There are several non-operative management options for the treatment of osteochondral lesions, including: In younger patients, this condition has the potential to heal, making it possible to treat acute non-displaced talar OLTs with immobilization in a cast or CAM walker. This prevents the need from harvesting bone and cartilage from another part of the body (ex. OCLs most commonly occur in two areas of the talus (Figure 1A and 1B): Many patients with talar OLTs are asymptomatic (no pain or swelling). Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. Fig. Did you know our resouces can be found in. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. lage OCD may have genetic risk factors that predispose them to developing the disease, although as per Zanon et al9 in ‘Osteochondritis Dissecans of the Talus’, ‘there are no ongoing studies to identify such genes’. Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. OCD talus. OCD Lesions of Talus Introduction The ankle joint of made up of 3 bones; the tibia (including the medial malleolus), the fibula (including the lateral malleolus) and the talus. The pain is often worse with activities, particularly running, walking and jumping. 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). Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for … Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. 2. postoperative treatment regime? Laboratory and clinical work continue in this area. This treatment approach can be initially attempted in non-displaced OLTs. cartilage injury with associated subchondral fracture but without detachment Plain film mortise view (consider repeat in 2-4 weeks if films are normal) Four classes 1. Two children had bilateral involvement, for a total of 26 lesions. It occurs when OCD develops in an articulating surface before closure of the growth plate.14 Owing to rarity of juvenile OCD of the talus, existing management guidelines are predominantly 269 Chestnut St. #271 When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). OCD occurs in a number of locations in the hock, including the intermediate ridge of the tibia (most common), the lateral trochlear ridge of the talus, the medial malleolus of the tibia, and the medial trochlear ridge of the talus. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury The most common clinical sign of hock OCD is joint … OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. This can be done without a medial malleolar osteotomy. Current complaints: Deep left ankle pain during sport and axial bearing/load on left ankle and swelling. Top arrow indicates bruising of the distal tibia and the lower red arrow indicates bruising of the talus Mechanical malalignment overloads either the medial or lateral boarders of the talus depending if there is tibial or hindfoot varus or valgus [8]. There were 10 boys and 14 girls. However, the larger the graft, the more likely it seems that it will collapse as a new blood supply is established into the graft after transplantation. Whereas, the OLTs on the inside part of the top of the talus (medial talar osteochondral lesions) are more commonly associated with chronic overload of the medial aspect of the ankle, such as would occur in a patient with a higher arched foot (subtle cavus foot). OCD remains uncertain. Plain x-rays can be used to help diagnose an osteochondral lesion. It is often associated with a traumatic injury, such as a severe ankle sprain. • Accounts for only 4% of reported cases of OCD – Vascular etiology? X-ray: Retrograde drilling and fixation scored 88 and 89%, respectively. The talusis one of the large bones in the back part of the foot that helps form the ankle joint. OCD of the Talus Radiographs. Flattening of the medial talar dome. Osteochondritis dissecans (OCD) of the talus is rare in children. Surgery is usually required to repair Talar OCD. As the ankle twists, the edge of the talus bone impacts the adjacent bone which bruises or shreds the cartilage. Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4-6 weeks can help reduce stress on the OLT and allow healing. Non-operative treatment can be successful for non-displaced talar OLTs, especially if the condition is recognized and treated early, and the lesion is relatively small. If you want advise on a difficult case, you can upload it here. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. 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. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. OLTs on the top outside part of the talus (Antero-lateral lesions) usually have a history of a traumatic injury with a twisting component, such as an ankle sprain. Fixation with a headless compression screw or absorbable screw. These symptoms could include localized ankle pain, as well as discomfort on either the inside (medial talar OLT) or outside (anterolateral talar OLT) of the ankle. An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). Period of non-weight bearing since this is a big lesion? These various types of damage are called osteochondral defects (OCD) of the talus (an older term was osteochondritis dissecans). Other? This may affect healing… Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. While initial symptoms may be similar to a sprained ankle, persistent pain, swelling, and a catching sensation while using the ankle may indicate this more serious condition. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). OCD of the Talus Tx. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. The fragment is large enough to fix. [Picture 1] 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. 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