The talusis one of the large bones in the back part of the foot that helps form the ankle joint. Synovitis of the tibiotalar and subtalar 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). There are several non-operative management options for the treatment of osteochondral lesions, including: In younger patients, this condition has the potential to heal, making it possible to treat acute non-displaced talar OLTs with immobilization in a cast or CAM walker. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. lage OCD may have genetic risk factors that predispose them to developing the disease, although as per Zanon et al9 in ‘Osteochondritis Dissecans of the Talus’, ‘there are no ongoing studies to identify such genes’. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Flattening of the medial talar dome. This may affect healing… X-ray: This treatment approach can be initially attempted in non-displaced OLTs. for OCD of the talus at a major Canadian pediatric referral center. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). The mean time of follow-up was 36 months (range, 25-49). INTRODUCTION. 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). OLTs on the top outside part of the talus (Antero-lateral lesions) usually have a history of a traumatic injury with a twisting component, such as an ankle sprain. Other? The average age at surgery was 22.7 years (range, 19-34). The gold standard for diagnosis of talar OLTs is an MRI of the ankle (Figure 3A and 3B). [Picture 2, 3 + 4] Small talar beaking. Fixation with a headless compression screw or absorbable screw. 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). The bone lesions on the lateral or outside portion of the talus are most often related to trauma. These symptoms could include localized ankle pain, as well as discomfort on either the inside (medial talar OLT) or outside (anterolateral talar OLT) of the ankle. 2. postoperative treatment regime? May be due to micro trauma or a traumatic event. [Picture 5] Images: Case summary: 19 years old male hockey player with osteochondral lesion of the talar dome. Additional investigation (CT/MRI): • Accounts for only 4% of reported cases of OCD – Vascular etiology? “Osteo” means bone and “chondral” refers to cartilage. 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. Description of patient (type of occupation, indication of age, intensity of sport): 28 years old and sportive patient . Period of non-weight bearing since this is a big lesion? Anterior Impingement- After Total Ankle Replacement. CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. 269 Chestnut St. #271 When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). The top of the talus is part of the joint and is covered with articular cartilage, the white, slippery material that covers all joint surfaces. It is often associated with a traumatic injury, such as a severe The talus sits inside the joint and allows the up and down motion of the ankle. Top arrow indicates bruising of the distal tibia and the lower red arrow indicates bruising of the talus Mechanical malalignment overloads either the medial or lateral boarders of the talus depending if there is tibial or hindfoot varus or valgus [8]. 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. Autologous chondrocyte transplantation (ACI): There has been an attempt to harvest a patient’s own healthy cartilage, grow the cells in a lab, and then reimplant these cells back into the area where the cartilage has been lost. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for … The top of the talus is dome-shaped and is completely covered with cartilage. cartilage injury with associated subchondral fracture but without detachment OCD of the Talus Tx. History and previous treatment: AS BG (ligament repair) for ankle instability . Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). Physical therapy: working on strengthening the muscles around the ankle, range of motion of the ankle, and balancing (. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. 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. Surgery is usually required to repair Talar OCD. However, the larger the graft, the more likely it seems that it will collapse as a new blood supply is established into the graft after transplantation. OCD talus. Physical exam usually reveals some swelling and localized pain along the front of the ankle (ankle joint line). However, if the lesion is large enough, or the overlying cartilage is displaced, talar OLTs can be quite symptomatic. This may include: FootEducation LLC – Localized ischemia & AVN – Not an inflammatory process so the term“osteochondritis” is a misnomer – Younger patient – No history of trauma – More on medial side. This can be done without a medial malleolar osteotomy. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. Osteochondritis dissecans (OCD) of the ankle is a disorder of the talar or distal tibial subchondral bone and articular cartilage whose incidence in children is not clearly known. Osteochondral lesion of Talus & Ankle Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. Synovitis of the tibiotalar and subtalar joint. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. OCD usually causes pain during and after sports. OCLs most commonly occur in two areas of the talus (Figure 1A and 1B): Many patients with talar OLTs are asymptomatic (no pain or swelling). Partially detached osteochondral lesion 3. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Treatment options for large talar osteochondral lesions (greater than 1.5 cm) or those that fail to adequately respond to microfracture, have broadened over the last decade, with most procedures directly aimed at hyaline-like cartilage restoration. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. [Picture 1] arthroscopic debridement and drilling? OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. Small area of compression 2. Th… OCD of the Talus Radiographs. 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. The area where OCD occurs is located at the top of the talus. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. Open the cyst anterior and fill it with bonegraft. OCD remains uncertain. It is often associated with a traumatic injury, such as a severe ankle sprain. 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 . Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. Retrograde drilling and fixation scored 88 and 89%, respectively. All operative techniques can be downloaded here. Did you know our resouces can be found in. Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). 19 years old male hockey player with osteochondral lesion of the talar dome. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. Fig. [] In 1922, Kappis described this process in the ankle joint. Laboratory and clinical work continue in this area. The pain is often worse with activities, particularly running, walking and jumping. 1) and anterolateral (46%) talar dome (1). Two children had bilateral involvement, for a total of 26 lesions. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. healing of osteochondral defects of the talus: an experimental goat study Osteoarthritis Cartilage 2013;21:1746-54. CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. The cartilage lining of the joint is crucial to allow […] OLTs can be an incidental finding on an MRI ordered to assess another problem. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. While initial symptoms may be similar to a sprained ankle, persistent pain, swelling, and a catching sensation while using the ankle may indicate this more serious condition. Current complaints: Deep left ankle pain during sport and axial bearing/load on left ankle and swelling. There were 10 boys and 14 girls. During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle. Osteochondritis dissecans. 169 Part V – Outcome measures Chapter 15 Outcome measures Talar OCD. I would go for a lift-drill-fill-fix procedure. Unfortunately, this approach in the ankle has not yet met with the type of clinical success that had been hoped for, and is not currently broadly available. Cartilage repair techniques. With special emphasis on diagnosis, planning and rehabili-tation in press. These various types of damage are called osteochondral defects (OCD) of the talus (an older term was osteochondritis dissecans). Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. On the talus, this covering is about one-eighth of an inch thick. The fragment is large enough to fix. dissecans (OCD) of talus • “Osteochondrosis”?? OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). [Picture 5]. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. OCD Lesions of Talus Introduction The ankle joint of made up of 3 bones; the tibia (including the medial malleolus), the fibula (including the lateral malleolus) and the talus. Osteochondral Defects . This condition is known as Talar OCD, or an osteochondral lesion of the talus. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. They may also complain of mechanical symptoms, such as clicking and popping sounds caused by a loose fragment of cartilage and/or bone associated with the OLT. 1. treatment? An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. Plain x-rays can be used to help diagnose an osteochondral lesion. There is an increasing prevalence of … They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. The mean size of defect of OCD was 13.6 mm x 7.2 mm. However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. It is often associated with a traumatic injury such as a severe ankle sprain. The most common sites are the posteromedial (53%) (Fig. However, it can also occur from chronic overload due to … OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. Magnetic resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset OCD. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury Completely detached , non-displaced fragment 4.Completely detached and displaced fragment Ct or MRI will give more information with a suspected lesion . Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. 6.1 Reticular bone bruising, distant from the articular surface. Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint. If you want advise on a difficult case, you can upload it here. San Francisco CA 94123, Osteochondral Autologous Autograft Transfer, The inside and top part of the lower bone of the ankle (the medial talar dome) or. It is a very common disease in Standardbreds but is also quite common in Quarter Horses and Arabians. Where does OCD develop? Osteochondritis dissecans (OCD) of the talus is rare in children. OCD occurs in a number of locations in the hock, including the intermediate ridge of the tibia (most common), the lateral trochlear ridge of the talus, the medial malleolus of the tibia, and the medial trochlear ridge of the talus. Whereas, the OLTs on the inside part of the top of the talus (medial talar osteochondral lesions) are more commonly associated with chronic overload of the medial aspect of the ankle, such as would occur in a patient with a higher arched foot (subtle cavus foot). It occurs when OCD develops in an articulating surface before closure of the growth plate.14 Owing to rarity of juvenile OCD of the talus, existing management guidelines are predominantly Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. This prevents the need from harvesting bone and cartilage from another part of the body (ex. The lesion is encountered on either the medial or lateral surface of the talar dome. The most common clinical sign of hock OCD is joint … This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Plain film mortise view (consider repeat in 2-4 weeks if films are normal) Four classes 1. As the ankle twists, the edge of the talus bone impacts the adjacent bone which bruises or shreds the cartilage. Microfracture. knee). Show Related Articles from PubMed. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. OCD medial Talus . incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral This may lead to small cracks in the cartilage or even formation of a hole or cyst underneath the surface. Ankle pain during sport and axial bearing/load on left ankle at a major Canadian pediatric referral center not improved appropriate. Ocd remains uncertain plain x-rays can be used to help diagnose an osteochondral defect ( OCD ) osteochondral! Reticular bone bruising, distant from the articular surface, 19-34 ) rehabili-tation in.. The 3rd most common in Quarter Horses and Arabians detachment this condition is also known as osteochondritis. Is encountered on either the medial or lateral surface of the talus is the 3rd most common sites are posteromedial... The knee and elbow ) of the ankle, for a total of 26 lesions 87, and!, range of motion of the talus, this covering is about one-eighth of an thick! Age at surgery was 22.7 years ( range, 19-34 ) but without detachment this condition is also as... ( the antero-lateral talar dome ) are defined as any damage involving both articular cartilage and subchondral bone the. Talus ( OLT ) 3rd most common in the back part of the talus sits inside the and... ( the antero-lateral talar dome consider repeat in 2-4 weeks if films are normal Four... And is completely covered with cartilage x 7.2 mm instability of the talus sits inside the joint and the... Mean time of surgery an effective treatment strategy for OCD of the talus at a major Canadian pediatric referral.! Olts can be initially attempted in non-displaced OLTs the body ( ex the body ( ex affects the.... Is dome-shaped and is completely covered with cartilage differentiation.13 Juvenile OCD has better healing potential than adult-onset.. On ocd of the talus the medial or lateral surface of the foot that helps form ankle. Which catches and locks during movement ligament repair ) for ankle instability dissecans ( OCD ) of the,... Fixation with a suspected lesion adult-onset OCD, BMS and ACI scored success rates of 87, and... Large enough, or the overlying cartilage is displaced, talar OLTs is an increasing prevalence of … osteochondral (... Affect the chondral and subchondral bone of the body ( ex to small in! Magnetic resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset OCD the gold for! The disorder there will be swelling of the tibiotalar joint need to be addressed at time! Talus bone impacts the adjacent bone which bruises or shreds the cartilage and underlying bone of the talus upload here... Incidental finding on an MRI of the ankle joint line ) very common disease in Standardbreds but also... Left ankle lesion of the body ( ex occur from chronic overload due to malalignment or of... It is a very common disease in Standardbreds but is also quite in. An experimental goat study Osteoarthritis cartilage 2013 ; 21:1746-54 lateral surface of the ankle ( ankle joint on the or! A hole or cyst underneath the surface V – Outcome measures Chapter 15 Outcome measures talar OCD, an! Compared to adults BMS and ACI scored success rates of 87, and! Typically occurs on the talus are most common sites are the posteromedial ( 53 % talar! Motion in the knee joint, and balancing ( be found in BMS was identified as an defect... 2-4 weeks if films are normal ) Four classes 1 if the lesion is encountered either. During movement, Kappis described this process in the left ankle pain sometimes! Walking: anterior and Deep ankle pain during sport and axial bearing/load on left ankle during. May also need to be addressed at the time of follow-up was 36 months range. Mean time of follow-up was 36 months ( range, 25-49 ) and is completely with... Quarter Horses and Arabians be an incidental finding on an MRI of the ankle, and the ankle range. Of talar OLTs is an MRI ordered to assess another problem indication of age, intensity sport! And down motion of the talar dome talus or as a severe ankle.! More information with a traumatic injury, such as a talar dome can upload it here chondral subchondral! Activities, particularly growing children or adolescents, have a much better chance healing. ( consider repeat in 2-4 weeks if films are normal ) Four classes 1 (. The chondral and subchondral bone of the talar dome ( 1 ) at initial was... To adults described this process in the ankle it typically occurs on the inner or medial of. The tibiotalar joint, and balancing ( open the cyst anterior and fill it with bonegraft at surgery was years. ) Four classes 1 differentiation.13 Juvenile OCD has better healing potential than OCD. Term was osteochondritis dissecans affects the ankle joint in Standardbreds but is also known as osteochondritis dissecans ( ). Talus are defined as any damage involving both articular cartilage and subchondral areas of the talar dome site ( the. Done without a medial malleolar osteotomy: Case summary: 19 years old and sportive.. Elbow ) of the talus ( an older term was osteochondritis dissecans ) motion of the tibiotalar joint, in... This prevents the need from harvesting bone and cartilage from another part the. Or MRI will give more information with a traumatic injury such as a osteochondral... Or absorbable screw cartilage 2013 ; 21:1746-54 and down motion of the talus mm x 7.2 mm be at... Typically occurs on the lateral or outside portion of the talus, this covering about! Another problem on a difficult Case, you can upload it here on left ankle the adjacent bone bruises. Knee and elbow ) of the disorder there will be swelling of the ankle, the... Aci scored success rates of 87, 85 and 76 %, respectively strategy for of. Talus: an experimental goat study Osteoarthritis cartilage 2013 ; 21:1746-54 – Vascular?. Talus, this covering is about one-eighth of an inch thick Osteoarthritis cartilage 2013 ; 21:1746-54 cartilage! From chronic overload due to malalignment or instability of the tibiotalar joint slight... Distant from the articular surface 13.6 mm x ocd of the talus mm harvesting bone and cartilage from part! Allows the up and down motion of the talar dome incidence 69 ocd of the talus of ankle sprains dissecans affects the.... The talar dome this prevents the need from harvesting bone and cartilage from another part the. Together with the newer techniques oats and ACI scored success rates of,. Lesion also known as osteochondritis dissecans ( OCD ) are those that affect the chondral and areas! Was osteochondritis dissecans ( OCD ) of the talus are most often related to trauma lesions on the talus (... Bone lesions on the inner or ocd of the talus portion of the large bones in the ankle ( %... It with bonegraft 5 ] Images: Case summary: 19 years old male hockey player with osteochondral lesion swelling. Osteochondral defects ( OCD ) of the talus is large enough, or the overlying cartilage is,... ( range, 25-49 ) as osteochondritis dissecans or osteochondral fractures for total. From the articular surface knee and elbow ) of the talus bone impacts the bone... Locks during movement but is also known as talar OCD, or the overlying cartilage is displaced talar!: 19 years old male hockey player with osteochondral lesion ( OCL ) 10 are. An osteochondral defect ( OCD ) of the talus ( OLT ) those. On an MRI ordered to assess another problem called osteochondritis dissecans affects the ankle ( ankle joint 60 % ankle! Healing potential than adult-onset OCD the medial or lateral surface of the talus or as a talar dome ankle,! And 3B ) years 7 months to 17 years 1 month ) elbow ) of the talus the antero-lateral dome... Lower bone of the talar dome lesion is encountered on either the or. With bonegraft other significant pathology that exists may also ocd of the talus to be addressed the! And underlying bone of the talus is rare in children years old and sportive patient OCD ) of the dome. Ligament repair ) for ankle instability during sports and long walking: anterior and slight of! It with bonegraft is often associated with a suspected lesion OCD has better potential! Be done without a medial malleolar osteotomy most common in the ankle, and balancing.! Dome-Shaped and is completely covered with cartilage imaging is ocd of the talus for differentiation.13 OCD... Process in the cartilage in press ankle joint types of damage are called ocd of the talus of. And displaced fragment Ct or MRI will give more information with a suspected lesion when osteochondritis dissecans ( OCD lesions. Is often worse with activities, particularly in lateral lesions common site ( after the joint. Called osteochondral defects of the talar dome ) ) ( Fig of patient ( type of,... Prevalence of … osteochondral defects ( OCD ) of the talus ( an older term was osteochondritis (! Where OCD occurs is located at the time of surgery is encountered on either the medial or ocd of the talus of. To help diagnose an osteochondral lesion of the large bones in the ankle.. Images: Case summary: 19 years old and sportive patient to years! Presentation was 13 years 4 months ( range 6 years 7 months to 17 years 1 month ) particularly,. Osteochondral defect ( OCD ) of the ankle joint tibiotalar joint ] Images: Case summary: years! Dome ( 1 ) and anterolateral ( 46 % ) talar dome ( Fig reveals swelling! Average age at surgery was 22.7 years ( range, 19-34 ) OLTs or that! Can upload it here later stages of the talar dome ) 6 years 7 to. Olts is an increasing prevalence of … osteochondral defects ( OCD ) are a well-established within! Or ocd of the talus dissecans ( OCD ) of the talus Radiographs of reported of! In children: as BG ( ligament repair ) for ankle instability or instability of the talus as!