Your browser does not support JavaScript!. A trial of nonsurgical management may be appropriate for OLTs, with several authors recommending a trial period minimum of 3 months. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 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). … Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the pediatric population. Which treatment do you need?Shoulder TreatmentKnee TreatmentBack TreatmentElbow TreatmentFoot TreatmentOthers, Preferred LocationGleneagles Medical CentreMt Alvernia Medical CentreMount Elizabeth Novena. OLTs represent approximately 4% of all osteochondral lesions. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. There are many options for surgical intervention, typically categorized as primary repair, reparative techniques, and restorative techniques. Osteochondritis dissecans was originally described in 1888 as a process of loose body formation associated with articular cartilage and subchondral bone fracture in the hip and knee. Most authors believe that trauma has an integral role in the pathogenesis of most OLTs and that OLTs most likely represent the chronic phase of a compressed talar dome fracture. This most common symptom of osteochondritis dissecans might be triggered by physical activity — walking up stairs, climbing a hill or playing sports. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. Their findings support the notion that the most common osteochondral lesions are not the traditionally described anterolateral and posteromedial lesions, but rather central medial and central lateral lesions. In a review of serial MRIs of 29 patients who had OLTs that were treated nonsurgically, 45% showed progression, 24% improved, and 31% remained unchanged. Furthermore, it is hard to figure out why some … Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. This is often referred to as a chip inside your ankle joint. Published many acclaimed articles on Sports Medicine. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The primary mechanism is damage and insufficient repair of the subchondral bone plate. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. This condition is also known as … This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. The top of the talus is dome-shaped and is completely covered with cartilage. Treatment principles of osteochondral lesions of the ta… Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Grade I: Hyperintense but intact cartilage surface, Grade II: Fibrillation of fissures not extending to bone. Local osteolysis can then predispose to the development of a subchondral cyst. Authors of a 2010 study theorized that water from compressed cartilage is forced into the microfractured subchondral bone during loading, which subsequently leads to localized increased fluid pressure within the subchondral bone. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. The approach and objectives of surgery are variable and are determined by the type of lesion. The physical examination may reveal tenderness at the level of the ankle mortise anteriorly or posteriorly. “Osteo” means bone and “chondral” refers to cartilage. For those with persistent pain, surgical treatment is offered. OCLs most commonly occur in two areas of the talus: Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. Articular cartilage has … When planning the treatment of osteochondral lesions of the talus, it is important to evaluate the articular cartilage to distinguish between stable and unstable lesions (1,2). Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. Patients also may report mechanical symptoms including catching, clicking, and locking. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion … Isolated lesions … However, medial lesions were larger, and lateral lesions were seen more commonly in association with ligamentous injury. A single event of macrotrauma or repetitive microtrauma may elicit initiation of the lesion in a person who is already predisposed to talar dome ischemia. Patients … Please enable javascript in your browser in order to get form work properly. Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. Treatment of osteochondral lesions of the talus: a systematic review The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral … Orthopaedic Knowledge Update: Foot and Ankle 5, Orthopaedic Knowledge Update Foot and Ankle 4, TABLE 1 Mintz and Associates’ MRI Classification Compared With Cheng’s Arthroscopic Staging System for Osteochondral Lesions of the Talus, 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), Sports-Related Injuries of the Foot and Ankle, Forefoot, Sesamoid, and Turf Toe Injuries, Orthopaedic Knowledge Update: Foot and Ankle 6. Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. The etiology of an OLT may be nontraumatic or traumatic. They require a strong plan. If the cartilage does not heal properly following the injury, it softens and begins to break off. Endocrine or metabolic abnormalities, vasculopathy, and osteonecrosis are potential etiologic factors in nontraumatic OLTs. Those that fail to respond may be candidates for v… Some smaller cystic lesions … Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. Impaired function, limited range of motion, stiffness, catching, locking an… focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT) may be caused by traumatic event or result of repetitive … 16 years of experience in surgical and non-surgical procedures in sports injuries as a. In most cases, the condition is associated with chronic ankle pain, especially after inversion injury to the lateral ligamentous complex. The first is injury to the cartilage surface with an … The appropriate surgical technique should be taken into account the type, stability, and displacement of the lesion. Often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. 6 Napier Road, #04-05 Subchondral cysts with overlying chondromalacia, osteochondral fragments, and loose bodies all represent various stages in the progression of OLTs. This commonly occurs after an ankle sprain where … Terminology. A variety of surgical techniques is available to accomplish this: Orthopaedics is the medical specialty that focuses on injuries and diseases of your body’s musculoskeletal system. Singapore 329563, Mon – Fri : CT scans are used predominantly as an adjunct for a more comprehensive evaluation of and preoperative planning for known lesions, MRI is the preferred imaging study for detection of suspected OLTs that are not seen on initial plain radiographs. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. Two common lesions are notable on the talus. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. The differential diagnosis is wide, but a high index of suspicion must be maintained for an OLT when evaluating patients with chronic ankle pain. Although this can occur in other joints, when it occurs on the ankle bone, it is called an osteochondral lesion of the talus (OLT). 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