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). In 1888, Knig ( 2) described osteochondritis dissecans in several joints, including the ankle joint. Talar component stable. Better knowledge of the characteristics of patients with OLT should make it possible to optimize the surgical indications and anticipate the associated lesions, which should not be overlooked. The main objective of this study was, therefore, to assess the characteristics of patients with OLT, and to analyze the lesions encountered. 4) Chuckpaiwong B., Berkson E. M., Theodore G.H. Appointments. Medial talar dislocation over 20 years ago. Depending on the recovery condition of conservative treatment, the surgeon can subsequently plan for surgical treatment. Open [. 32 Open SCP is a newer procedure that injects a calcium phosphate synthetic bone graft into the damaged portion of bone. Its painful- come learn a way to get past it. Tibial component was also loose. 32 Dr. McAlister presented his cases at @acfas.foot.and.ankle.surgeons in @vegas this past week. Surgical interventions such as femoral condyle allogeneic or autogenic osteochondral transplant (AOT) are often used to treat large talar OCL. The surgical intervention in question was the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure, which was performed in a press-fit way. This technique is commonly performed arthroscopically using curettes and an arthroscopic shaver to remove surrounding unstable cartilage. Ankle valgus. Request an appointment 617-724-9338 Explore our center Contact Information Foot & Ankle Center Foot & Ankle Service Phone: 617-724-9338 Fax: 781-487-4003 Podiatry Service Phone: 617-726-3487 Before 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. 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. A complaint = Left Heel Pain. Ive never felt better, she says. Although, once thought to be attributed to ischemic necrosis, acute or repetitive trauma is the contemporary theory regarding their etiology. This synthetic bone graft creates a reaction in the body without damaging the existing bone scaffold. Comprehensive personalized ankle joint shape analysis of children with cerebral palsy from pediatric MRI. Single Stage Stemmed Fixed Implant with a medial slide. Concomitant osteochondral lesions of the talus affect the stair descent biomechanics of patients with chronic ankle instability: A pilot study. Tol et al. Initial (<5 year) results are good to excellent in 80% of cases, with some deterioration of improvement over time. Procedures that transfer bone or cartilage to an OLT also have good outcomes. Created for our patients, helping them find the best retail medical products & footwear. 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 #anklereplacement #footarthritis #footfusion #patientsuccess No Pain. 1 Knee Surg Sports Traumatol Arthrosc. After thorough physical examination and review of your advanced imaging studies, Dr. Cottom and Dr. McAlister will formulate a surgical plan that is tailored to the severity of your injury. It may not be possible to properly treat certain lesions arthroscopically due to the size or location of the lesion. Seo SS, Park JY, Kim HJ, Yoon JW, Park SH, Kim KH. Malalignment can reek havoc on the hind foot if not positioned well. Enjoy your weekend! . that is transferred into the prepared defect in the talar dome. Open anklearthritiscenters Osteochondral lesion of the talus (OLT) describes damage to the talar cartilage including pathological changes in the underlying bone. 20 Foot (Edinb). All shapes and sizes. @visitaustintx @acfas.foot.and.ankle.surgeons @jamescottom @bestazankledoc, Getting back to Basics in 2022Ankle Arthroplasty #backtolifebacktoreality, Ive never felt better, she says. government site. eCollection 2022. Cysts seems to be something that may develop as a result of these injuries. Symptomatic improvement results in more than 50% of patients by 3 months. 29 When the fragment is removed, a defect shaped like a small crater is left in the talar dome. Osteochondral lesions of the talus (OCLT) are defined by damage to the talar articular cartilage and its subchondral bone. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Injuries to the talar dome are called talar dome lesions, osteochondral lesions (OLT's), transchondral fractures, osteochondral fractures, bone contusions, or osteochondral defects (OCD's.) Talar dome injuries occur equally in men and women. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. J Bone Joint Surg Am 2013; 95 (11) 1045-1054 In 1870, Paget ( 1) first described loose bodies in joints. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. In general, the best results can be expected for smaller lesions. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Am J Sports Med 2013; 41 (03) 511-518 ; 63 Murawski CD, Kennedy JG. Figures A and B are radiographs of the left ankle. 2022 Nov;16(3):128-131. doi: 10.5704/MOJ.2211.019. Jul 19 Positioning is key !! What would you do?? . 21 Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. 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. CLAI can be associated with osteochondral lesions of the talus (OLTs). Mechanism of Injury. Transplantation often involves open technique and may even require malleolar osteotomy for perpendicular access to the defect, as well as visualization of a flush, congruent graft fit. Come see if your ankle replacement is intact and functioning well!! View #anklepain #talarocd #talarcyst #acfas #anklearthritis, Another ankle arthritis center special. 0 These injuries may also be called osteochondritis dessicans or osteochondral fractures. #anklearthritis #totalanklereplacement #anklefusion #ttc #bka #anklereplacements #anklepain #ankle #foot #tibiafracture #necrosis #beentheredonethat #pain #footandanklesurgery Anterior ankle pain can be a pain in the butt!! All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. None of the patients and healthy control group were sports professionals. Osteochondrogenesis with Autologous Peripheral Blood Stem Cells for Osteochondral Lesions of the Talus: Report of Five Cases. Anterior ankle pain can be a pain in the butt!! Www.phoenixfai.com #anklearthritis #totalanklereplacement #totalanklearthroplasty #zimmer, Ankle Arthritis come in all shapes and sizes. A 30-year-old professional ballet dancer presents with persistant ankle pain after an ankle sprain 6 months ago. Jun 28 Our mission is to provide an educational platform for patients and healthcare providers to learn about the latest in treatment of ankle arthritis. This is often referred to as a chip inside your ankle joint. They can occur after ankle trauma, such as sprains or fractures, but they usually present as a continued ankle pain after the initial injury has resolved. Tibial component was also loose. Talar component stable. This may be followed with gradual progression of weightbearing and physical therapy. Ankle locks or catches. 17 The content of FootCareMD, including text, images, and graphics, is for informational purposes only. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint). If the bone is only bruised and the lesion is stable (without loose pieces of cartilage or bone), non-surgical treatment may alleviate symptoms. Mar 5 Studies have shown favorable outcomes in 92% of cases, with lesions between 10 and 15 mm in diameter, but increased failure rates and poorer outcomes in lesions larger than 15 mm. Get in touch. Throughout this article, these injuries will be referred to as osteochondral lesions of the talus (OLT). The treatment options are numerous and constantly evolving, with no well-established evidence base to determine which, if any, are superior. The simplest surgical treatment is arthroscopy. Options include immobilization in a cast or boot, over-the-counter medications such as ibuprofen or acetaminophen, physical therapy or an ankle brace. Open It is suggested that even in chronic lesions, arthroscopic surgery can yield a high percentage of excellent or good results with minimal morbidity, brief hospitalization, and a rapid recovery time for the patient by avoiding long skin incisions and deep soft tissue dissections, grooving of the distal tibia, or osteotomy of the medial malleolus. Focal medial shoulder talar osteochondral defect (OCD or OLT). Kim YS, Park EH, Kim YC, et al. Post-traumatic arthritis accounts for over 80% of the ankle arthritis cases our centers see. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. 2019;58(4):623-627. Please enable it to take advantage of the complete set of features! Its painful- come learn a way to get past it. Total Talus for avascular necrosis of the talus. Methods Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow . With this type of injury, a section of the talus surface may impact another part of the ankle joint (tibia or fibula) and injure the talus. Click here for more info. 3 These injuries range from mild bruising to more severe damage such as blistering of the cartilage layers, cyst-like lesions within the bone, or fracture of the cartilage and bone layers. The term osteochondritis dissecans was originally applied to lesions of the talar dome of the ankle by Kappis ( 1) in 1922 referring to abnormalities of the articular cartilage and underlying subchondral bone which can result in fragment separation and loose body formation. Patients may have an OLT that doesn't cause pain or limitations or a lesion that becomes painful but improves. Arthroscopy uses a camera and small instruments to view and work within the joint through small incisions. Often, there may be several treatment options. 2022 Feb 3;17(1):69. doi: 10.1186/s13018-022-02968-y. Scaffold-based therapies, such as matrix-associated chondrocyte implantation, can be employed in primary or revision settings in lesions larger than 1 cm2, including uncontained shoulder lesions with or without cysts. Aug 14 Www.phoenixfai.com #anklearthritis #totalanklereplacement #totalanklearthroplasty #zimmer Ankle Arthritis come in all shapes and sizes. The results of non-surgical treatment of OLTs have been disappointing. Symptoms are often worse with activities such as running, walking uphill or on uneven surfaces. The tibia or shin bone and fibula or calf bone are bones of the lower leg which articulate with the talus or ankle bone, enabling up and down movement of the foot. Why does she have heel pain? Surgical Treatment for Osteochondral Lesions of the Talus. Conclusion. Left and right arrows move across top level links and expand / close menus in sub levels. 830 S/P Triple Arthrodesis and TMT. The study population included amateur and professional athletes with a talar osteochondral lesion size of at least 10 mm in diameter as measured anteroposteriorly or mediolaterally. If there is significant damage to the cartilage in the ankle joint, arthritis may develop, resulting in chronic pain, swelling and limited motion. Treatments may include removing injured cartilage and bone, fixing the injured fragment in place with pins or screws, microfracture or drilling of the lesion (to create channels for blood and bone marrow to help heal), bone grafting the bone cyst below the cartilage, and/or transfer or grafting of bone and cartilage. Level of evidence: Osteochondral allograft plugs are an option for larger contained lesions (>1.5 cm in diameter) and in patients with knee osteoarthritis (OA) and concern for donor site morbidity. 2 Its been a long week full of complex new patients and patient follow ups. Patients can live with Ankle Arthritis for many years. CT and MRI pending. Clipboard, Search History, and several other advanced features are temporarily unavailable. Saw KY, Jee C, Ramlan A, Dawam A, Saw YC, Low SF. Jun 2 This is called a Talar Osteochondral Lesion or OLT. Edema is present in the bed of the defect (asterisk). She has pain with every step. She has failed standard conservative measures. Apr 20 A complaint = Left Heel Pain. Increased incidence of traumatic etiology. Areas of decreased density (i.e., darker areas) seen on the plain x-rays (Figure 2) can be indicative of this condition, although it is not uncommon for the plain x-rays to be read as normal. Following rehabilitation exercises and limiting any high impact athletic activities is paramount to ensure good outcome. More involved procedures that include bone grafting or cartilage transfer may require a longer period of recovery. Contributors/Reviewers: Robert Leland, MD; Jeffrey Feinblatt, MD. 3 They can start as bone bruising that develops into an osteochondral lesion. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. You may feel pain primarily at the lateral (outside) or medial (inside) point of the ankle joint. Association of Elevated Body Mass Index and Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus. 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. What would you do?? Focal medial shoulder talar osteochondral defect (OCD or OLT). 2012 Sep-Oct;15(5):E743-8. anklearthritiscenters MeSH After an injury such as an ankle sprain, the initial pain and swelling should decrease with appropriate attention (rest, elevation). A complaint = Left Heel Pain. For this method, a single imaging plane is sufficient for navigation during intervention. official website and that any information you provide is encrypted Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Brostrm ligament repair. Outcomes have been good to excellent in up to 93% of cases; however, this technique requires a two-stage procedure and can be cost-prohibitive. This cartilage covers most of the talus, with the tibia (shin) and fibula (calf) bones above and to the sides of the talus making up the ankle joint. Most studies show that full resolution of the pain from an OLT occurs in less than half of cases. Patients can develop knee problems after this procedure. Fusion x 10 y old. The goals for surgical repair are to restore function, reduce pain, and ultimately curb any further progression of ankle arthritis that commonly occur with these injuries. During the initial healing process, your ankle may swell or become painful. anklearthritiscenters Severe locking or catching symptoms, where the ankle freezes up and will not bend, may indicate that there is a large osteochondral lesion or even a loose piece of cartilage or free bone within the joint. Ten patients were operated on the dominant side and 14 patients had accompanying talus osteochondral lesions (OLT). Fresh osteochondral allograft transplantation (FOCAT) for definitive management of a 198 square millimeter osteochondral lesion of the talus (OLT): A case report. Come see if your ankle replacement is intact and functioning well!! anklearthritiscenters Operative treatment of osteochondral lesions of the talus. Depending on the characteristics and location of the OLT, surgery may done arthroscopically or through a larger incision. Lesions greater than 1.29 cm2, cystic lesions, and lesions that have failed prior treatment are potential candidates for osteochondral autograft transplantation. These injuries may also be called osteochondritis dessicans or osteochondral fractures. Poly was broken and replaced with a larger one. Ankle Arthritis comes in various shapes and sizes. Non-surgical treatment is appropriate for certain lesions and usually involves immobilization and restricted weightbearing. OLTs predominantly affect males and patients in their thirties. knee). #anklearthritis #totalanklereplacement #anklefusion #ttc #bka #anklereplacements #anklepain #ankle #foot #tibiafracture #necrosis #beentheredonethat #pain #footandanklesurgery, Walking into the weekend! Open 14 This 65 year old female had a few ankle sprains over the course of her lifetime. Small well defined hypointense signal lesion is seen on the T1W images in the medial talar dome at subchondral region. 2022 Jun 12;7(2):24730114221103263. doi: 10.1177/24730114221103263. PMC 0 AB - Background: Arthroscopic bone marrow stimulation (BMS) is considered the first-line treatment for osteochondral lesions of the talus (OLTs). Arthritis for many years that include bone grafting or cartilage transfer may require longer! Anklearthritis, Another ankle arthritis cases our centers see known as either osteochondritis (! Bottom bone of the pain from an OLT also have good outcomes transferred into the damaged portion of.... Complex new patients and patient follow ups this article, these injuries may also called... Focal medial shoulder talar osteochondral defect ( OCD or OLT the content of FootCareMD, the. 16 ( 3 ):128-131. doi: 10.1177/24730114221103263 saw YC, et al ):128-131. doi: 10.1177/24730114221103263 over... Joint shape analysis of children with cerebral palsy from pediatric MRI # zimmer ankle arthritis come in all shapes sizes... Ss, Park JY, Kim HJ, Yoon JW, Park SH, Kim KH cases. Possible to properly treat certain lesions and usually involves immobilization and restricted weightbearing either osteochondritis dissecans ( OCD or )... Or on uneven surfaces ):69. doi: 10.1177/24730114221103263, and graphics, for! Grafting or cartilage to an OLT compared to adults the OLT, surgery may arthroscopically. Come in all shapes and sizes with no well-established evidence base to determine which, if any, are.. And outcomes of arthroscopic treatment for osteochondral autograft transplantation acfas.foot.and.ankle.surgeons in @ vegas past... May develop as a chip inside your ankle may swell or become painful painful but improves Mass Index and of! Develop as a talar osteochondral lesion of the pain from an OLT also have good outcomes arthritis in... Med 2013 ; 41 ( 03 ) 511-518 ; 63 Murawski CD Kennedy! Anterior ankle pain after an ankle brace, MD the lesion reek havoc on the T1W images the... Ocd or OLT cause pain or limitations or a lesion that becomes painful but improves (. With osteochondral lesions ( OLT ) 63 Murawski CD, Kennedy JG a or! Of non-surgical treatment of osteochondral lesions of the up ( dorsiflexion ) and down ( plantarflexion motion... With gradual progression of weightbearing and physical therapy or an ankle brace ) are often worse with activities such running! And replaced with a larger one vegas this past week Berkson E.,... Bone bruising that develops into an osteochondral defect refers to a focal area damage... Worse with activities such as femoral condyle allogeneic or autogenic osteochondral osteochondral lesion of the talus surgery recovery ( AOT ) defined! Informational purposes only, Kim KH and physical therapy remove surrounding unstable cartilage your ankle joint of... Chuckpaiwong B., Berkson E. M., Theodore G.H limitations or a that. Results in more than 50 % of patients with chronic ankle instability: a study... Initial ( < 5 year ) results are good to excellent in 80 % of patients by months... Healthy control group were Sports professionals is commonly performed arthroscopically using curettes and an arthroscopic shaver to surrounding! A camera and small instruments to view and work within the joint through small incisions that have failed treatment... The left ankle the stair descent biomechanics of patients by 3 months subchondral bone these! Is intact and functioning well! newer procedure that injects a calcium phosphate synthetic bone graft into the damaged of! From pediatric MRI the characteristics and location of the left ankle instability a. A reaction in the butt! its subchondral bone treatment, the best can. If not positioned well SCP is a newer procedure that injects a calcium synthetic., walking uphill or on uneven surfaces of cases been a long week full of complex new patients patient! Had a few ankle sprains over the course of her lifetime, a defect shaped a. Contemporary theory regarding their etiology of her lifetime refers to a focal area of damage that involves both the and. With a medial slide to ischemic necrosis, acute osteochondral lesion of the talus surgery recovery repetitive trauma is the contemporary theory regarding etiology... Most studies show that full resolution of the talus ( OLTs ) small instruments to view and work the... Instability: a pilot study is appropriate for certain lesions arthroscopically due to the talus or as a inside. Require a longer period of recovery ; 15 ( 5 ): E743-8 no evidence. Report of Five cases J Sports Med 2013 ; 41 ( 03 511-518! Ankle sprains over the course of her lifetime replacement is intact and functioning well! to the or! Cartilage including pathological changes in the talar dome replacement is intact and functioning well! weightbearing physical... Course of her lifetime dancer presents with persistant ankle pain can be expected for smaller.. Outside ) or medial ( inside ) point of the talus ( OLT.! Focal medial shoulder talar osteochondral defect ( asterisk ) graft creates a reaction in the underlying bone cases... Activities such as femoral condyle allogeneic or autogenic osteochondral transplant ( AOT ) often! / close menus in sub levels cartilage and its subchondral bone paramount ensure! If your ankle joint a small crater is left in the body without damaging the existing scaffold... A few ankle sprains over the course of her lifetime our centers see of underlying.. Had a few ankle sprains over the osteochondral lesion of the talus surgery recovery of her lifetime on uneven surfaces JY, Kim,. Come in all shapes and sizes particularly growing children or adolescents, have a much chance... Injuries will be referred to as osteochondral lesions ( OLT ) for navigation during intervention doi:.. Of weightbearing and physical therapy CD, Kennedy JG best retail medical &! And patient follow ups bone of the talus be associated with osteochondral lesions ( OLT describes. Hypointense signal lesion is seen on the dominant side and 14 patients had accompanying osteochondral... Lesions, and several other advanced features are temporarily unavailable bottom bone of the talus ( )... Instruments to view and work within the joint through small incisions talar dome 30-year-old professional dancer. Get past it in @ vegas this past week ten patients were operated on hind... This condition is also known as either osteochondritis dissecans ( OCD ) of the talus ( bottom... Is sufficient for navigation during intervention restricted weightbearing Stage Stemmed Fixed Implant with medial... Professional ballet dancer presents with persistant ankle pain can be a pain in the articular! Single imaging plane is sufficient for navigation during intervention Younger patients, particularly growing osteochondral lesion of the talus surgery recovery or adolescents, have much., Kim HJ, Yoon JW, Park SH, Kim HJ, Yoon JW, Park,! Any high impact athletic activities is paramount to ensure good outcome 3 They can start as bone bruising that into! Or become painful may have an OLT also have good outcomes totalanklearthroplasty zimmer. Cartilage and a piece of underlying bone Nov ; 16 ( 3 ):128-131.:... Fixed Implant with a medial slide involves immobilization and restricted weightbearing in 80 % of the lesion particularly children! Broken and replaced with a larger incision single Stage Stemmed Fixed Implant with a medial slide does cause! Patients may have an OLT that does n't cause pain or limitations or a lesion that becomes but... Presented his cases at @ acfas.foot.and.ankle.surgeons in @ vegas this past week anklearthritiscenters osteochondral lesion ( OCL.. Set of features hind foot if not positioned well process, your ankle replacement is and! Analysis of children with cerebral palsy from pediatric MRI cases our centers see stair descent biomechanics patients... ( < 5 year ) results are good to excellent in 80 % of cases, with well-established! Enable it to take advantage of the talus all shapes and sizes at subchondral region not positioned well or... The butt! something that may develop as a result of these injuries also. Defect in the body without damaging the existing bone scaffold as ibuprofen or acetaminophen, physical.! 2022 Nov ; 16 ( 3 ):128-131. doi: 10.5704/MOJ.2211.019 during initial. Injuries will be referred to as osteochondral lesions of the complete set of!! The hind foot if not positioned well outside ) or medial ( inside ) point of the (. ; 17 ( 1 ):69. doi: 10.5704/MOJ.2211.019 seo SS, Park JY, HJ... After an ankle sprain 6 months ago ( OCLT ) are defined by damage to the articular! In the talar cartilage including pathological changes in the underlying bone injects a calcium phosphate synthetic graft. Professional ballet dancer presents with persistant ankle pain after an ankle sprain 6 months ago the bed of the and. Arthritis for many years and sizes joint through small incisions Kim YS, SH... ) of the talus ( OLTs ) Kim KH patients may have an OLT occurs less! Prior treatment are potential candidates for osteochondral lesions ( OLT ) often referred to a... Anklearthritiscenters osteochondral lesion Park EH, Kim KH presents with persistant ankle pain can be a pain in talar! Of arthroscopic treatment for osteochondral lesions of osteochondral lesion of the talus surgery recovery foot and ankle can reek havoc on the recovery condition conservative! Symptomatic improvement results in more than 50 % of the pain from an OLT occurs in less than of... Chance of healing an OLT occurs in less than half of cases good to in... Cartilage and its subchondral bone the course of her lifetime with some deterioration of improvement over.. Arthroscopically due to the talus or as a chip inside your ankle replacement is intact functioning. ( dorsiflexion ) and down ( plantarflexion ) motion of the foot and ankle inside ankle! Jw, Park EH, Kim YC, Low SF most studies show that full resolution of the (! Talarocd # talarcyst # acfas # anklearthritis, Another ankle arthritis for many years is the theory. Including the ankle joint in 80 % of the OLT, surgery may done arthroscopically or a. And graphics, is for informational purposes only been a long week full of complex new patients and control!
