It may result in a defect that subsequently affects the subchondral bone and, in severe cases, may lead to formation of an osteochondral fragment. (OBQ12.74) A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. 2015 Dec 18;6(11):944-53. doi: 10.5312/wjo.v6.i11.944. Information from your Foot and Ankle Osteochondral Defect Surgeon in Orange County with offices in Newport Beach and Irvine – Southern California. The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect … Clinical Relevance: The location of peak stress in the ankle joint becomes closer to the rim of the defect in OLTs at a threshold of 10 mm and greater in diameter. Talar dome lesions are usually caused by an injury, such as an ankle sprain. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. Knee Surg. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. “Osteo” means bone and “chondral” refers to cartilage. To make these surfaces slide more easily, there is also fluid in the joint that is created by the capsule of the joint. Osteochondral defects and loose bodies are common causes of mechanical symptoms in the ankle. In most joints of the foot and ankle, this layer of cartilage is one to a few millimetres thick. 3-C). Manage pain 3. 1, in a review of >580 osteochondral defects … The experts opinion can be of interest for other physicians who meet similar problems. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. The most common joints affected by osteochondritis dissecans are the knee, ankle and elbow, although it can also occur in other joints. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. Talar Osteochondral Defects Diagnosis, Planning, Treatment, and Rehabilitation. Healthy cartilage tissue -- a graft -- is taken from an area of the bone that does not carry weight (non-weightbearing). The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. 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). This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). “Osteo” means bone and “chondral” refers to cartilage. 3-B) views; the defect cannot be detected on the lateral view (Fig. Protect surgical ankle 2. In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. Many synonyms for OCLs of the ankle have been used, such as osteocartilaginous bodies, joint mice, intra-articular fragmentary fractures, transchondral fractures, and osteochondral defects, with the acronym OCD being used interchangeably to refer to osteochondral defect or osteochondritis dissecans. Because of excessive overlying fibrous tissue and synovium, the defect cannot be adequately visualized. Osteochondral Defects in the articular cartilage can result from trauma, arthritic conditions, chronic wear and tear. Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. Through the years members of Ankle Platform have asked for treatment advise. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. Submissions are anonymized and transformed to cases which you can find in this section. We prefer to use the broader term osteochondral lesion to define a lesion of any origin … Trauma plays the most important role in the pathomechanism of talus OCLs. This allows us to treat the bone defect without affecting the cartilage. Therefore a small anteromedial synovectomy is done using a 5.5 mm bonecutter shaver with the ankle in the dorsiflexed position. The condition typically affects just one joint, however, some children can develop OCD in several joints. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. These data may have implications toward OLT size thresholds for surgical decision making in symptomatic lesions (ie, primary osteochondral transplantation procedure vs curettage and debridement). OCDs usually develop after an inversion or high impact injury to the ankle, leading to a portion of the cartilage to be injured. They may also be called osteochondritis dessicans or osteochondral fractures. However, it can be subdivided into a traumatic and nontraumatic cause. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). They include lateral or medial ankle pain, functio laesa and swelling. Fig. The ankle is plantarflexed to visualize the osteochondral defect (OCD). Osteochondral defect or Cyst. Immobilization of the ankle, medications, steroid injections and physical therapy are commonly tried but this often fails to relieve symptoms and surgery may be required. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. Definition. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. Osteochondral Defects – OCD of Foot and Ankle, Talus, Metatarsal. During loading, compressed cartilage … INTRODUCTION. When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. How is it caused? Physicians can upload their anonymized problem case for expert advice. Control post operative pain/swelling Treatment: - Patient to be progressed to PWB (up to 30% body weight) if a small lesion (per MD’s recommendations). In patients with an isolated ligamentous ankle injury, these symptoms usually resolve after functional treatment within 2–3 weeks. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Non-operative measures such as mobilisation, a heel lift and steroid injections are reasonable non-operative techniques to try before surgical referral, but pain from mechanical symptoms is often resistant to non-operative measures. (Eds.) Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. Overall, more than 80% of the talus OCLs are of traumatic origin. Keywords Osteochondral defect Cartilage Ankle joint Subchondral cyst Natural history Pain Introduction An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 46, 47, 50]. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an … Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities World J Orthop. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The ankle joint has a high congruency. 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). An osteochondral defect (OCD) of the ankle joint can lead to localised pain, swelling and stiffness in the ankle with difficulty weight bearing and mobilising. Osteochondral defects in the ankle: why painful? Tol et al. What causes it? There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. 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. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) Sports Traumatol Arthrosc 18:570–580. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. Osteochondral defects . 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. 31. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for. 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.Several treatment strategies—namely, arthrodesis, osteochondral allograft, and total ankle replacement (TAR)—have been described for large OCDs of the ankle (). 6 The cause of OCLs of the talus has multiple facets. During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). In acute conditions, symptoms of osteochondral ankle defects are similar to those of acute ankle injuries. [] Although majority may be associated with trauma, some may develop insidiously. If the cartilage does not heal properly following the injury, it softens and begins to break off. 3-A) and heel-rise (Fig. If the fragment has come loose, it can also cause locking or instability symptoms. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. The broad term “osteochondral lesion of the talus” describes an injury or abnormality of the talar articular cartilage and adjacent bone.1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. problems after ankle fracture. In osteochondral autograft transplantation, cartilage is transferred from one part of the joint to another. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Ankle: Chondral/Osteochondral Defect Repair ... 1. Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. It is often associated with a traumatic injury such as a severe ankle sprain. Begin Range of Motion 4. Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). With disease progression, the fragment may detach, leading to degenerative osteoarthritis . Editors: van Dijk, C. Niek, Kennedy, John G. The graft is taken as a cylindrical plug of cartilage and subchondral bone. For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. It is then matched to the surface area of the defect and impacted into place. Free Preview. 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