Partially detached osteochondral lesion 3. for OCD of the talus at a major Canadian pediatric referral center. Laboratory and clinical work continue in this area. [] In 1922, Kappis described this process in the ankle joint. INTRODUCTION. 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. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury knee). 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. Fig. Completely detached , non-displaced fragment 4.Completely detached and displaced fragment Ct or MRI will give more information with a suspected lesion . This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). 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. 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). 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. The fragment is large enough to fix. This treatment approach can be initially attempted in non-displaced OLTs. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). cartilage injury with associated subchondral fracture but without detachment 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. During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. This may lead to small cracks in the cartilage or even formation of a hole or cyst underneath the surface. The talus sits inside the joint and allows the up and down motion of the ankle. 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. 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’. 2. postoperative treatment regime? Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Osteochondral Defects . Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. “Osteo” means bone and “chondral” refers to cartilage. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Did you know our resouces can be found in. 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 – Localized ischemia & AVN – Not an inflammatory process so the term“osteochondritis” is a misnomer – Younger patient – No history of trauma – More on medial side. An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). The average age at surgery was 22.7 years (range, 19-34). MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. The cartilage lining of the joint is crucial to allow […] 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. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. However, if the lesion is large enough, or the overlying cartilage is displaced, talar OLTs can be quite symptomatic. This can be done without a medial malleolar osteotomy. OCD of the Talus Tx. 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. This may include: FootEducation LLC Fixation with a headless compression screw or absorbable screw. 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. 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]. Show Related Articles from PubMed. OCD usually causes pain during and after sports. [Picture 1] Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint. 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. OCD remains uncertain. The lesion is encountered on either the medial or lateral surface of the talar dome. OLTs can be an incidental finding on an MRI ordered to assess another problem. 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 … 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. It is often associated with a traumatic injury, such as a severe 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. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. 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). 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. OCD talus. Th… Small area of compression 2. • Accounts for only 4% of reported cases of OCD – Vascular etiology? Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). There is an increasing prevalence of … The mean time of follow-up was 36 months (range, 25-49). Where does OCD develop? OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Flattening of the medial talar dome. The most common sites are the posteromedial (53%) (Fig. May be due to micro trauma or a traumatic event. Osteochondritis dissecans (OCD) of the talus is rare in children. OCD of the Talus Radiographs. 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