Fig. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). It is then matched to the surface area of the defect and impacted into place. Editors: van Dijk, C. Niek, Kennedy, John G. Manage pain 3. When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. In patients with an isolated ligamentous ankle injury, these symptoms usually resolve after functional treatment within 2–3 weeks. Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. Overall, more than 80% of the talus OCLs are of traumatic origin. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. During loading, compressed cartilage … Osteochondral Defects in the articular cartilage can result from trauma, arthritic conditions, chronic wear and tear. Tol et al. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. These data may have implications toward OLT size thresholds for surgical decision making in symptomatic lesions (ie, primary osteochondral transplantation procedure vs curettage and debridement). 3-A) and heel-rise (Fig. The experts opinion can be of interest for other physicians who meet similar problems. Osteochondral defects and loose bodies are common causes of mechanical symptoms in the ankle. 3-C). [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. 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. 31. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for. Joint preservation is challenging in cases with large osteochondral defects (OCDs) of the tibia plafond after trauma or septic arthritis of the ankle joint (1,2), and it is particularly necessary among young individuals or athletes.Several treatment strategies—namely, arthrodesis, osteochondral allograft, and total ankle replacement (TAR)—have been described for large OCDs of the ankle (). Because of excessive overlying fibrous tissue and synovium, the defect cannot be adequately visualized. Osteochondral defects . If the fragment has come loose, it can also cause locking or instability symptoms. During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). Definition. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. 1, in a review of >580 osteochondral defects … Clinical Relevance: The location of peak stress in the ankle joint becomes closer to the rim of the defect in OLTs at a threshold of 10 mm and greater in diameter. How is it caused? We prefer to use the broader term osteochondral lesion to define a lesion of any origin … What causes it? The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. 3-B) views; the defect cannot be detected on the lateral view (Fig. With disease progression, the fragment may detach, leading to degenerative osteoarthritis . Non-operative measures such as mobilisation, a heel lift and steroid injections are reasonable non-operative techniques to try before surgical referral, but pain from mechanical symptoms is often resistant to non-operative measures. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). An osteochondral defect (OCD) of the ankle joint can lead to localised pain, swelling and stiffness in the ankle with difficulty weight bearing and mobilising. (Eds.) OCDs usually develop after an inversion or high impact injury to the ankle, leading to a portion of the cartilage to be injured. This allows us to treat the bone defect without affecting the cartilage. Osteochondral defects in the ankle: why painful? The ankle is plantarflexed to visualize the osteochondral defect (OCD). In acute conditions, symptoms of osteochondral ankle defects are similar to those of acute ankle injuries. Talar Osteochondral Defects Diagnosis, Planning, Treatment, and Rehabilitation. Therefore a small anteromedial synovectomy is done using a 5.5 mm bonecutter shaver with the ankle in the dorsiflexed position. The condition typically affects just one joint, however, some children can develop OCD in several joints. Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. Healthy cartilage tissue -- a graft -- is taken from an area of the bone that does not carry weight (non-weightbearing). problems after ankle fracture. Immobilization of the ankle, medications, steroid injections and physical therapy are commonly tried but this often fails to relieve symptoms and surgery may be required. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. In osteochondral autograft transplantation, cartilage is transferred from one part of the joint to another. The ankle joint has a high congruency. It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Osteochondral lesion (OCL) describes an injury to the articular cartilage surface of bone within a joint. A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. Keywords Osteochondral defect Cartilage Ankle joint Subchondral cyst Natural history Pain Introduction An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 46, 47, 50]. The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect … 6 The cause of OCLs of the talus has multiple facets. Osteochondral defect or Cyst. Talar dome lesions are usually caused by an injury, such as an ankle sprain. Knee Surg. They include lateral or medial ankle pain, functio laesa and swelling. The broad term “osteochondral lesion of the talus” describes an injury or abnormality of the talar articular cartilage and adjacent bone.1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an … Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities World J Orthop. “Osteo” means bone and “chondral” refers to cartilage. Control post operative pain/swelling Treatment: - Patient to be progressed to PWB (up to 30% body weight) if a small lesion (per MD’s recommendations). It is often associated with a traumatic injury such as a severe ankle sprain. Begin Range of Motion 4. “Osteo” means bone and “chondral” refers to cartilage. However, it can be subdivided into a traumatic and nontraumatic cause. It may result in a defect that subsequently affects the subchondral bone and, in severe cases, may lead to formation of an osteochondral fragment. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. 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