Fig. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. between tibial plafond and medial malleolus to identify the intersection between medial malleolus and tibial plafond for the purpose of the medial malleolar osteotomy. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac … The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. ed by the tibial plafond. A topographic study was also performed. Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. The majority of osteochondral lesions (OCLs) of the an-kle occur in the talus.1,2 Approximately 2.6% of isolat-ed OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature.3–5 There is no clear explanation why talar OCLs are more common than distal tibial …  |  HHS Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Ankle; BMDCT; Cartilage; OLTP; Osteochondral lesions. A K-wire can be inserted into the talus through one of the predrilled holes to hold the Objectives: septic ankle. Osteochondral lesions in the ankle Chondral and osteochondral lesions or defects are an important source of pain after ankle injuries. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. In the knee, osteochondral defects were created at the medial femoral condyle (MFC) and patellar groove (PG). However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. On MR imaging, osteochondral defect of the tibial plafond has low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, with adjacent bone marrow edema (Figs. Background: The aim of this study was to evaluate the incidence and morphologic characteristics of osteochondral lesions of the distal tibial plafond (OLTP) by location and morphologic characteristics on MRI. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. After creating the osteochondral defect, drilling was performed. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. Cuttica DJ, Smith WB, Hyer CF, Philbin TM, Berlet GC. Tibial OCL . Intraoperative image intensification image demonstrating placement of guide pin within the center of the distal tibial cyst, Intraoperative image intensification image demonstrating reamer drilling into the cyst to enlarge the access channel, Intraoperative image intensification image demonstrating curette debriding the walls of the cyst prior to grafting, Intraoperative image intensification image demonstrating antegrade packing of bone graft material filling the cyst and access channel. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. This requires a detailed evaluation to be performed to assess the integrity of the remaining cartilage, the underlying bone and to look for evidence of healing capacity. Exclusion criteria were: age < 18 or > 50 years, patients with severe osteoarthritis (stage III according to Van Dijk classification), presence of kissing lesions of the ankle and patients with rheumatoid or hemophilic arthritis. Unfallchirurg. osteochondral defect. Epub 2017 Jul 29. Methods: 413 If the osteotomy is created too medially (i.e. Pilon fractures involve the tibial plafond. At the ankle, defects were created in the talus at either a covered or uncovered area by the tibial plafond. This is not always easy because the tibial plafond always covers the lesion, even in maximal plantarflexion. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. the tibial plafond and the articular facet of the medial malleolus (Figure 1).40,167,281,350,351,413 The optimal angle has been determined to be 30° in relation to the long tibial axis. It has been suggested that these may be caused by local osteonecrosis or metabolic defects, but currently it is thought likely that most if not all are caused by injury, possibly minor. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. Foot Ankle Int. In distal tibia the cleft tends to prefer the medial plafond at its connection with the medial malleolus. Introduction Approximately 63% of osteochondral defects doi: 10.1016/j.eats.2019.04.002. 2014 Oct 15;96(20):1708-15. doi: 10.2106/JBJS.M.01370. The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. Evidence-based therapy].  |  (1,2) Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. in the articular facet of the malleolus), exposure of the talar dome may be insufficient for adequate treatment. The duration of nonoperative treatment is not well defined and should include input from the patient. This must be prevented in young athletes.  |  Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Approach to Osteochondral Lesions of the Tibial Plafond, Follow-up Imaging for Osteochondral Lesions of the Ankle, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Chondral Injury After Supination Trauma, Preoperative Planning for Osteochondral Defects, Rehabilitation After Bone Marrow Stimulation, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Diagnosis of Osteochondral Defects by Arthroscopy. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. The bisector of this angle indicated the osteotomy perpendicular to the tibial articular surface. NIH CrossRef Google Scholar Introduction The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. The purpose of this study was to evaluate the clinical outcomes and the level of sports activity following arthroscopic microfracture for osteochondral lesions of the tibial plafond. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. AbstractPost-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. Knee Surg Sports Traumatol Arthrosc. 4.Retrieved Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. 5. Ross KA, Hannon CP, Deyer TW, Smyth NA, Hogan M, Do HT, Kennedy JG. Literature data do not report clinical records with significant number of cases and follow-up. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. MRI scan - osteochondral lesion on the talus … COVID-19 is an emerging, rapidly evolving situation. 3A and 3B). OCD usually causes pain during and after sports. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. (1,2) Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. 3C). the opposing tibial plafond were observed in two patients. The second most common localization of the osteochondral defect in the OCD with loose bodies group was the medial plafond of distal tibia [in 9 of 29 (31.1%) patients]. Osteochondral Defects . It appeared that the use of ta lar osteochondral graft does not adversely affect the joint surface and easily incorporates into the surrounding surface cartilage. Objectives. This site needs JavaScript to work properly. Radiographically, they are lucent defect traversing the length of epiphysis, and may have sharp or irregular borders. Main sport surfing. dome. Osteochondral lesions of the tibial plafond (OLTP) are rare disorder compared with osteochondral lesions of the talus (OLT), and its frequency is 2.6% of osteochondral lesions of the ankle. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). instability was seen. (2) It can fill massive (>3 cm 2) defects that are not amenable to autograft techniques [12, 13]. 2018 Jul;26(7):2116-2122. doi: 10.1007/s00167-017-4591-x. An osteochondral defect that is in the early stages may be suitable for a repair technique to keep the native bone and cartilage. Ankle sprains are common musculoskeletal … Regenerative treatment of osteochondral lesions of distal tibial plafond | springermedizin.de Literature data do not report clinical records with significant number of cases and follow-up. Its radiologic findings are similar to those of osteo- chondritis dissecans located elsewhere in … The advent of CT and MR scanning has shown that they are commoner and more complex than was thought. It contains free information. 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. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. Literature data do not report clinical records with significant number of cases and follow-up. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac … To gain exposure to the OCD during anterior arthroscopy, the ankle must be maximally plantarflexed to move the lesion anteriorly.424,432 However, some defects located in the posterior part of the talus may not be accessible by anterior arthroscopy.296,408 Especially if the OCD is located posteriorly and There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. 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. Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. ... Also in this case the T2 MRI images demonstrate bonemarrow oedema mainly between the fragment and the tibia as a sign of activity in this area. In the knee, osteochondral defects were created at the medial femoral condyle (MFC) and patellar groove (PG). The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. View larger version (207K) Fig. Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. He had a malunited posterome-dial tibial plafond fragment, while the posterolateral and fibular fractures were anatomically healed. Foot Ankle Int. Knee Surg Sports Traumatol Arthrosc. Literature data do not report clinical records with significant number of cases and follow-up. Arthroscopic Antegrade Cancellous Bone Autotransplantation for Osteochondral Lesions of the Tibial Plafond. Abstract: Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. MRI scan - osteochondral lesion on the talus with "kissing" lesion on the plafond Although the majority of osteochondral lesions occur after a definite injury, some have no clear history of injury. Bone defects after septic arthritis of the ankle joint result in arthrodesis and severe loss of ankle motion. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. 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. Introduction The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating these rare lesions. This must be prevented in young athletes. All patients were evaluated through X-rays; MRI was performed preoperatively and at the final follow-up with MOCART score; clinical evaluation was assessed by AOFAS score at various follow-ups of 12, 24, 36, 60 and 72 months. (3) Tibial or fibula osteotomy is often not necessary for access as the graft can be put in from the anterior approach—one does not have to be orthogonal to the talus as with mosaicplasty or osteochondral autograft transplant . Treatment of talus osteochondral defects in chronic lateral unstable ankles: small-sized lateral chondral lesions had good clinical outcomes. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. There may be slight spreading of either half of the epiphysis away from the cleft. Elias I, Raikin SM, Schweitzer ME, Besser MP, Morrison WB, Zoga AC. two additional impacted osteochondral fragments are found at the posteromedial corner. Osteochondral lesions of the distal tibia represent a challenge for the orthopedic surgeon because of their difficulty diagnostic and rarities. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. After creating the osteochondral defect, drilling was performed. Results: Last modified Feb 10, 2011 07:52 ver. Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid. CONCLUSION: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 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Final follow-up bone and cartilage tissues simultaneously: osteochondral lesions or osteochondritis dessicans can occur in the knee ankle! Shown that they are lucent defect traversing the length of epiphysis, and several other advanced features temporarily!