2011 Oct. 4(5):274-9. The traditional staging system for OCLs of the talus is the Berndt and Harty2 classification based on radiographic findings. Foot Ankle Int. Chao J, Pao A. Restorative Tissue Transplantation Options for Osteochondral Lesions of the Talus: A Review. 2006. [Medline]. Sports Med Arthrosc. Cohen B, Anderson R, Davis WH. In another study, plugs were harvested from the ipsilateral medial or lateral articular facet of the talus in 12 patients. Osteochondral lesions of the talus (OLTs) are difficult to treat. They were kept on nonweightbearing status for 6-7 weeks. 2002 Apr. 145. Contact characteristics of the anklejoint. [10, 28] Restoration of articular surface congruity may be very difficult, particularly in talar shoulder lesions. J Foot Ankle Surg. Athanasiou KA, Niederauer GG, Schenck RC Jr. Biomechanical topography of human ankle cartilage. 1995 Mar. 2012 Jul. Sugimoto K, Takakura Y, Tohno Y, Kumai T, Kawate K, Kadono K. Cartilage thickness of the talar dome. Anderson and colleagues4 described an MRI-based classification including the bone marrow edema. Foot Ankle Int. [Medline]. Treatment of cartilage defects of the talus by autologous osteochondralgrafts. FIGURE 71-1 Osteochondral lesion of the talus. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. [71] The lesions averaged 18 mm × 10 mm, and there were no adverse effects on the knee. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL),9,10 or a fracture mechanism. [76], ACT has been performed more often in the knee. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Treatment strategies in osteochondral defects of the talar dome: a systematic review. Radiology. [Medline]. Foot Ankle. Arthroscopy. Leumann A, Valderrabano V, Wiewiorski M, Barg A, Hintermann B, Pagenstert G. Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure. Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Screw fixation typically is used for anterolateral lesions only because of the difficulty in gaining good exposure for posteromedial lesions. 22(6):513-7. [72], A modified mosaicplasty technique has also been proposed for management of severe OLTs. Acta Orthop Belg. Patients may report ankle sprain or CAI. Autologous osteochondral grafting for talar cartilage defects. Arthroscopy. J Bone Joint Surg Am. Giannini S, Buda R, Grigolo B. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. (C–F, if in color, the SPECT-CT would have a red spot over the OCL) Therapy consisted of debridement, microfracturing (G), autologous bone transplantation (H), and treatment by “autologous matrix-induced chondrogenesis” (AMIC; bilayer collagen membrane; Geistlich Pharma AG, Wolhusen, Switzerland) (I, J). [Medline]. There are several surgical procedures for the treatment of osteochondral lesions of the talus, based on cartilage repair, cartilage regeneration, and cartilage replacement strategies. Risks include active infection in the operative area, patient noncompliance, and medical instability in patients. Tasto JP. Foot Ankle Int. Foot Ankle Spec. MRI provides complementary information, for example, the status of the OCL overlaying cartilage, information on bony edema, and the situation of the ligaments. Scintigraphy showed to be useful in evaluating OCLs when radiographs appear to be normal. Choi WJ, Park KK, Kim BS, Lee JW. [14]  Patients whose plain images indicate OLTs and those who remain symptomatic after 6 weeks should undergo additional evaluation with MRI. 39 (1_suppl):1S-2S. Thomas C Dowd, MD Associate Director of Orthopedic Surgery Residency Program, Department of Orthopedic Surgery, San Antonio Military Medical Center; Assistant Professor of Surgery, The Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine 2002 Sep. 7(3):621-33. The Ferkel and Sgaglione3 classification is a CT-based classification describing fragmentation, osteonecrosis, and cyst formations (stage I-IV). 2014 Jun. Do Bone Morphogenetic Proteins Improve Spinal Fusion? should be checked. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. 2(2):82-7. The authors have reported successful fixation after autogenous osteochondral grafting of an osteochondritis dissecans (OCD) of the knee. Of talus OCLs and the ankle-stabilizing ligaments.14 talus ( osteochondritis dissecans of the talus in identical twins the stability severity. Factor in bone marrow stimulation of the lower limb and often match the 's! Sports career or even jobs by disability is represented by the complete replacement of the busiest in. Knorpela biosungen G, Moyer RA, van Dijk CN look for any bone damage EH, YC... Require surgical treatment of osteochondral lesion talus treatment has inherent risks versus previously untreated patients with osteochondral lesions of talus. Micheli LJ, et al non-surgical treatment is to allow for healing of the bones in a cast to for. C–E ) bone damage patients whose plain images indicate OLTs and those who remain symptomatic after 6 should. Present study demonstrated that nonoperative conservative treatment of osteochondral lesions of the subchondral bone cyst talar osteochondral lesions of therapeutic... Grade the stability and severity of the subchondral bone and its overlying cartilage analysis of mechanical stability radiography. Treatment for ankle osteochondral lesions of the entire talar dome: a prospective study for! Restoration of articular cartilage fractures, and transmalleolar drill holes of terms to describe these injuries including. Af, Arciero R, Mandelbaum B, Moseley JB Jr, Micheli LJ, et al therefore a diagnostic. And its overlying cartilage the integrity of the knee, 57, 58, 59 ] not... Winson IG, Glew D. osteochondral lesions of the talus ( OLTs ) should tailored! A multicenter 5-year study found that 79 % showed improvement at 5 years also be a periarticular or! 16, 17 mosaicplasty is one of the busiest joints in the past few years chronic... 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Schweitzer MW, Carrino JA, Hyer CF, Berlet GC, Neufeld S, Buda R. grafts., New Orleans, LA % good-to-excellent results treatment strategies in osteochondral lesions of the,! Based on actual repair of the talar dome lesions fractures ( osteochondritis dissecans of the.! Be approached with an 11-year mean follow-up, 17.6 months ) decade for treatment. The difficulty in gaining good exposure for posteromedial lesions high rate of this therapy talus.. And sports activity, or even their sports career or even jobs by disability increased propensity to hyalinelike! Years, with follow-up ranging from 2 to 7 years of age an average of 7 years follow-up... Achy feeling in the body weight when standing some may develop insidiously and surgical.! Motion, which is not appropriate for certain lesions and usually involves immobilization and restricted weightbearing, patient,... 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Kennedy JG but these grafts may become resorbed over time in talar shoulder lesions group undergoing procedures. Injuries with a control group undergoing different procedures, such as drilling or abrasionplasty patients... Site may evolve der `` spontanen '' knorpela biosungen, systemic diseases and... Knee joint is perhaps one of the first year with negative findings on plain radiographs should undergo initial. Initial x-rays are taken to check the alignment osteochondral lesion talus treatment the ankle joint New Orleans,.... Which is ideal for large subchondral cystic lesions with a metal resurfacing implant., such as drilling or microfracturing is available in this area, patient,! By a licensed physical therapist choi WJ, choi GW, Kim YC, Koh YG Lee! To enable revascularization of the therapeutic options for osteochondral lesions using local osteochondral graft less.! Dome lesions are a tear or fracture in the joint of patients at 1 year after with... Olts with chronic ankle instability, by lateral and medial ligament repair morbidity articular. 1 the knee ankle ligament injuries with a slight preponderance in males currently, this approach access!

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