Swelling is commonly found in acute injuries, although it may be absent in chronic cases especially with medial lesions. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Talar dome lesions are most common, while talar head lesions are relatively rare. CT staging again mimics the plain radiographic and MRI evaluations and also incorporates evaluation of the cystic component (. Allograft (AlloSource®, Centennial, CO) to repair the defect in 2015. Please call our office at 972-274-5708 to schedule an appointment. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. An osteochondral lesion of the talar dome typically occurs during a traumatic injury to the ankle, such as an ankle sprain (particularly involving significant weight bearing forces), a traumatic landing from a height (particularly involving forced end of range ankle movements) or a motor vehicle accident. Talar dome lesions are usually caused by an injury, such as an ankle sprain. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Depending on the type of injury, the leg may be placed in a … Robinson DE, Winson IG, Harries WJ, Kelly AJ. Excision of the loose fragment with treatment of the base by curettage, abrasion, or microfracture has been the most commonly recommended treatment for these lesions. Patients frequently present with an acute injury and positive radiographic findings. Treatment depends on the severity of the talar dome lesion. MRI is sensitive in detecting osteochondral lesions of the talar dome and may also aid in the evaluation of other soft tissue and bony entities on the differential diagnosis. If the lesion doesn’t heal correctly, the cartilage can break down, and sometimes, a fragment of cartilage can break away and “float” nearby. The only exception is in the case of a loose talar dome lesion, which will present on radiographs with a fleck of cartilage and bone loose or floating in the joint. Systematic review of treatment strategies for osteochondral defects of the talar dome. What is a Talar Dome Lesion? Medial lesions tend to be deeper and cup shaped. A patient with an osteochondral lesion of the talar dome will most commonly present with a chief complaint of ankle pain, sometimes poorly localized and nonspecific. OCD lesions of the elbow are typically found in athletes in the teen years after the physis has closed. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … HOW TO TELL IF YOU HAVE A STRESS FRACTURE? The decision for arthroscopic intralesional curettage was only done when the cyst diameter was 10 mm or more in the preoperative CT scan. Because the history and physical examination findings are often nonspecific and the differential diagnosis includes multiple other entities such as tendonitis, instability, impingement lesions, neurological causes such as neuroma or tarsal tunnel syndrome, subtalar symptoms including os trigonum, a careful physical examination must be performed to assess these possibilities. We just can’t do anything to load that part of the cartilage in isolation to confirm the diagnosis. Talar dome lesions usually occur from an injury, such as an ankle sprain. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended. Anterolateral lesions on the talar dome result from inversion and dorsiflexion forces, which cause the anterolateral aspect of the talar dome to impact the fibula. Clinical testing by a health professional is unable to detect talar dome lesions. Physiotherapy treatment is vital for all patients with an osteochondral lesion of the talar dome to maximise the healing process, ensuring an optimal outcome and to reduce the likelihood of recurrence. Autologous cartilage was then reimplanted arthroscopically. Surgical approaches include simple excision; excision with curettage; and excision, curettage, and drilling. The surgical technique allows preservation of intact articular cartilage, in contrast to traditional methods. Background: The treatment options of talar osteochondral lesions are numerous. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. To diagnose this injury, the foot and ankle surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking, or limitation of motion within that joint. The staging system proposed by Berndt and Harty (, In the absence of a discrete lesion on plain radiograph, MRI examination is the most appropriate follow-up examination for patients with persistent symptoms despite a period of nonoperative management. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. In addition, the mortise view may be obtained in plantar flexion to better assess a posteromedial lesion or in dorsiflexion to assess an anterolateral lesion. Treatment of Osteochondral Lesions of the Talar Dome Although osteochondral lesions can occur over any portion of the talar dome or the tibia, the talar lesions typically... Medial lesions tend to be deeper and cup shaped. His initial observation was that they were loose osteocartilaginous bodies that … The surgeon will select the best procedure based on the specific case. Procedure selection is generally based on lesion size, location on the talar dome and/or a history of prior failed surgical management. Foot Ankle Clin. 6 However, … There is a slight male predominance in incidence of injury, In the absence of a discrete lesion on plain radiograph, MRI examination is the most appropriate follow-up examination for patients with persistent symptoms despite a period of nonoperative management. Baker CL, Andrews JR, Ryan JB. These incidents can be a singular, acute macrotraumatic incident, or a repet-itive, cumulative microtrauma-induced event. Nonoperative treatment for acute, nondisplaced osteochondral lesions of the talus and cystic lesions has been associated with successful clinical results in about 50% of cases 5, 24, 25. Smaller diameter cysts would not accommodate the arthroscopic tools. Treatment depends on the severity of the talar dome lesion. These lesions are usually shallower and more wafer-shaped than medial lesions, possibly because of a more tangential force vector that results in shearing-type forces. Treatment depends on the severity of the talar dome lesion. Conservative Treatment: The treatment of a talar dome fracture is often delayed due to late diagnosis. Treatment depends on the severity of the talar dome lesion. 62(4):646-52. . They require a strong plan. Talar dome lesions do occur with no history of trauma. Although studies show these treatments have been used with varying success, the ability to return to activity (RTA), including sports after treatment of talar dome injurie s, have not been well documented. A varietyof surgical techniques is available to accomplish this. ; ... Osteochondral lesions can occur in the talar head, body, and dome. Tenderness localized to the joint line may be noted in the plantar flexed ankle laterally in the case of an anterolateral talar dome lesion and posteromedially in the dorsiflexed ankle in the case of a posteromedial lesion. Credit for originally describing OLTs of the ankle is given to Alexander Monro, 1 in his description in 1738. Internal fixation is usually only appropriate for acute anterolateral lesions with a bone base which is sufficient to support internal fixation with pins or screws. suggested internal fixation of the lesion if it is larger than one third of the size of talar dome while Stone et al. [ Links ] 35. In the acute setting of ankle sprain, patients protect the ankle with either a boot or brace. Patients tend to present with more chronic symptoms of ankle pain, rather than acute injury. Either lesion may be associated with clinical evidence of joint laxity, so the examiner should compare the effected joint to the normal joint and check for evidence of anterior or lateral laxity. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article 12). Talar dome lesions generally involve either the superomedial or superolateral corners of the talus. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment 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. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. 1999;15(1)77-84. 2, No. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Depending on the amount of damage to the cartilage in the ankle joint, arthritis may develop in the joint, resulting in chronic pain, swelling and limited joint motion. • Cystic lesion within dome of talus with an intact roof on all view: Stage 2a • Cystic lesion communication to talar dome surface: Stage 2b • Open articular surface lesion with the overlying nondisplaced fragment. These lesions are often suspected after 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint. Treatment depends on the severity of the talar dome lesion. 1. soft tissue massage 2. Treatment of Osteochondral Lesions of the Talar Dome. in 1984 emphasized that these lesions should not be called as osteochondritis dissecans but be grouped under a broader term “osteochondral lesions of the talar dome.” The arthroscopic treatment of these lesions was first described by Parisien and Pritsch et al. A variety of surgical techniques is available to accomplish this. Treatment depends on the severity of the talar dome lesion. bone graft may be placed if underlying cyst and bone loss. An osteochondral defect, also known as a Talar dome lesion, is a spot where the cartilage has been damaged or worn through. Treatment of osteochondral lesions of the talus: a systematic review. 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: • Immobilization. To avoid damage to healthy cartilage and malleolar bone by antegrade drilling techniques, some physicians prefer to use a retrograde transtalar technique (8,11). Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Kouvalchouk et al. The medial lesions tend to be deeper and cup shaped whereas the lateral lesions tend to be thinner and more wafer shaped (, Most studies have suggested that the lesions are traumatic in nature. They are found to have an osteochondral lesion on plain radiograph or magnetic resonance imaging (MRI) of the ankle. Arthroscopy, Vol. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. 1980. It was determined that the midmedial zone was the most common location (53%). We have reviewed charts and radiographs in 13 cases of OCL in children, examined at follow-up as adults. These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). Assessment of Treatment* Rating Pain Function Exam X-ray Good None No restriction on Normal Normal activities Fair Occasionally with Some limitation of Mild swelling; slight Minimal change activity activities … 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. 2,3 To date, there has been one proposed surgical algorithm, which included general recommendations based broadly on lesion size. 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: Immobilization. Osteochondral fractures of the dome of the talus. The surgeon willselect the best procedure based on the specific case. J Bone Joint Surg Am. It was treated by curettage and autocorticocancellous bone grafting through an opening in the talonavicular joint without disturbing the intact talar dome cartilage. In 2007, MRIs of 428 ankles with OLTs were studied. Talar dome lesions are usually caused by … Talar dome fractures are often missed at the initial examination following an ankle sprain or injury. If an osteochondral lesion is noted on plain radiographs, the MRI may be useful in evaluating the lesion itself for articular cartilage congruity, whether there is fluid signal beneath the bony fragment to suggest a loose lesion and to evaluate the degree of edema in the surrounding talus. Treatment depends on the severity of the talar dome lesion. Typical modalities of activity modification, bracing, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and protected weight-bearing in a walking boot may alleviate symptoms 26 - 28 . If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. TREATMENT OF TALAR DOME FRACTURES Treatments for this fracture are predicated on the severity of the defect along with the age and activity of the patient. Treatment decisions are based upon the site of the lesion, the size of the lesion, the skeletal maturity of the patient, the quality of the articular cartilage, and the quality of the associated bone fragment. In contrast to the historically described anterolateral and posteromedial locations, the midtalar dome was involved in 80% of lesions. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. Patients tend to present … 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: Immobilization. The result is a persistent deep pain in the ankle and recurrent swelling with activity. (8,9) Differential diagnosis. Two studies date from the past (1953 and 1975 ), when surgical treatment of osteochondral talar lesions was not as common as it is today. DeLee et al. If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. We studied 24 patients (25 lesions) with OCLs of the talar dome. The patient will usually report a distinct episode of trauma when a lateral lesion is present, but with medial lesions there may be no specific injury or the common historical association of one or more ankle sprains in the past. “Osteo” means bone and “chondral” refers to cartilage. The largest series has been reported by Kumai et al. The talus is a bone in the foot that helps form the ankle joint. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. Sixteen patients (16 ankles) with symptomatic osteochondral lesions of the medial talar dome were treated arthroscopically with percutaneous retrograde drilling through the sinus tarsi. “Osteo” means bone and “chondral” refers to cartilage. Treatment decisions are based upon the site and size of the lesion, the skeletal maturity of the patient, the quality of the articular cartilage, and the quality of the associated bone fragment. There is no universally accepted treatment algorithm for osteochondral lesions of the talar dome. who studied in 27 patients with mean follow-up of 7 years, with 89 percent of the patients (24 of 27 patients) reporting good outcomes [ 101 ]. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. The simplest treatment is to place the patient in a cast to keep the ankle joint from moving and allowing the defect to heal. A variety of surgical techniques is available to accomplish this. 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