reported significant pain relief from 7.5/10 pre-operatively to 3.7/10 at 29-months post-operatively and the subjective function increased from 4.6/10 pre-operatively to 8.2/10 at 29-months post-operatively [92]. What code should we use for the excision, curettage, and drilling of osteochondral defect in the talus (i.e., osteochondritis dessicans of talus) while performing an ankle arthrotomy? Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. It was later suggested to add a mortise view of the ankle with the ankle in maximal plantar flexion to evaluate lesions along the posterior medial dome [16, 17]. Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM. The most common sites are the posteromedial (53%) ( Fig. X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. Current concept review: osteochondral lesions of the talus. Arthroscopic treatment of talus osteochondral lesions with particulated juvenile allograft cartilage. Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. Indication for this technique is large lesion or revision of the large lesion that does not respond to bone marrow stimulation techniques [85, 87]. J Bone Joint Surg Am 1999; 81(9): 1229-35. For this discussion, OLT will refer to a focal articular cartilage injury/deficit and underlying bony involvement in the form of edema, fracture, and/or cyst formation. Int Orthop 2012; 36(11): 2279-85. Lee CH, Chao KH, Huang GS, Wu SS. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Charles J. Malemud received the Ph.D. from George Washington University in 1973 and completed postdoctoral studies at the State University of New York at Stony Brook in 1977. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Moreover, MRI was used to evaluate OLT after arthroscopic microfracture in 22 patients by Kuni et al. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D. Osteochondral fractures of the dome of the talus. The surgical technique of osteochondral allograft transplantation has been demonstrated in (Fig. A second arthroscopic staging system by Ferkel and Cheng [31] was also based on the status of the articular cartilage, but has been shown to be predictive of patient outcomes. reported successful fixation of a posteromedial talus fragment using posterior arthroscopic 3-portal technique [65]. J Am Acad Orthop Surg 2009; 17(7): 407-14. The accepted contraindication of non-operative treatment is a displaced intra-articular osteochondral fragment [40]. On physical examination, there is often tenderness, decreased range of motion, pain with inversion or dorsiflexion, or an effusion of the ankle. reported excellent results after fixation of inverted OLT using three absorbable pins in 2008 [102]. Dome fracture of the talus. The surgeon will select the best procedure based on the specific case. Recently, matrix associated ACI (MACI) has emerged replacing the need for periosteal flap and thereby providing easier and time-saving handling [114]. studied 12 patients with mean follow-up of 63 months, reporting that the improvement of AOFAS score was 43.5 to 88.5 and Hanover score was improved from 40.4 to 85.5 at final post-operative visit [110]. demonstrated that the overall good/excellent results were 45 percent (91 of 201 patients) of the patients who had OLT and treated by conservative management; however, the truly successful rate of conservative treatment of OLT is still debatable [39]. The techniques that can be performed include either mosaicplasty [67, 116, 119] or osteochondral autograft transplantation (OATS) procedures [115, 117, 118]. Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B. Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Treatment of talar osteochondral lesions using local osteochondral graft. Am J Sports Med. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and subchondral bone, and stimulate healing of the bone and damaged cartilage. Depending on the amount of damage to the cartilage in the ankle joint, arthritis may develop in the joint, resulting in chronic pain, swelling and limited joint motion. ", "Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content. Chuckpaiwong B, Berkson EM, Theodore GH. Foot Ankle Int 1997; 18(10): 628-34. In addition, Chandran et al. Evaluation and management initiate with careful diagnosis including advanced imaging studies. Previous studies have reported the improvement of functional outcomes in both juvenile and adult population [89-97]. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. 107 cases] Revue du rhumatisme et des maladies osteo-articulaires 1991; 58(2): 93-7. ", "Open access journals make up a new and rather revolutionary way to scientific publication. Moreover, Kim et al. Those that fail to respond may be candidates for v… A report of ten cases. van Dijk CN, van Bergen CJ. [25] suggested that SPECT-CT is used in conjunction with MRI for the assessment of OLT. Patients tend to present with more chronic symptoms of ankle pain, rather than acute injury. Foot Ankle Int 1999; 20(12): 789-93. Impaired function, limited range of motion, stiffness, catching, locking an… Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. The microfracture technique induces the repair of cartilage damage with fibrocartilage, resulting in good functional outcomes as reported in the previous studies [34, 50, 61, 78-80]. Berndt and Harty proved this in a report in which anteromedial and posterolateral lesions were created using cadavers.4 They found that anterolateral lesions could be created by dorsiflexing and inverting the ankle, causing the anterolateral aspect of the talar dome to impinge on the fibula. Dipaola JD, Nelson DW, Colville MR. Characterizing osteochondral lesions by magnetic resonance imaging. Draper SD, Fallat LM. This article summarizes the contemporary concepts in the clinical evaluation and treatment of OLTs with particular emphasis on surgical strategies. Although the standard treatment of the OLT has remained controversial, a non-displaced Berndt and Harty Grade I and II lesion should be initially treated with conservative treatment with immobilization and restriction of the activity. There is a currently limited literature to demonstrate the short-term and long-term outcomes of this technique. Even with the addition of these views, Verhagen et al. Moreover, the complex anatomy of the ankle joint makes exact retrograde drilling of the ankle with… The AOFAS score was improved from 57.2 pre-operatively to 89.5 at 36 months post-operatively [105]. 5). “Osteo” means bone and “chondral” refers to cartilage. The following images show a trans-tibial approach for a stage 4 medial talar dome lesion with a free osteochondral graft taken from the great toe joint. Pubmed Central PMCID: Pmc4175163. 1959;41-A:988-1020. Part 2. Osteochondral lesion of the talar dome Share | Definition. 3D and 3E) stimulating the release of mesenchymal stem cells, growth factors, and healing proteins [81]. Robinson DE, Winson IG, Harries WJ, Kelly AJ. 34 ] journals offer an innovative and efficient way of publication for academics and professionals in a hot area at., Stinnett SS, Nunley JA II Am 2009 ; 91 ( ). The ligament structures, tendons and cartilage can then break loose, causing and! 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