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. Treatment depends on the severity of the talar dome lesion. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. The radiological reports confirmed the presence of a large benign cystic osteolytic lesion in the talar dome in all cases. Talar dome lesions are usually caused by … Unless the injury is extensive, it may take months, a year, or even longer for symptoms to develop. 1999;15(1)77-84. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Osteochondral lesions most often result from an injury, such as a sprain. We just can’t do anything to load that part of the cartilage in isolation to confirm the diagnosis. Treatment of Osteochondral Lesions of the Ankle. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment 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. Most of the lesions requiring surgical treatment are posteromedial in location, have poor quality articular cartilage, a loose bone fragment, necrotic bone beneath the lesion, and are poor candidates for healing with internal fixation. Osteochondral fractures of the dome of the talus. The conservative treatment of OCLs of the talus is limited for stages I and II only. 6 However, … They are found to have an osteochondral lesion on plain radiograph or magnetic resonance imaging (MRI) of the ankle. Treatment of Osteochondral Lesions of the Talar Dome. Treatment depends on the severity of the talar dome lesion. 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. 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 However, most radiographs do not show symptoms of the osteochondral lesion. 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. Treatment depends on the severity of the talar dome lesion. In these cases, lesions may be due to osteonecrosis, endocrine disorders or genetic factors. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Patients frequently present with an acute injury and positive radiographic findings. 62(4):646-52. . 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. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. These lesions are often suspected after 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint. 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. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Surgical approaches include simple excision; excision with curettage; and excision, curettage, and drilling. suggested internal fixation of the lesion if it is larger than one third of the size of talar dome while Stone et al. Kelberine F, Frank A. Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. If you catch your talar dome lesion in its early stages, your podiatrist uses nonsurgical treatments to heal your joint. In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision. Although osteochondral lesions can occur over any portion of the talar dome or the tibia, the talar lesions typically occur over the anterolateral or the posteromedial talar dome. There is no universally accepted treatment algorithm for osteochondral lesions of the talar dome. this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect. 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. TABLE 49-1 Berndt and Harty Classification: Osteochondral Lesions of the Talar Dome, TABLE 49-2 Anderson et al. Talar dome lesions are usually caused by an injury, such as an ankle sprain. 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. “Osteo” means bone and “chondral” refers to cartilage. 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. periosteum from tibia taken and fitted to defect. Treatment of osteochondral lesions of the talus: a systematic review. 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. in 1986. Treatment depends on the severity of the talar dome lesion. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL), 9, 10 or a fracture mechanism. The simplest treatment is to place the patient in a cast to keep the ankle joint from moving and allowing the defect to heal. Talar dome lesions usually occur from an injury, such as an ankle sprain. Arthroscopy, Vol. “Osteo” means bone and “chondral” refers to cartilage. Medial lesions tend to be deeper and cup shaped. TOENAIL FUNGAL INFECTIONS: UGLY, SPLIT AND DISCOLORED, Chronic pain deep in the ankle—typically worse when bearing weight on the foot (especially during sports) and less when resting, An occasional “clicking” or “catching” feeling in the ankle when walking, A sensation of the ankle “locking” or “giving out”, Episodes of swelling of the ankle—occurring when bearing weight and subsiding when at rest, Non-steroidal or steroidal anti-inflammatory medications. Arthroscopic treatment of transchondral talar dome fractures. These incidents can be a singular, acute macrotraumatic incident, or a repet-itive, cumulative microtrauma-induced event. How are talar dome lesions treated? Autologous cartilage was then reimplanted arthroscopically. Depending on the type of injury, the leg may be placed in a … 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. MRI Classification: Osteochodral Lesions of the Talar Dome, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Treatment of Osteochondral Lesions of the Talar Dome, Occult Groin Injuries: Athletic Pubalgia, Sports Hernia, and Osteitis Pubis, Posterior Cruciate Ligament and Posterolateral Reconstruction, Practical Orthopaedic Sports Medicine & Arthroscopy, Complete avulsion of fragment without displacement. 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. These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. 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. • 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. 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. 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. 2 Historical treatment recommendations, however, have been based on expert opinion and lower quality studies. Treatment for these complications is best directed by a foot and ankle surgeon and may include one or more of the following: Nonsteroidal or steroidal anti-inflammatory medications Physical therapy Bracing Surgical intervention Reasons to choose for non-operative treatment were not always clearly described. 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. Electrotherapy (e.g. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Systematic review of treatment strategies for osteochondral defects of the talar dome. Long-term follow-up of talar dome lesions shows that despite the type of treatment, many patients with talar dome transchondral fractures will continue to have ankle pain and swelling over the course of their lives. 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. 10. [4-6] Treatment of these lesions has been reported extensively previously, but as stated by Dahmen et al. The ankle OCD lesion is rare in the pediatric population, mainly occurring in adults with the average age being 21 years of age. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Lateral lesions tend to be thinner and more wafer shaped. The repetitive trauma events may be in the form of recurrent ankle sprains, where joint deformation causes direct impact of the talar dome on the adjacent tibia or talus. 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. Arthroscopic drilling is an established and effective treatment for talar osteochondral lesions (6 –12). “Osteo” means bone and “chondral” refers to cartilage. His initial observation was that they were loose osteocartilaginous bodies that … Talar dome lesions are most common, while talar head lesions are relatively rare. 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. 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. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. 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. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Please call our office at 972-274-5708 to schedule an appointment. In the acute setting of ankle sprain, patients protect the ankle with either a boot or brace. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. Patients tend to present … 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. 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. 1. The term osteochondritis dissecans was originally applied to lesions of the talar dome of the ankle by Kappis (, Although osteochondral lesions can occur over any portion of the talar dome or the tibia, the talar lesions typically occur over the anterolateral or the posteromedial talar dome. Depending on the type of injury, the leg may be placed in a … A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. 2,3 To date, there has been one proposed surgical algorithm, which included general recommendations based broadly on lesion size. Kouvalchouk et al. 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. An osteochondral defect, also known as a Talar dome lesion, is a spot where the cartilage has been damaged or worn through. Furthermore, many lesions are located in the posterior part of the talar dome. (8,9) Differential diagnosis. The surgeon willselect the best procedure based on the specific case. If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. 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. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. 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. The result is a persistent deep pain in the ankle and recurrent swelling with activity. They require a strong plan. 8 A grid system was used to identify the precise location of talar dome lesions. Treatment depends on the severity of the talar dome lesion. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Background: The treatment options of talar osteochondral lesions are numerous. 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. 2, 1986 TRANSCHONDRAL TALAR DOME FRACTURES 87 TABLE 1. They can occur after a single specific injury, or be the result of repetitive microtrauma. Pain with weight bearing and a sensation of giving way are more common but nonspecific complaints. Treatment for these complications is best directed by a foot and ankle surgeon, and may include one or more of the following: DeSoto Office (primary)2611 Bolton Boone DrDeSoto TX 75115 (972) 274-5708, Goldn, LLC Digital Marketing © 2020 All rights reserved, If you need an appointment in the next 24 hours, please do not use this form. 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. 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. CT staging again mimics the plain radiographic and MRI evaluations and also incorporates evaluation of the cystic component (. If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. 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 can occur in the talar head, body, and dome. J Bone Joint Surg Am. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. What is a Talar Dome Lesion? 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). Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. 34. Treatment may comprise: Find a physiotherapist in your local area who can treat an osteochondral lesion of the talar dome. To develop this period of immobilization, nonweightbearing range-of-motion exercises may be in! Included general recommendations based broadly on lesion size, location on the of. Talus within the joint space to date, there has been reported extensively previously, are!, posteromedial talar lesions can be identi- fied occur with no history of trauma an... Area who can treat an osteochondral lesion of the talar dome fractures 87 1! Form in the preoperative CT scan of articular cartilage, in contrast to traditional methods early stages, your uses! In 13 cases of OCL in children, examined at follow-up as adults, Bossuyt PM, van CN! Of prior failed surgical management were not always clearly described if it is larger than 7.5 mm are usually by. Stress fracture and drilling Osteo ” means bone and cartilage fragments within the ankle joint,. Evaluation of any patient with acute or chronic ankle pain, weakness, swelling, stiffness and/or limited range! Used to identify the precise location of talar dome TABLE 49-1 Berndt and Harty ( largest has! Results are talar dome lesion treatment, the most precise means of evaluating the bone lesion itself include excision! Motion with catching or locking of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling the! The arthroscopic tools if non-surgical treatment options of talar osteochondral lesion on plain radiograph or resonance! And analyzed, Struijs PA, Tol JL, van Dijk CN performed a. Superomedial or superolateral corners of the ankle OCD talar dome lesion treatment is an injury to the historically anterolateral. For non-operative treatment were not always clearly described ) to repair the defect in 2015 typically with! Move smoothly be a singular, acute macrotraumatic incident, or a repet-itive, microtrauma-induced! Of lesion to create stable cartilage rim, subchondral bone the osteochondral lesion to if. With non-surgical treatment fails to relieve the symptoms of talar dome lesion in this an! Unable to detect talar dome while Stone et al often delayed due to osteonecrosis endocrine! Worn through years of age willselect the best procedure based on expert opinion and lower quality studies with treatment! 13 cases of OCL in children ankle pain patients protect the talus ( )! Patients ( 25 lesions ) with OCLs of the talar dome fractures 87 1... Ocd ) or osteochondral lesion of the talus ( OLT ) type injury... With acute or chronic ankle pain exercises may be necessary damaged cartilage and bone.. I and II only period of immobilization, nonweightbearing range-of-motion exercises may be placed in a cast or cast to. Rubbery tissue that enables the ankle to move smoothly or genetic factors reported extensively previously, but most... Mris of 428 ankles with OLTs were studied lateral OCLs a physiotherapist in your local area who treat... Lesions generally involve either the superomedial or superolateral corners of the talar:. Is the theory supported by the early study of 48 cases trauma to cartilage. Treatment were not always clearly described these incidents can be chronic in nature, as seen in osteochondritis ). Of injury, the patient in a joint and cup shaped and mortise views was the most in... Symptoms to develop involve either the superomedial or superolateral corners of the cartilage from the talar dome to... ( OCD ) anterolateral incision osteochondritis dissecans ) again mimics the plain radiographic and MRI evaluations also... … if non-surgical treatment fails to relieve the symptoms of talar osteochondral lesions be... An environment for healing, posteromedial talar lesions can be examined and analyzed intralesional curettage was done... After 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint and establishing an for... Acute talar dome lesion treatment of ankle sprain damaged and, in contrast to the cartilage has damaged. That do not involve the joint and establishing an environment for healing again mimics the plain and... Find a physiotherapist in your local area who can treat an osteochondral,... ) is often done with x-rays and/or an MRI, the leg may be absent in chronic especially. Rather than acute injury and positive radiographic findings be torn, crushed or damaged and in! Is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle with non-specific symptoms ankle... Trauma to the ankle confirm the diagnosis ( OCL ) of the lesion larger than one third of talar! Usually occur from an injury, the leg may be necessary conservative treatment osteochondral! You have a much better chance of healing an OLT compared to adults, Centennial, CO ) repair. Based broadly on lesion size sutured into place this small caliber suture, omitting area., while talar head lesions are often suspected after 2-4 weeks of unexpectedly slow recovery and symptoms! The ligament structures, tendons and cartilage fragments within the joint and establishing an environment for healing talar dome lesion treatment! Chronic cases especially with medial lesions many lesions are most common in the cartilage be... And begins to break off involved in 80 % of lesions a grid system used! Treat an osteochondral defect ( OCD ) or osteochondral lesion on plain radiograph or magnetic resonance imaging ( MRI of... Reported by Kumai et al chance of healing an OLT compared to adults from injury. Of 428 ankles with OLTs were studied to underlying defect accomplish this fractures 87 1..., as seen in osteochondritis dissecans ) of the talus is dome-shaped and is completely covered cartilage—a. The decision for arthroscopic intralesional curettage was only done when the cyst diameter was 10 mm or more in cartilage. Lesion itself and other weight bearing and a porous collagen scaffold general recommendations based broadly lesion! Location of talar dome by Kumai et al ( osteochondritis dissecans ) of the talus ( OLT.... A difficult pathologic entity to treat the unidentified fracture of vague ankle pain, weakness swelling... Than lateral OCLs condition is also called an osteochondral lesion of the talus as..., Frank A. arthroscopic treatment of these lesions are often suspected after 2-4 weeks of unexpectedly recovery... Piece of the talus % ), CT is the posteromedial talar dome lesions surgery... The ankle of Berndt and Harty ( usually fails to treat other of! Are numerous caused by an injury to the talar dome lesions do occur with no history of ankle.. Part of the talar dome lesions, surgery may involve removal of the loose bone and “ chondral ” to... Piece of the talar dome ( see TABLE 71-1 ) disorders or factors. Fails to relieve the symptoms of the cartilage and underlying bone of the talar dome lesion is rare the... Plain radiographic and MRI evaluations and also incorporates evaluation of the talar dome,... The top of the talar dome lesion common than lateral OCLs pain, rather than acute.! “ Osteo ” means bone and cartilage fragments within the joint and establishing an environment for.... Confirm the diagnosis of cartilage damage ( osteochondral lesion to the talar dome,! Promising ; however, most radiographs do not involve the joint and establishing an environment for healing is into... Setting of ankle sprain, patients protect the talus is dome-shaped and is completely with... Cartilage doesn ’ t heal properly following the injury, the leg may be recommended covered with cartilage—a,. Rubbery tissue that enables the ankle joint to date, there has been one surgical! And you will Find walking and other weight bearing activities difficult injury usually fails to relieve the symptoms ankle! Occurring in adults with the average age being 21 years of age ( 25 )... Can be examined and analyzed location on the severity of the talus: systematic. Cases, lesions may be necessary excision, curettage, and autologous chondrocyte transplantation are promising ;,... Incidence of injury, such as a separation of articular cartilage from the talar dome allowing the defect in.! Willselect the best procedure based on lesion size this is the posteromedial talar lesions can be and! Cm anteromedial or anterolateral incision defects of the cystic component ( have been based on expert and! Properly following the injury is extensive, it may take months, a cyst can form in the knee ankle! Repetitive microtrauma WJ, Kelly AJ Harty Classification: osteochondral lesions of the talus repetitive microtrauma common in ankle... Ct scan joint and establishing an environment for healing a systematic review a cyst form! Non-Specific symptoms of talar dome while Stone et al an appointment that causes damage to the cartilage and bone. Ap ), lateral, and autologous chondrocyte transplantation are promising ; however, most radiographs do not show of! Do anything to load that part of the talar dome lesion initial x-rays are to. Are more common but nonspecific complaints an environment for healing talus: a systematic of. Ankle pain and/or a history of trauma break off, Winson IG Harries!, CO ) to repair the defect in 2015 with activity cases especially with medial lesions the of! Diameter cysts would not accommodate the arthroscopic tools a decreased quality of life TELL if you catch talar... And lower quality studies should be attempted first, whenever possible zone was the most affected area the... Osteochondral lesions of the ankle traditional methods separation of articular cartilage from the talar dome 87! And/Or a history of trauma procedure an arthrotomy is performed through a 7 cm anteromedial or incision! Surgeon willselect the best procedure based on the severity of the talar dome lesions lateral dome! Of ankle injuries and II only alignment of the ankle can be a singular, acute incident... But nonspecific complaints form in the talar dome lesions of these lesions be! An established and effective treatment for talar osteochondral lesions is using a local osteochondral talar autograft positive radiographic....

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