Osteochondral lesion of the talus: still a problem? Arthroscopy allows direct visualization of the ankle joint and avoids any trauma to surrounding structures that would be at risk in a traditional, open approach. Traumatic events can cause multiple mechanisms of injury including shearing, fracture, avulsion and compaction. Single Stage Stemmed Fixed Implant with a medial slide. Osteochondral Lesions of the Talus: An Individualized Treatment Paradigm from the Amsterdam Perspective. Talar component stable. The surgical intervention in question was the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure, which was performed in a press-fit way. Congruent Valgus. Positioning is key !! CT and MRI pending. Aetiology Copyright 2007-2023. It is important to elevate the ankle elevated above your heart level and to ice around your knee to reduce swelling. She has pain with every step. Osteochondral Lesions of the Talus are focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage which may be caused by a traumatic event or repetitive microtrauma. An official website of the United States government. #happy #totalanklereplacementsurgery #totalankle #anklerehab #ankle #anklereplacement #anklearthritiscenters #anklearthritis #djo #strykermedical #scottsdale #phoenixsurgeon #phoenix #anklepain American Orthopaedic Foot & Ankle Society, The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. Up and Down arrows will open main level menus and toggle through sub tier links. 23 View Acute symptomatic but stable lesions and chronic lesions first should be treated conservatively. Another alternative to OATS is ACI, which is a two-stage procedure involving first harvesting a small amount of healthy cartilage from a non-weight bearing surface. that is transferred into the prepared defect in the talar dome. Does anyone know why this happened? If the bone is only bruised and the lesion is stable (without loose pieces of cartilage or bone), non-surgical treatment may alleviate symptoms. Osteochondral lesion of the talus, (cartilage damage of the ankle) can occur from a traumatic fracture or ankle sprain when the bones in the ankle joint hit each other damaging the cartilage surface . Open The talus is a unique bone heavily covered in articular cartilage that is necessary to provide pain-free range of motion within the ankle joint. More complex procedures with an open surgical approach or bone or cartilage transfer may have additional risks. S/P Triple Arthrodesis and TMT. Up to 75% of OLTs are caused by trauma, such as an ankle sprain or fracture. Although, once thought to be attributed to ischemic necrosis, acute or repetitive trauma is the contemporary theory regarding their etiology. . Osteochondral lesions usually occur as the result of an acute trauma, such as an ankle sprain. An official website of the United States government. This 65 year old female had a few ankle sprains over the course of her lifetime. Tol et al. Search for condition information or for a specific treatment program. Dr. McAlister presented his cases at @acfas.foot.and.ankle.surgeons in @vegas this past week. Plan for multiple procedures here!!! What would be the next most appropriate step for treatment? Edema is present in the bed of the defect (asterisk). eCollection 2022. Mild joint effusion is seen at tibio-talar and subtalar joints. Get the latest news, explore events and connect with Mass General. #anklearthritis #ankle #anklefracture #footandanklesurgery Valgus Revision. Apr 20 This young 40 year old patient had little options for this size of OCD lesion and he is only six weeks out but off of narcotics and only on Advil. for professional medical advice, diagnoses or treatments. Anesthesia, Critical Care & Pain Medicine, Billing, Insurance & Financial Assistance, Footeducation.com: Osteochondral Lesion of the Talus (OLT), The inside and top part of the lower bone of the ankle (the medial talar dome) or, The outside and top part of the lower bone of the ankle (the antero-lateral talar dome), 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. Current treatment algorithms are based on the size and location of the lesion, integrity of the cartilage within the ankle joint, and the presence of any subchondral cysts or swelling around the joint. Joint stiffness. View 3 Lesions with greater than 4 mm of bone loss following debridement may require bone grafting to augment with the scaffold. Development of an osteochondral scaffold which bridges the gap between small defect treatment and joint replacement is still a grand challenge. Furthermore, bulk osteochondral allograft from a size-matched talus can also be used for even larger, unstable/uncontained shoulder lesions. Epub 2014 Oct 19. 21 Nov 18 When compared to medial talar OCDs, which of the following statements is true regarding lateral talar OCDs? What would you do?? Lesions greater than 1.29 cm2, cystic lesions, and lesions that have failed prior treatment are potential candidates for osteochondral autograft transplantation. 11. You and your foot and ankle orthopaedic surgeon can discuss these treatment options and decide which one is best. None of the patients and healthy control group were sports professionals. 27 Walking into the weekend! Bookshelf The earliest report of osteochondritis dissecans (OCD) was published in 1888 by Konig, who characterized a loose-body formation associated with articular cartilage and subchondral bone fracture. Jul 19 HHS Vulnerability Disclosure, Help This young 40 year old patient had little options for this size of OCD lesion and he is only six weeks out but off of narcotics and only on Advil. Talar component stable. 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. Post-traumatic arthritis accounts for over 80% of the ankle arthritis cases our centers see. A complaint = Left Heel Pain. Posttraumatic Tibial Plateau Lesions with Fresh Osteochondral Allograft . They can start as bone bruising that develops into an osteochondral lesion. Acute lesions that are too small for fixation can be treated with morselization and reimplantation of the cartilage fragments. OLTs predominantly affect males and patients in their thirties. When the fragment is removed, a defect shaped like a small crater is left in the talar dome. A talus fracture can cause significant loss of function in your ankle. This patient was over 13 years out and had no history of wounds or prev. Specific risks associated with surgical repair of osteochondral defects using minimally invasive techniques may include, Numbness to part of the skin near the incisions, Injury to vessels, nerves, and a chronic pain syndrome. Jun 8 Open The https:// ensures that you are connecting to the This may include: Our foot & ankle surgeons and podiatrists provide personalized & compassionate care. Conclusions: Osteochondral lesions of the talar dome can be treated successfully by biological inlay osteochondral reconstruction technique without medial malleolar osteotomy, with good to excellent clinical outcomes expected. Malalignment can reek havoc on the hind foot if not positioned well. Ankle Arthritis comes in various shapes and sizes. anklearthritiscenters Safe Care CommitmentGet the latest news on COVID-19, the vaccine and care at Mass General.Learn more. Foot (Edinb). Osteochondral lesion of the talus (OLT) describes damage to the talar cartilage including pathological changes in the underlying bone. S/P Triple Arthrodesis and TMT. collected, please refer to our Privacy Policy. Shim, DW, Park, KH, Lee, JW, Yang, YJ, Shin, J & Han, SH 2021, ' Primary Autologous Osteochondral Transfer Shows Superior Long-Term Outcome and Survival Rate Compared With Bone Marrow Stimulation for Large Cystic Osteochondral Lesion of Talus ', Arthroscopy - Journal of Arthroscopic and Related Surgery, vol. Persistent pain after several months despite appropriate treatment may be a sign you have developed an OLT. The recovery period after an osteochondral lesion usually lasts six months to a year. This young 40 year old patient had little options for this size of OCD lesion and he is only six weeks out but off of narcotics and only on Advil. Effects of bilayer gelatin/-tricalcium phosphate sponges loaded with mesenchymal stem cells, chondrocytes, bone morphogenetic protein-2, and platelet rich plasma on osteochondral defects of the talus in horses During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). She would like to know her options. What would you do?? Pain Physician. 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. Ankle sprains are a common cause of OLTs. OCLT present a common ankle pathology and have been shown to occur in over 65% of chronic ankle sprains and up to 75% of ankle fractures [ 4, 5, 9 ]. Open We have developed a team of consultants that have expertise in a myriad of treatments for the thousands of ankle arthritis patients out there. Foot Ankle Clin. Osteochondral Lesions of the Talus. It was once thought that all OLTs progress and worsen with time, but this is no longer believed to be true. View Before Unauthorized use of these marks is strictly prohibited. #totaltalusarthroplasty #totaltalus #anklereplacement #anklesprain #anklebreaker #ankleavn #avascularnecrosis #deadtalus #aofas @aofas1 @acfas.foot.and.ankle.surgeons @restor3d. 31 NCI CPTC Antibody Characterization Program. The OATS procedure is a one-step procedure that harvests a plug of healthy bone and cartilage taken usually from your knee. Ankle Arthritis comes in various shapes and sizes. Acute osteochondral talus fractures, which have a bone fragment thickness greater than 3 mm with displacement will benefit from early surgical intervention. Most studies show that full resolution of the pain from an OLT occurs in less than half of cases. The theoretical advantage of this procedure is that it replaces the damaged cartilage with cartilage and bone harvested from the patient (autograft). 3 . The demographic, clinical and radiological data of the patients were analyzed. The patients were operated with spinal block, general anesthesia, or combined. Painful Total Ankle Arthroplasty can have multiple etiologies. #anklearthritis #anklefusion #hindfoot varus #anklepain #footandanklesurgeon #acfas, Medial talar dislocation over 20 years ago. anklearthritiscenters 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. Aug 12 OCLs most commonly occur in two areas of the talus: Many patients with talar OLTs are asymptomatic (no pain or swelling). Wagner KR, DeFroda SF, Sivasundaram L, Kaiser JT, Meeker ZD, Condron NB, Cole BJ. anklearthritiscenters In these cases, no additional treatment is necessary. Jan 4 Signs and Symptoms. anklearthritiscenters Our mission is to provide an educational platform for patients and healthcare providers to learn about the latest in treatment of ankle arthritis. The site is secure. This information is an overview of the management of osteochondral lesions of the talus and is not all inclusive. It may not be possible to properly treat certain lesions arthroscopically due to the size or location of the lesion. PMC 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). What is OCD (Osteochondral Defect of Talus). J Bone Joint Surg Am 2013; 95 (11) 1045-1054 Surgical technique. May 24 Cancellous bone graft augmentation may be used for subchondral cysts with volume greater than 100 mm3 or with those with a depth of more than 10 mm. Open official website and that any information you provide is encrypted Osteochondral lesions are commonly the result of excessive force going through the knee. The defects cause deep ankle pain associated with weightbearing. Patients may have an OLT that doesn't cause pain or limitations or a lesion that becomes painful but improves. Medial talar dislocation over 20 years ago. This 65 year old female had a few ankle sprains over the course of her lifetime. #lifeofasurgeon #podiatrylife #podiatrist #acfas #smithandnephew #medline #footandankleaurgery #surgeon #scottsdaleaz #footandankleresident Talar osteochondral lesions (OCL) frequently occur following injury. 0 Open Www.phoenixfai.com #anklearthritis #totalanklereplacement #totalanklearthroplasty #zimmer Procedures that transfer bone or cartilage to an OLT also have good outcomes. 42 yo F. Peroneal muscle wasting and pain on uneven surfaces. #anklereplacement #footarthritis #footfusion Arthroscopy, 24:106-107. Why does she have heel pain? Aug 14 You may feel pain primarily at the lateral (outside) or medial (inside) point of the ankle joint. Your talus is the main connection between your foot and your leg. 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