“Osteo” means bone and “chondral” refers to cartilage. 2F) (arrow). The MRI demonstrates the osteochondral lesions of the talus (OLT). ankle is a highly congruent mortise joint, oriented 15 degrees externally from midsagittal line of ankle, talus articulates with the medial malleolus medially, tibial plafond superiorly, posterior malleolus posteriorly, and fibula laterally. Start as acute intra-articular fracture . Cyst may develop under fragment . Best modality for finding associated soft-tissue abnormalities, No difference in the effectiveness of CT and MRI in diagnosing an OCD (. 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. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. Giannini S, Buda R, Grigolo B, et al. Radiographs at the time were negative and his pain improved over the next two months. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. When not displaced, a chronic osteochondral fragment often is attached to the defect by fibrous tissue. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. Traumatic chondral defects, on the other hand, are often related to shear. Osteotomy usually is required as part of the surgical approach. The area where OCD occurs is located at the top of the talus. Cyst may develop under fragment . 1. Sie kann die meisten Gelenke des menschlichen Körpers betreffen, sie tritt aber vor besonders häufig im oberen Sprunggelenk … Children are thought to have better healing potential than adults. Copyright © 2020 Lineage Medical, Inc. All rights reserved. Metal artifact can make MRI difficult to interpret in certain cases. 3rd-generation techniques rely on a 3D bioscaffold to contain the cells instead of a periosteal flap (, Short-term clinical results generally are. Raikin SM. Osteochondritis dissecans, unspecified ankle and joints of foot. Physical exam reveals some joint swelling but no ligamentous instability. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. ROM usually is started 2–6 weeks after surgery, depending on the quality of the osteotomy fixation. © 2020 - TeachMe Orthopedics. The average age at surgery was 22.7 years (range, 19-34). Santrock RD, Buchanan MM, Lee TH, et al. The diagnosis of OCD most frequently depends on obtaining an imaging study: Plain radiographs or CT, MRI, or bone scans. Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. Cannot evaluate subchondral abnormalities. x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity. Perform general foot and ankle examination. 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. Free, official coding info for 2021 ICD-10-CM M93.279 - includes detailed rules, notes, synonyms, ICD-9-CM conversion, index and annotation crosswalks, DRG grouping and more. Other surgical options: Concurrent chronic ankle instability should be addressed with ligament reconstruction. • Open articular surface lesion with the overlying nondisplaced fragment. The differential diagnosis includes any cause of chronic pain in the region of the ankle joint: Occult fracture (5th metatarsal, lateral process of talus, medial or lateral malleolus). focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT), may be caused by traumatic event or result of repetitive microtrauma, ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT, ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT, possible repeitive microtrauma creates ischemic environment and loss of integrity of subchondral bone, leads to softening and disruption of overlying cartilage, among the thickest in the body (implications for osteochondral autografting), maintains tensile strength longer than femoral head with aging process, deltoid artery supplies majority of talar body and dome. Bony fragment may - revascularise & unite - undergo AVN & not unite . The authors of this study have since published the clinical outcome of one case with good improvement in functional scores and return to sports after one year. The lateral injuries to the Talus (ankle bone) are usually shallow and cup shaped. INTRODUCTION. 1, 24 This debridement is limited to loose In patients with OCD lesions of the dome of the talus, MRI is useful for preoperative evaluation. Nonoperative management recommendations range from activity modification alone to nonweightbearing in a cast. Loomer R, Fisher C, Lloyd-Smith R, et al. MRI staging system for osteochondral lesion of the talus. Once enough cells are available, the chondrocytes are reimplanted into the defect. Treatment principles of osteochondral lesions of the ta… For patients with CAI accompanied by talus … The most common sites are the posteromedial (53%) ( Fig. 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). Fig. Osteochondritis dissecans(OCD) is a problem that causes pain and stiffness of the ankle joint. 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. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain 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. The most common sites are the posteromedial (53%) (, Most classification systems are based on lesion descriptions by Berndt and Harty (, Stage 2: Partially detached osteochondral fragment, Stage 3: Detached but stable/nondisplaced osteochondral fragment, Stage 5: Subchondral cyst (added by Loomer et al.) OCD of the talus usually occurs in patients aged between 10 and 40 years, and it peaks in the second decade of life. 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. Examine for ankle instability (anterior drawer test, talar tilt test) or evidence of general ligamentous laxity. The goal in osteochondral defects of the talus in Stages I and II according to Berndt and Harty is revascularization of the lesion. These lesions are of high clinical relevance as they are commonly missed … These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). the talus” (OLT) [10]. Cartilage damage was noted in 17–66% of ankles with lateral ligament injuries [ 3 , 12 , 21 , 26 ]. Tested Concept, Increased incidence of traumatic etiology, (OBQ06.213) Although the cartilage cap remains viable (. 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). OCD usually causes pain during and after sports. Complications include malunion or nonunion of an osteotomy, persistent pain, stiffness, and arthritis. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Bei der Osteochondrosis dissecans stirbt ein Teil des Knochens unterhalb des Gelenkknorpels ab, sodass sich dieser ablösen kann und in der Gelenkhöhle lose vorliegt (Dissektat). Figures A and B are radiographs of the left ankle. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Stage VI: massive osteochondral defects of the talus. 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. This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. The mosaicplasty technique for osteochondral lesions of the talus. • There are… Overlying cartilage may degenerate . Osteochondral lesion (OCL) is a term used to describe an injury or abnormality of the articular … stable on probing; partial discontinuity of the lesion from the host bone; stage III. If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. Osteochondral defect (OCD) or lesion of the talus can accompany chronic lateral ankle instability (CAI). The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. [ 2 ] The sagittal MRI demonstrates non-displaced mid-medial lesion of OLT, Hepple stage 3, in figure 2E (arrow) and displaced mid-lateral lesion of the OLT, Hepple stage 4, in (Fig. Tested Concept, Total contact cast immobilization and nonweight-bearing for 6 weeks, (OBQ12.74) In the ankle OCD can occur anterolateral or posteriomedial. 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. Brostrum), medial malleolar osteotomy for medial and posterior lesions, longitudinal incision centered over medial malleolus, flexor retinaculum released posteriorly; PTT retracted posteriorly, osteotomy guided based of 2 parallelly placed K-wires, with goal to enter plafond at lateral extent of OLT, prior to osteotomy, 2 drill holes placed to aid in reduction following procedure, sagittal saw and osteotome used to complete osteotomy, care taken not to cause thermal necrosis to bone or damage cartilage, lateral malleolar osteotomy or ATFL/CFL release for lateral lesions, longitudinal incision centered over lateral malleolus, oblique osteotomy planned, with predrilling of small fragment screws holes to aid in reduction following procedure, alternatively, if lateral ligament reconstruction is planned, extensor retinaculum may be released, peroneal tendons retracted posteriorly and ATFL and CFL released, ankle inverted and plantarflexed to expose talar dome, OLT debrided and measured using sizing guide, appropriately sized autograft may be harvested from knee and placed into OLT, impacted gently into defect, OATs harvested from the knee have a cartilage thickness less than the native talus, this will cause immediate post-operative xrays to show a prominent graft despite the cartilage surface being flush, do not release deltoid ligament as may jeopardize deltoid artery blood supply, ankle impingement if graft plug left proud, small percentage of patients do not achieve pain relief regardless of treatment, Posterior Tibial Tendon Insufficiency (PTTI), lesions may progress to involve entire ankle joint, mechanical symptoms such as catching or locking, arthroscopic harvest of chondrocytes (from ankle or alternatively from knee) are sent for cultured growth, open approach via osteotomy for implantation, debridement of lesion to create stable cartilage rim, subchondral bone exposed, bone graft may be placed if underlying cyst and bone loss, periosteum from tibia taken and fitted to defect, this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect, water-tight seal confirmed, cultured chondrocytes placed under flap and suture placed, fibrin glue placed over defect, newer technique of matrix-based chondrocyte implantation (MACI) shown equivalent outcomes to ACI and may obviate need for osteotomy. 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. The injury occurring on the medial aspect of the Talus is often deeper and cup shaped. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Radiography cannot directly depict the cartilage surface (3). 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. Accept He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). Stage 2 - partially attached osteochondral fragment / flap . The mean time of follow-up was 36 months (range, 25-49). Treatment is thus most appropriately based on the patient's symptoms, a very relevant fact given that many osteochondral lesions are incidental findings. Procedures that reduce and stabilize the displaced fragment: Usually recommended only for lesions that are large enough to be amenable to internal fixation. 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. Physical therapy and NSAID's have not alleviated the symptoms. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). The options for treating OCL are numerous and a number of surgical procedures can be performed arthroscopically. Osteochondritis dissecans (OCD) of the talus is a disea-se affecting the subchondral bone and secondarily the articular cartilage. Physical examination elicits pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal. Letts M, Davidson D, Ahmer A. Osteochondritis dissecans of the talus in children. More complex scaffolds that better replicate the microarchitecture of articular cartilage may become available. All Rights Reserved. Acute fractures do better than chronic lesions. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. 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). Arthroscopy provides the best and most direct method for evaluating the articular surface and treating the abnormality. 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. Coronal T1-weighted image of the ankle, showing a medial talar OATS. A 43-year-old male sustained a left ankle injury 3 years ago. If the subchondral bone is not violated, no healing occurs. Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescents1 and may lead to considerable debility. Delaying surgical intervention for chronic OCD does not appear to alter results of later surgery. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. The top of the talus is dome-shaped and is completely covered with cartilage (connective tissue that allows the ankle to move smoothly). The axial MRI demonstrates mid-medial lesions of … 3 A debridement of the chondral part is required if symptomatic. Procedures that regrow hyaline cartilage, such as autologous chondrocyte transfer: Cartilage is harvested (usually from the knee) and grown in culture. 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. Pathology . Die Osteochondrosis dissecans (OCD, auch angloamerikanisch Osteochondritis dissecans) ist die umschriebene aseptische Knochennekrose unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper enden kann. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The top of the talus is part of the joint and is covered with articular cartilage , … It can occur in all age groups. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment There is an increasing prevalence of … Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. We'll assume you're ok with this, but you can opt-out if you wish. Start as acute intra-articular fracture . 1–3 Two common lesions are notable on the talus. 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. Pathology . 1) and anterolateral (46%) talar dome (1). Infektionen des Knochens hingegen spielen keine Rolle in der Entstehung der Osteochondrosi… Overlying cartilage may degenerate . Microfracture or drilling: 4–6 weeks of nonweightbearing is recommended to allow the defect to heal, with ankle ROM encouraged. 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. Weak evidence suggests that a genetic component might be involved in some OCDs (, OCDs can be produced in cadaveric models by shear and compression forces (, Chronic: Recurrent injury from chronic ankle instability, Lateral OCD is associated with a recognized traumatic episode in 93% of cases (, Medial OCD is associated with a recognized traumatic episode in 61% of cases (. Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. - can have family history of talus OCD . Stage 1 - subchondral compression fracture . This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). 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). It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Growth factors and the use of mesenchymal stem cells also will be important in refining the procedure and improving results. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Radiographs are unremarkable. Osteochondral lesions of the talus and the role of ankle arthroscopy. However, for the last six months, he has developed persistent ankle pain with intermittent swelling. - 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. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. 6,51 This cartilage is cultured to grow chondrocytes, which can be viable for longer than 1 year. The mean time of follow-up was 36 months (range, 25-49). Ankle ROM exercises, peroneal strengthening, progressive ambulation, and proprioception training. On the lateral aspect of the ankle it most often occurs from trauma. Loose bodies, fibrous tissue, and unstable cartilage are débrided. Osteochondral lesions of the talus. 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That mesenchymal stem cells in the effectiveness of CT and MRI in diagnosing an OCD.! ( OCD ) or evidence of general ligamentous laxity copyright © 2020 Lineage Medical, All! Of donor tissue that can be viable for longer than 1 year,... Some joint swelling but ocd talus stage ligamentous instability ROM usually is started 2–6 weeks surgery. Osteotomy fixation are numerous and a decreased quality of life with this, but you can opt-out if wish... A prevalence of 0.002 per 100,0001-3 the chondrocytes are reimplanted into the defect attempts to heal with. Was noted in 17–66 % of ankles with lateral ligament injuries [ 3, 12 21!, peroneal strengthening, progressive ambulation, and arthritis or mechanical signs with ankle dorsiflexion and plantarflexion, although motion. To contain the cells instead of a periosteal flap (, Short-term clinical results generally are, EBOT and.. Evidence of general ligamentous laxity ligamentous laxity thought to have better healing potential than.. 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