Hyaline cartilage has abundant water content, accounting for approximately 75% of the cartilage matrix. Marrow-stimulating techniques, particularly microfracture, have shown good to excellent results in most patients with small (<15 mm) acute lesions, and have a low complication rate. Pritsch14 introduced a three-stage system in 1986 describing the cartilage as intact, soft, or frayed. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Plain radiographs, CT, and MRI are all intended to help with treatment selection and preoperative planning where indicated; however, MRI seems to offer the most useful information and should be performed in most cases. The procedure includes removing graft tissue from the knee joint on the same side as the damaged ankle joint or obtaining it from a tissue donor. Ferkel and colleagues9 developed a classification scheme based on CT describing the osseous component with respect to cystic changes and communication with the joint surface. Much of this bone is covered with cartilage. Lesions can be described using several characteristics, which over time have been delineated by several classification systems. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Fibrocartilage is the natural repair and physiologic alternative. 63, in a meta-analysis on the use of ACI/MACI for the treatment of osteochondral lesions of the talus, analyzed the data for 213 patients who had nearly 3 years of follow-up and a mean lesion size of 2.3 cm 2. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended. The treatment for Osteochondral Defect depends on the size of the defect and whether the overlying cartilage is damaged. Medial lesions tend to be located posteriorly and have been described as cup-shaped, because they are often deeper with a more significant osseous component. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. There are no specific physical examination findings that can accurately assess and diagnose osteochondral lesions of the talus, and plain films are commonly negative. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. Therefore, if painful lesions are assumed to be painful because of instability, these MRI findings are consistent with both. Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. The deepest layer is the calcified cartilage, the beginning of which is called the tidemark, which separates the hyaline cartilage from the underlying subchondral bone. 1��N@Z��4>�n�X�th�i�� ��MZ39�'�m�qٟ`٠?� ��b`fSҌ@�ށ{P��YtD�a@� ߝF� A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. They explain that this sensitizes nerve endings in the subchondral bone plate via alterations in the pH. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. The treatment strategy for osteochondral lesions depends upon the location and lesion size. This finding can be explained by a similar mechanism in which the subchondral plate is fractured and the fluid content of the cartilage is exsanguinated and forced into the subchondral bone with repetitive weight-bearing pressures. This type of injury can be due to a severe ankle sprain that causes bone and cartilage to become loose, resulting in ongoing ankle pain. The extent of surgery is determined by the size of the lesion, the presence of ankle instability and the location of the lesion. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. Osteochondral lesions (OCLs) of the ankle represent a host of pathologies, from subtle chondromalacia to full-thickness defects with underlying cystic changes and osteonecrosis. In their recent work exploring why only some osteochondral defects in the ankle are painful, van Dijk and colleagues5 attribute painful lesions to the repetitive increased fluid pressures. For small sized defects if the overlying cartilage is intact, then retrograde drilling of the defect is done and the space is filled with bone cement. Once violated, degradation and fibrillation become progressive, manifesting as a combination of any of the lesions previously described, depending on local physiology and external stress. A basic knowledge of cartilage anatomy and physiology helps in understanding of the goals, mechanism, and limitations of arthroscopic treatment of OCLs. Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. Box 1 Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Only gold members can continue reading. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. The healthy tissue is transplanted into holes in the ankle joint until it forms a smooth surface. Frequently these lesions are traumatic in origin, most commonly occurring after an acute ankle sprain; however, atraumatic mechanisms have been described. Hyaline cartilage, however, cannot be regenerated once injured. Partial-thickness or full-thickness flaps of cartilage that have separated from the underlying subchondral bone are created through shearing forces and are not amenable to being left alone to repair themselves because of lack of blood supply. Arthroscopic Treatment of Ankle Osteochondral Lesions Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,* a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester… MRI is the best imaging modality to detect evidence of high fluid pressures surrounding lesions, which manifest as high signal intensity around the lesion and bone marrow edema on fat-suppressed images. How is it caused? Fig. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. Once the unhealthy tissue is found, it is removed with a large drill to leave healthy bone underneath. 106,120. The pain is typically difficult to reproduce on examination but can be confirmed with a response to a diagnostic ankle block. Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. When arthroscopy is used, arthroscopic-specific classification systems can be used and have been shown to have prognostic value.13 Several arthroscopic staging systems have been introduced. Osteochondral lesions of the talus are common and difficult problems to treat. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. ➢ Operative treatment should be reserved for patients who have mechanical symptoms following an acute osteochondral lesion of the talus or who are not satisfied with the result after 3 to 6 months of nonoperative treatment. Regardless of the inciting event or baseline pathology, the processes through which these lesions become symptomatic are the same. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. Surgical treatment of talar OLTs includes: Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. Remove the lesion and all non-viable articular cartilage. Fig. Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. “Osteo” means bone and “chondral” refers to cartilage. On T2-weighted images, increased signal intensity can be seen surrounding completely detached lesions, and bone edema may be present. 1), although this is of unknown importance for preoperative planning and prognosis. 2010;18: 238-46 [Google Scholar] Steele JR, Dekker TJ, Federer AE, Liles JL, Adams SB, Easley ME. These features should be noted and may offer clues as to the physiologic process and appropriate treatment (Fig. Foot Ankle Orthop. MRI has gained popularity in its ability to delineate both the cartilage and bone extent of the lesion in addition to associated soft tissue pathology. 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 microtrauma; Epidemiology . Hyaline cartilage, however, cannot be regenerated once injured. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. It helps to move the ankle joint to help determine if there is pain, clicking or limited motion within that joint. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: 1. Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Subchondral cyst formation may have occurred. By doing this, the bone defect is treated without causing any damage to the overlying cartilage. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Log In or, 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), on Treatment of Ankle Osteochondral Lesions, Osteochondral lesions (OCLs) of the ankle represent a host of pathologies, from subtle chondromalacia to full-thickness defects with underlying cystic changes and osteonecrosis. Currently, ankle arthroscopy allows beside direct diagnostic visualization and palpable assessment, as well as simultaneous minimally invasive osteochondral treatment (debridement, drilling, microfracturing, and others). Plain radiographs, CT, and MRI are all intended to help with treatment selection and preoperative planning where indicated; however, MRI seems to offer the most useful information and should be performed in most cases. Arthroscopic Treatment of Ankle Osteochondral Lesions, Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,*, a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA, b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester Road South West G-10, Seattle, WA 98166, USA, c Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics and Podiatric Surgery, Kaiser Permanente, 280 West MacArthur Boulevard, Oakland, CA 94611, USA. Medial lesions tend to be more common and, although often atraumatic in origin, can occur from inversion and plantar flexion ankle injuries. The theory of these nuances led to the development of many of the operative treatments currently used. Native articular cartilage consists of hyaline cartilage. In their landmark paper, Berndt and Harty1 delineated both a classification system and a clarification of the behavior of these injuries, focusing on mechanism and location of the lesion. This finding is not a consistent rule, because OLTs can have variable appearance throughout the talar dome. Treatment of osteochondral lesions of the talus: A systematic review. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). h��X]S��+z�[Ssے,K�ڢ*|���,0�ŃI��gb����{Z�C�@��n�}P,K-���9�%�H8#d�K���pV�oN�� Theoretically, medial lesions with their larger osseous component have a better chance of consolidating with the underlying bone and its blood supply with proper treatment, which may range from immobilization to microfracture or open reduction and internal fixation. To diagnose this injury, podiatrists should question the patient about recent or previous injuries and will examine the foot and ankle. Hyaline cartilage has abundant water content, accounting for approximately 75% of the cartilage matrix.5,6 The matrix also contains fillers such as proteoglycans that aid in resisting compressive forces. Bernt and Harty’s, CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. On T2-weighted images, increased signal intensity can be seen surrounding completely detached lesions, and bone edema may be present. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. For surgical treatment the following types of surgery are in clinical use: debridement and bone marrow stimulation, retrograde drilling, internal fixation, cancellous bone grafting, osteochondral autograft transfer, autologous chondrocyte implantation, and allograft transplantation. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. The pain is typically difficult to reproduce on examination but can be confirmed with a response to a diagnostic ankle block. These studies often assist in preoperative planning. Not what you're looking for? 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Currently used by doing this, the processes through which these lesions are traumatic in origin, commonly! Surrounding completely detached lesions, and limitations of arthroscopic treatment of osteochondral lesions the! Lesions ( OCLs ) of the ankle joint check the lesion, the presence of secondary degenerative..