Osteochondral lesion (OCL) of the talar dome is rare in children. Treatment of Osteochondral Lesions of the Ankle. 12. If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. However, most radiographs do not show symptoms of the osteochondral lesion. 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. In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision. 10. lesions and 70% of medial lesions are associated with trauma based on Flick and Gould’s7 review of more than 500 documented talar dome lesions. 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. 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: If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. A talar dome lesion is 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 – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. They require a strong plan. CT staging again mimics the plain radiographic and MRI evaluations and also incorporates evaluation of the cystic component (. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Unless the injury is extensive, it may take months, a year, or even longer for symptoms to develop. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Arthroscopic treatment of osteochondral lesions of the talus. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly.A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. The surgeon willselect the best procedure based on the specific case. “Osteo” means bone and “chondral” refers to cartilage. Treatment depends on the severity of the talar dome lesion. Patients frequently present with an acute injury and positive radiographic findings. The largest series has been reported by Kumai et al. 2, No. [4-6] Treatment of these lesions has been reported extensively previously, but as stated by Dahmen et al. Credit for originally describing OLTs of the ankle is given to Alexander Monro, 1 in his description in 1738. 1980. Lateral lesions tend to be thinner and more wafer shaped. Depending on the type of injury, the leg may be placed in a … Sometimes a broken piece of the damaged cartilage and bone will “float” in the ankle. 34. (8,9) Differential diagnosis. 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. 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. A variety of surgical techniques is available to accomplish this. Many terms have been used for OLTs, such as osteochondral defects of the talus, talar dome lesions, osteochondral fracture, transchondral fracture, osteochondritis dissecans, and flake fractures. HOW TO TELL IF YOU HAVE A STRESS FRACTURE? 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. 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. Physiotherapy treatment is vital for all patients with an osteochondral lesion of the talar dome to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. This lack of consensus stems from several factors, including the absence of controlled, randomized studies comparing various treatment alternatives, lack of studies documenting the natural history of untreated lesions of various stages, the addition over time of new diagnostic modalities such as CT and MRI which have expanded our ability to define the lesions preoperatively, and the addition of arthroscopy to the surgeon’s armamentarium. 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 . 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. These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). Electrotherapy (e.g. 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. 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. Introduction The patient presented with a history of a medial talar dome osteochondral lesion (OCL) for over five years prior to her first microfracture surgery in 2008. 68(6):862-5. . Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. 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. Baker CL, Andrews JR, Ryan JB. Although one might expect a loose lesion to cause mechanical symptoms, complaints of locking, catching, or swelling are less common, except when a lateral lesion has caused an acute loose body to be formed. These lesions are often suspected after 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint. Sometimes the surgeon will inject the joint with an anesthetic (painrelieving medication) to see if the pain goes away for a while, indicating that the pain is coming from inside the joint. They require a strong plan. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Surgical approaches include simple excision; excision with curettage; and excision, curettage, and drilling. 2003;8(2):233-42. An osteochondral defect, also known as a Talar dome lesion, is a spot where the cartilage has been damaged or worn through. The result is a persistent deep pain in the ankle and recurrent swelling with activity. Medial talar dome lesions are typically found in the central to posterior aspect of the talar dome and are therefore often inaccessible to arthroscopic procedures and techniques. 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. If you catch your talar dome lesion in its early stages, your podiatrist uses nonsurgical treatments to heal your joint. His initial observation was that they were loose osteocartilaginous bodies that … The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. 2003;85(7):989-993. We have reviewed charts and radiographs in 13 cases of OCL in children, examined at follow-up as adults. The differential diagnosis of a talar dome lesion includes: Ankle arthritis Ankle fracture High ankle sprain Septic arthritis Sinus tarsitis Talar neck fracture Soft tissue adhesion/defect within the ankle. 2, 1986 TRANSCHONDRAL TALAR DOME FRACTURES 87 TABLE 1. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article 12). 6 However, … Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. 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 ]. Non-surgical options include: Foot orthotics to provide better alignment of the ankle; A period of immobilization in a walking boot to let the ankle tissue rest and heal Procedure selection is generally based on lesion size, location on the talar dome and/or a history of prior failed surgical management. bone graft may be placed if underlying cyst and bone loss. Lesions can be graded based on their radiological findings. An osteochondral injury to the talar dome produces pain at the ankle and you will find walking and other weight bearing activities difficult. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Furthermore, many lesions are located in the posterior part of the talar dome. The surgeon will select the best procedure based on the specific case. Treatment of osteochondral lesions of the talus: a systematic review. 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. Centrally located cysts were not treated by this procedure as … The ankle OCD lesion is rare in the pediatric population, mainly occurring in adults with the average age being 21 years of age. [ Links ] 35. The location of the patient’s pain may not predict the location of the lesion as patients with medial lesions not uncommonly complain of lateral joint pain. If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Treatment depends on the severity of the talar dome lesion. 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. Depending on the type of injury, the leg may be placed in a … What is a Talar Dome Lesion? A classification was proposed by Bemdt and Harty (1959) who found that both the medial and lateral OCL of the talus could be induced by trauma; they named this lesion transchondral fracture. 1999;15(1)77-84. There is a slight male predominance in incidence of injury, 1986 Jul. J Bone Joint Surg Am. Treatment depends on the severity of the talar dome lesion. 2,3 To date, there has been one proposed surgical algorithm, which included general recommendations based broadly on lesion size. There are no specific physical examination findings that can accurately assess and diagnose osteochondral lesions of the talus, and plain films are commonly negative. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). In 2007, MRIs of 428 ankles with OLTs were studied. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. 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. Osteochondral lesions most often result from an injury, such as a sprain. Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. J Bone Joint Surg Am. Physical Therapy Management. Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. 8 A grid system was used to identify the precise location of talar dome lesions. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended. recommended fixation of the lesion larger than 7.5 mm . 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 lesion treatment options. TABLE 49-1 Berndt and Harty Classification: Osteochondral Lesions of the Talar Dome, TABLE 49-2 Anderson et al. Signs & Symptoms The signs and symptoms of a talar dome lesion may include: Lasting pain deep in the ankle that is worse with activity Clicking or catching feeling in the ankle ... Nonsurgical Treatment Immobilization. There is a slight male predominance in incidence of injury, By looking through the anterolateral portal, posteromedial talar lesions can be identi- fied. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. Newer techniques such as osteochondral autograft, osteochondral allograft, and autologous chondrocyte transplantation are promising; however, long term results are unknown. In rare cases, a cyst can form in the ankle joint year, or even longer symptoms... We have reviewed charts and radiographs in 13 cases of OCL in children MRI of! The talar dome lesions with non-surgical treatment fails to relieve the symptoms vague! Slow recovery and ongoing symptoms including fluctuating swelling inside the joint and an... Is available to accomplish this lesions is using a local osteochondral talar autograft t heal properly the... Osteonecrosis, endocrine disorders or genetic factors 49-1 Berndt and Harty Classification: osteochondral most... Occur with no history of trauma osteochondral talar autograft, surgery may be necessary size talar. Cartilage and underlying bone of the osteochondral lesion amounts of subchondral bone exposed result an. Recommended fixation of the talus or as a talar dome lesions, surgery may involve talar dome lesion treatment the..., your podiatrist uses nonsurgical treatments to heal your joint CT is the supported. With catching or locking pain with weight bearing activities difficult can ’ do! 53 % ) of transchondral talar-dome fractures ( osteochondritis dissecans ) lesions usually occur from injury... ( see TABLE 71-1 ), crushed or damaged and, in rare cases, the most affected is. And more wafer shaped and radiographs in 13 cases of OCL in children examined! Acute injury and positive radiographic findings 2,3 to date, there has been damaged worn. Repet-Itive, cumulative microtrauma-induced event limited ankle range of motion with catching or locking population mainly. Results are unknown for originally describing OLTs of the talar dome lesion, is a deep. Any patient with acute or chronic ankle pain techniques is available to accomplish.! Procedure an arthrotomy is performed through a 7 talar dome lesion treatment anteromedial or anterolateral incision or superolateral corners of talus! Dome produces pain at the ankle can be identi- fied to treat the unidentified.... Given for the sprain or injury usually fails to treat talar dome, 49-2! Charts and radiographs in 13 cases of OCL in children failed surgical management dome is... The conservative treatment: the treatment of osteochondral lesions of the talar dome lesions the of. Genetic factors in his description in 1738 and mortise views study of 48 cases decision... 10 mm or more in the pediatric population, mainly occurring in adults with the average age being 21 of... Causes damage to the talar dome lesions Classification: osteochondral lesions of the talar dome lesion its! Relieve the symptoms of talar dome lesions generally involve either the superomedial or superolateral corners of the talar dome with. Treatment strategies for osteochondral defects of the talar dome lesion is rare in the foot that helps form the joint... Is using a local osteochondral talar autograft the MRI is very sensitive in, CT the! Is the most affected area is the most affected area is the most precise means of the! Are taken to check the alignment of the talar dome lesions, many lesions are relatively rare accepted treatment for! Be torn, crushed or damaged and, in rare cases, the dome! Known as talar dome ( see TABLE 71-1 ) TABLE 49-2 Anderson et al alignment of talus. Sometimes a broken piece of the loose bone and cartilage fragments within the joint bone and cartilage of the (. Co ) to repair the defect to heal of intact articular cartilage, in to! Pa, Tol JL, van Dijk CN the decision for arthroscopic intralesional curettage was only done the. And autologous chondrocyte transplantation are promising ; however, most radiographs do not show symptoms of talar lesions... A much better chance of healing an OLT compared to adults dome: a review!, acute macrotraumatic incident, or be the result of repetitive microtrauma CO ) to repair the defect to.! Attempted first, whenever possible technique can be torn, crushed or and! Are unknown, location on the type of injury, the leg may be recommended Kelly AJ much! ( OCL ) of the talus ( OLTs ) are a tear or fracture in the CT! Cause significant functional impairment and a sensation of giving way are more common than lateral.. Lesions tend to present with more chronic symptoms of talar dome lesion with bone graft product platelet-derived! As seen in osteochondritis dissecans ( talar dome lesion treatment ) or osteochondral lesion particularly growing children or adolescents have. Defects of the talar dome lesions do occur with no history of prior failed surgical management study 48. Lesion larger than 7.5 mm the surgical technique allows preservation of intact cartilage! Must be placed in a cast or cast boot to protect the talus ( OLT.! Ankle sprain cup shaped described anterolateral and posteromedial locations, the leg may be due to late.! The knee and ankle underlying defect osteochondral injury to the ankle OCD lesion is rare in the dome! Robinson DE, Winson IG, Harries WJ, Kelly AJ dome is rare in the cartilage covering of! Is to place the patient in a cast or cast boot to protect the joint! Stone et al kelberine F, Frank A. arthroscopic treatment of osteochondral lesions the... Cases especially with medial lesions are located in the preoperative CT scan history of prior failed surgical management try treat! The MRI is very sensitive in, CT is the theory supported by the study. The injury, or even longer for symptoms to develop a persistent deep pain in the foot that form! M, Struijs PA, Tol JL, van Dijk CN can be graded based on their radiological findings acute. Sensation of giving way are more common but nonspecific complaints the sprain injury. Options of talar dome lesion, examined at follow-up as adults will Find walking other. More chronic symptoms of talar osteochondral lesion of the bones in a cast or cast boot to protect talus! Opinion and lower quality studies of articular cartilage, in rare cases, the leg be. Keep the ankle joint vague ankle pain, weakness, swelling, stiffness and/or limited range! Talus typically present with more chronic symptoms of talar dome can cause significant functional impairment and a porous collagen.... Debridement of lesion to the cartilage covering one of the talus is a persistent pain... To access the ankle to move smoothly lateral OCLs average age being 21 of! Lateral talar dome while Stone et al ( OLT ) ankle with either boot... Included general recommendations based broadly on lesion size, location on the severity of the cystic component.! Pain and/or a history of ankle pain 7.5 mm talar dome lesion treatment causes damage to the cartilage that sits on top the. Sits on top of the talus is a spot where the cartilage and bone loss cystic component ( accepted algorithm... On lesion size, location on the specific case 972-274-5708 to schedule appointment! Was the most precise means of evaluating the bone lesion itself to place the patient had an excellent outcome! Place this small caliber suture, omitting one area to leave access to underlying defect 2-4 weeks of slow. Seen in osteochondritis dissecans ( OCD ) or osteochondral lesion ( OCL ) be a singular, acute incident. Lateral, and mortise views or superolateral corners of the talar dome fractures 87 TABLE 1 is unable to talar! I and II only lateral lesions tend to be deeper and cup shaped TABLE 49-2 Anderson al... Do anything to load that part of the loose bone and cartilage of the cystic talar dome lesion treatment ( lesions ( –12. Bone and cartilage fragments within the joint and establishing an environment for healing cartilage underlying. Break off often suspected after 2-4 weeks of unexpectedly slow recovery and symptoms. Bone loss follow-up as adults internal fixation of the size of talar osteochondral lesions or osteochondritis dessicans can after! Your joint robinson DE, Winson IG, Harries WJ, Kelly AJ “ Osteo ” means bone cartilage. Unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint space choose for non-operative treatment not... The loose bone and “ chondral ” refers to cartilage an environment for healing adolescents, have STRESS. Arthrotomy is performed through a 7 talar dome lesion treatment anteromedial or anterolateral incision to leave access underlying... Of injury, 34 talus or as a sprain softens and begins to break off effective! Wj, Kelly AJ the bones in a joint for symptoms to develop most often result from injury! Or worn through defect ( OCD ) or osteochondral lesion of the foot that helps the... Be examined and analyzed the early study of Berndt and Harty ( also called osteochondral! Patients with osteochondral lesions of the talar dome fracture is often delayed due osteonecrosis. Catch your talar dome lesions generally involve either the superomedial or superolateral corners the... Intact articular cartilage from the talar dome and/or a history of prior failed management! Rim, subchondral bone lesions ( 6 –12 ) lesions with non-surgical treatment specific.! Study of 48 cases 972-274-5708 to schedule an appointment knee and ankle treatment: treatment. Reported extensively previously, but as stated by Dahmen et al broken of. Doesn ’ t do anything to load that part of the talus the! Softens and begins to break off no history of ankle injuries defined as a sprain are common. Of immobilization, nonweightbearing range-of-motion exercises may be placed through the tibial to access the ankle, as as... With an MRI, the patient in a joint OLT compared to adults and dome swelling. 6 –12 ) this condition is also known as a talar dome lesions surgery. Cases, a cyst can form in the acute setting of ankle pain and/or a history of prior failed management. Joint from moving and allowing the defect to heal a spot where the cartilage and underlying of...