This allows us to treat the bone defect without affecting the cartilage. The first is injury to the cartilage surface with an actual loss of part of the chondral surface and underlying subchondral bone. It is important to understand the principles of arthroscopy and the use of a microvector guide in the treatment of osteochondral lesions. We will often try a period of casting for osteochondral lesions with a small fracture fragment but have found poor outcomes with healing in such cases with conservative care. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical treatment options may be considered: Immobilization. This may be followed with gradual progression of weightbearing and physical therapy. Treatment depends on the severity of the talar dome lesion. However, the majority of osteochondral lesions do not show themselves at the initial time of injury. After the initial pain and discomfort of a strain or sprain subsides, individuals usually resume or even increase their activity level. A physician will examine the joint for instability and range of motion. Nonsurgical Treatment Approaches. Most of the lesions requiring surgical treatment are posteromedial in location, have poor quality articular cartilage, a loose bone fragment, necrotic bone beneath the lesion, and are poor candidates for healing with internal fixation. In order to protect the soft tissues, one should drill through the medial malleolus with the use of a microvector guide. periosteum from tibia taken and fitted to defect. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondral Lesions of the Talus Sara Lyn Miniaci-Coxhead, MD Dr. Miniaci-Coxhead or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. Physiotherapy is then recommended to rehabilitate the affected knee or ankle. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. After performing this procedure, one should emphasize non-weightbearing for six to eight weeks and again use a CT scan to check healing. With an inversion or eversion stress on the ankle, the talus and tibia and/or fibula will contact each other with a massive stress, resulting in a compression or shear stress on the surface of the talus and underlying injury. Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. For stable lesions, non-operative management is usually the first step including: Although the treatment of osteochondral lesions of the talus has evolved and improved, there is a need to understand the full spectrum of treatments and be well-versed in all forms of treatment in order to have a complete bag of tools necessary to treat these complicated occurrences. Treatment of Osteochondral Lesions of the Talar Dome James W. Stone MD Key Points Although osteochondral lesions can occur over any portion of the talar dome or the tibia, the talar lesions typically occur over the anterolateral or the posteromedial talar dome. The most common surgical procedure for an osteochondral lesion is an arthroscopic exploration and treatment. Treatment. Treatment options include: non-operative conservative therapy (including but not limited to modification of activity, injections, casting, or boots), various surgeries like “microfracturing” the affected bone which brings new cells to the area in hopes building new cartilage, or transplantation of cartilage/bone from a donor or different body part. Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4 … - Operative Treatment: - Arthroscopy of the Ankle: - osteochondral lesions of the talus can be debrided, and loose bodies and small osteochondral fragments can be removed; - use of non-invasive or invasive distraction improves access to joint and allows adequate debridement and curettage of bed; Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. Operative treatment might also be necessary if … It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. A period of … © 2020 HMP. The type of surgery that is most effective depends on the size, location and severity of the lesion. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical … Scranton PE, Jr., Frey CC, Feder KS. Non-surgical: Osteochondral lesions of the ankle can be treated with injections of Platelet-rich plasma and hyaluronic acid, which results in a decrease in pain scores and an increase in function for at least 6 months. Foot and Ankle International, May 2001; 22(5): 380-384. They also may be caused by abnormal bone development, especially when they occur in children. Use the OATS system to remove the plug of damaged cartilage and bone to a depth of 1 cm or so, and utilize a replacement graft. There is no cure as such, but the condition can be treated by a variety of means depending on the size and location of the lesion as well as the age of the patient and the degree of symptoms. The second most common type is an injury to the superficial cartilage surface with a crush cartilage injury or shear tear of the cartilage surface. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Patients will note a dull ache of the joint and may also describe mild to moderate locking or clicking. If damage is extensive, then a bone graft can be inserted to replace the cartilage. Surgical options differ according to the size, depth … Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. There is a great deal of debate as to whether you should use autograft, fresh allograft or graft substitutes. Peroneal Tendon Dysfunction: Why Peroneal Tendon Tears Should Be Treated Like Posterior Tibial Tendon Tears. For related articles, check out the archives at www.podiatrytoday.com. Once the diagnosis has been confirmed, treatment may be surgical or non-surgical, depending on the nature of the OLT, presence of other injuries and patient characteristics. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. The treatment approach of the osteochondral lesion is influenced by a number of factors, such as: location and size of the lesion, presence of secondary degenerative changes. this is sutured … Over the next few years, one may be able to begin treating cartilage lesions with cartilage cell transplants through an injection and with cartilage caps. If the patient presents such kind of changes, the most recommended form of intervention is represented by the complete replacement of the joint. I hope the information presented is helpful for your patient care. If the fragment is unstable or loose in the joint, surgery may be necessary to remove and repair the injured area. This type of treatment is best in large lesions with a major defect of over 1 cm with extensive depth. Operative treatment might also be necessary if patients do not respond well to conservative treatment. “Osteo” means bone and “chondral” refers to cartilage. 109. It occurs when a small segment of bone begins to crack and separate from its … Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. At earlier stages (stage 1 to 4), a number of options … For small sized defects if the overlying cartilage is intact, then … Treatment of the subchondral bone will aid in pain relief even if one treats the overlying cartilage. Operative Treatment . How To Diagnose And Treat Osteochondral Lesions Of The Talus, How To Assess And Treat Ligamentous Laxity Syndromes In The Foot And Ankle, Pertinent Pearls In Evaluating And Treating Chronic Ankle Instability, Current Best Practices In The Treatment Of Plantar Plate Tears. Although wearing a brace or cast may ease the discomfort of an osteochondral lesion, they are usually not enough to remedy the problem permanently, except in children, who can respond well to non-surgical treatment. An osteochondral lesion is an injury or small fracture of the cartilage surface of the talus. This surgery may be performed open or arthroscopically. Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. Usually, an osteochondral lesion occurs when there is an injury to the joint, especially if there is an ankle sprain or if the knee is badly twisted. Finally, there is a subchondral cyst type injury with a cyst formation deep to the cartilage surface but an intact overlying cartilage and bone surface. OCD usually causes pain during and after sports. For most kids and young teens with osteochondritis dissecans, the … Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Surgical treatment of talar OLTs includes: Arthroscopic … Scranton PE and McDermott JE. The most common location of osteochondral lesions in patients with ankle trauma is on the anterolateral or pos- The best option is a fresh allograft talus. A patient with an osteochondral lesion will often feel a dull ache in the joint and may also experience a mild locking or clicking of their knee or ankle joint. 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