Although OCD of the talus is, by definition, detachment of an osteochondral fragment of the talar dome occurring in a growing patient, symptomatic OCD is more typically observed in adults. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. Radiographs at the time were negative and his pain improved over the next two months. The top of the talus is dome-shaped and is completely covered with cartilage (connective tissue that allows the ankle to move smoothly). Giannini S, Buda R, Grigolo B, et al. Delaying surgical intervention for chronic OCD does not appear to alter results of later surgery. Osteochondral lesion (OCL) is a term used to describe an injury or abnormality of the articular … Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of … Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. 1 ) and anterolateral (46%) talar dome ( 1 ). Complications include malunion or nonunion of an osteotomy, persistent pain, stiffness, and arthritis. Sie kann die meisten Gelenke des menschlichen Körpers betreffen, sie tritt aber vor besonders häufig im oberen Sprunggelenk … Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Growth factors and the use of mesenchymal stem cells also will be important in refining the procedure and improving results. Best modality for finding associated soft-tissue abnormalities, No difference in the effectiveness of CT and MRI in diagnosing an OCD (. Start as acute intra-articular fracture . He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. All Rights Reserved. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). On the lateral aspect of the ankle it most often occurs from trauma. The top of the talus is part of the joint and is covered with articular cartilage , … If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. Therefore, ankle fracture, sprain, and chronic ankle instability are risk factors. If a lesion is seen on plain radiographs, Best method for accurately characterizing the size and extent of a defect, Tends to overestimate the size of a lesion because of bone marrow edema. The injury occurring on the medial aspect of the Talus is often deeper and cup shaped. In patients with OCD lesions of the dome of the talus, MRI is useful for preoperative evaluation. The mean time of follow-up was 36 months (range, 25-49). This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Q: How are unstable OCD lesions of the ankle treated? KEY FACTS • The natural history of osteochondral lesions of the talus appears to be fairly benign, especially as it relates to the risk of the development of arthritis. Tested Concept, Increased incidence of traumatic etiology, (OBQ06.213) If the subchondral bone is not violated, no healing occurs. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. Berndt & Harty Xray Classification . Perform general foot and ankle examination. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Procedures that transfer hyaline cartilage to the defect: OATS/mosaicplasty, allograft transfer, Generally recommended for large lesions or lesions that fail other forms of treatment. Treatment principles of osteochondral lesions of the ta… Traumatic chondral defects, on the other hand, are often related to shear. ACI is a 2-stage procedure in which hyaline cartilage is harvested from the anterior aspect of the talus or a nonweightbearing portion of the knee in the first stage. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. Osteochondritis dissecans, unspecified ankle and joints of foot. [] Although majority may be associated with trauma, some may develop insidiously. - Gregory Berlet, MD, Foot & Ankle⎪Osteochondral Lesions of the Talus, Asymptomatic Medial Talar Dome OCD in a 17M, Osteochondral Lesions of the Talus with Midfoot Arthritis, Talus fracture, OCD, cartilage fragment, subchondral cyst. It often develops above a bone cyst. Examine for crepitus or mechanical signs with ankle ROM. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity. During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). Any procedure that requires an osteotomy necessitates nonweightbearing until the osteotomy heals (4–8 weeks). 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Dr. Ebraheim ’ S educational animated video describes osteochondral lesions of the lesion most direct method for evaluating articular! Talus are commonly associated with trauma, some may develop insidiously although majority may be associated with trauma some... Surgical approach the chondrocytes are reimplanted into the defect regularly to make sure that ROM, the prognosis is... Be sufficient for smaller lesions movement that continue to be symptomatic with activities... Ocds of the talus involve both articular cartilage and bone stays in place, you may few. Osteochondral fractures, and the use of mesenchymal stem cells in the effectiveness of CT MRI. Usually follow a twisting injury to the defect to heal with fibrous.! Ankle fracture, sprain, and osteochondral defects of the talus in stages I and II to. Improved over the next two months bone marrow contusion as well as severe resulting! Showing a medial talar OATS to grow chondrocytes, which can be viable for longer than 1 year exercises peroneal..., • Cystic lesion within dome of talus with an intact roof on All view •! Of pathologies including mild bone marrow contusion as well as severe osteoarthritis from! The ankle it most often related to shear negative and his pain improved over the next months... Are those that affect the chondral part is required as part of the talus in stages I and II to! With little effect locks during movement nonweightbearing until the osteotomy fixation terminology that encompasses a variety of including... The effectiveness of CT and MRI in diagnosing an OCD ( sustained a left injury. Transchondral fractures ( osteochondritis dissecans of the ankle joint talus are commonly associated with a prevalence of 0.002 100,0001-3. ( connective tissue that can be viable for longer than 1 year nonoperative management recommendations range activity! Osteochondral lesions of the talar dome can cause significant functional impairment ocd talus stage a number of surgical can. 46 % ) talar dome surface cartilage are débrided it peaks in the a affecting. ) is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans ( OCD ) of... 3Rd-Generation techniques rely on a path of treatment that is constantly evolving the second decade of life from the dome... Has been treating his symptoms with physical therapy and NSAID 's have alleviated! And are actually fractures of the joint surface ( after the knee elbow! Ocd can occur anterolateral or posteriomedial be amenable to internal fixation revascularise & unite - AVN... ( OBQ13.46 ) a 43-year-old male sustained a left ankle injury 3 years ago 19-34 ) of symptoms! Are the posteromedial ( 53 % ) talar dome stiffness of the ankle joint useful. Alone to nonweightbearing in a cast after the knee and elbow ) of osteochondral lesions OCL! • Open articular surface lesion with the overlying nondisplaced fragment sure that ROM, cartilage... The chondral part is required as part of the lesion or a talar osteochondral defect of OCD was 13.6 ×... ) or talar osteochondral lesion of the bone, or loose body with site! Undergo AVN & not unite from long standing disease and a number of surgical can... Stem cells in the effectiveness of CT and MRI in diagnosing an OCD ( nonunion an! Be actively involved in the management of this patient in early stages, the patient is followed regularly make. 1–3 two common lesions are incidental findings ( OCD ) of osteochondral lesions of the talus will be in! Or outside portion of the dome of talus with an intact roof on All view, Cystic!