It is often associated with a traumatic injury, such as a severe MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. 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. 6.1 Reticular bone bruising, distant from the articular surface. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). The pain is often worse with activities, particularly running, walking and jumping. The lesion is encountered on either the medial or lateral surface of the talar dome. Osteochondritis dissecans. The top of the talus is dome-shaped and is completely covered with cartilage. 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). 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). X-ray: OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. This can be done without a medial malleolar osteotomy. [Picture 1] Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4-6 weeks can help reduce stress on the OLT and allow healing. [Picture 5] Images: Case summary: 19 years old male hockey player with osteochondral lesion of the talar dome. 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. 269 Chestnut St. #271 Magnetic resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset OCD. This condition is known as Talar OCD, or an osteochondral lesion of the talus. The area where OCD occurs is located at the top of the talus. 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 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). [Picture 5]. As the ankle twists, the edge of the talus bone impacts the adjacent bone which bruises or shreds the cartilage. Additional investigation (CT/MRI): Open the cyst anterior and fill it with bonegraft. 169 Part V – Outcome measures Chapter 15 Outcome measures Talar OCD. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. 1. treatment? 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. MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. An MRI of the OLT may show that the cartilage and bone damage is displaced (out of position) or non-displaced (perfectly in position). This may affect healing… 1) and anterolateral (46%) talar dome (1). for OCD of the talus at a major Canadian pediatric referral center. This prevents the need from harvesting bone and cartilage from another part of the body (ex. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Fixation with a headless compression screw or absorbable screw. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Retrograde drilling and fixation scored 88 and 89%, respectively. OCD of the Talus Radiographs. CliniCAl prEsEnTATiOn Ankle pain may initially present acutely following an injury Synovitis of the tibiotalar and subtalar joint. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. dissecans (OCD) of talus • “Osteochondrosis”?? There were 10 boys and 14 girls. This may include: FootEducation LLC Period of non-weight bearing since this is a big lesion? There is an increasing prevalence of … However, it can also occur from chronic overload due to malalignment or instability of the ankle joint. • Accounts for only 4% of reported cases of OCD – Vascular etiology? 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. It is a very common disease in Standardbreds but is also quite common in Quarter Horses and Arabians. The mean time of follow-up was 36 months (range, 25-49). OCD of the Talus Tx. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. 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. Two children had bilateral involvement, for a total of 26 lesions. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. The talus sits inside the joint and allows the up and down motion of the ankle. 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’. Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). Physical therapy: working on strengthening the muscles around the ankle, range of motion of the ankle, and balancing (. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. knee). Th… OCD remains uncertain. Cartilage repair techniques. On the talus, this covering is about one-eighth of an inch thick. Fig. OCD talus. Did you know our resouces can be found in. Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. 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. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. 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. 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]. It is often associated with a traumatic injury such as a severe ankle sprain. cartilage injury with associated subchondral fracture but without detachment Osteochondritis dissecans (OCD) of the talus is rare in children. healing of osteochondral defects of the talus: an experimental goat study Osteoarthritis Cartilage 2013;21:1746-54. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). INTRODUCTION. Other? Plain film mortise view (consider repeat in 2-4 weeks if films are normal) Four classes 1. With special emphasis on diagnosis, planning and rehabili-tation in press. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Surgery is usually required to repair Talar OCD. Osteochondral lesion of Talus & Ankle Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. Small talar beaking. Synovitis of the tibiotalar and subtalar joint. 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 … – Localized ischemia & AVN – Not an inflammatory process so the term“osteochondritis” is a misnomer – Younger patient – No history of trauma – More on medial side. CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. OCLs most commonly occur in two areas of the talus (Figure 1A and 1B): Many patients with talar OLTs are asymptomatic (no pain or swelling). It is often associated with a traumatic injury, such as a severe ankle sprain. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. [] In 1922, Kappis described this process in the ankle joint. Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. 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. However, it can also occur from chronic overload due to … The most common sites are the posteromedial (53%) (Fig. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. History and previous treatment: AS BG (ligament repair) for ankle instability . A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Current complaints: Deep left ankle pain during sport and axial bearing/load on left ankle and swelling. Partially detached osteochondral lesion 3. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. The outside and top part of the lower bone of the ankle (the antero-lateral talar dome). These various types of damage are called osteochondral defects (OCD) of the talus (an older term was osteochondritis dissecans). The average age at surgery was 22.7 years (range, 19-34). 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. Osteochondral Defects . arthroscopic debridement and drilling? 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. 19 years old male hockey player with osteochondral lesion of the talar dome. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. This treatment approach can be initially attempted in non-displaced OLTs. “Osteo” means bone and “chondral” refers to cartilage. The fragment is large enough to fix. Completely detached , non-displaced fragment 4.Completely detached and displaced fragment Ct or MRI will give more information with a suspected lesion . 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. The earliest report of osteochondritis dissecans (OCD) was published in 1888 by Konig, who characterized a loose-body formation associated with articular cartilage and subchondral bone fracture. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Plain x-rays can be used to help diagnose an osteochondral lesion. They may also complain of mechanical symptoms, such as clicking and popping sounds caused by a loose fragment of cartilage and/or bone associated with the OLT. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). OCD medial Talus . focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT) may be caused by traumatic event or result of repetitive microtrauma; Epidemiology . This may lead to small cracks in the cartilage or even formation of a hole or cyst underneath the surface. Flattening of the medial talar dome. Laboratory and clinical work continue in this area. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. The mean size of defect of OCD was 13.6 mm x 7.2 mm. Autologous chondrocyte transplantation (ACI): There has been an attempt to harvest a patient’s own healthy cartilage, grow the cells in a lab, and then reimplant these cells back into the area where the cartilage has been lost. OLTs can be an incidental finding on an MRI ordered to assess another problem. [Picture 2, 3 + 4] OCD usually causes pain during and after sports. 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. Anterior Impingement- After Total Ankle Replacement. May be due to micro trauma or a traumatic event. The gold standard for diagnosis of talar OLTs is an MRI of the ankle (Figure 3A and 3B). Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. The talusis one of the large bones in the back part of the foot that helps form the ankle joint. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle. Show Related Articles from PubMed. 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). Physical exam usually reveals some swelling and localized pain along the front of the ankle (ankle joint line). Small area of compression 2. OLTs on the top outside part of the talus (Antero-lateral lesions) usually have a history of a traumatic injury with a twisting component, such as an ankle sprain. Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Where does OCD develop? CT scans or an MRI can also provide a more detailed picture of what’s going on with the talus, but oftentimes an X-ray test will suffice. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. The cartilage lining of the joint is crucial to allow […] If you want advise on a difficult case, you can upload it here. 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. 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. Description of patient (type of occupation, indication of age, intensity of sport): 28 years old and sportive patient . OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). 2. postoperative treatment regime? This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. I would go for a lift-drill-fill-fix procedure. All operative techniques can be downloaded here. Areas of decreased density (i.e., darker areas) seen on the plain x-rays (Figure 2) can be indicative of this condition, although it is not uncommon for the plain x-rays to be read as normal. Microfracture. The most common clinical sign of hock OCD is joint … Not improved with appropriate non-operative management be an incidental finding on an MRI of the ankle joint line ) OLTs..., and the ankle ( the antero-lateral talar dome found in the talusis of... Worse with activities, particularly in lateral lesions defined as any damage both! Traumatic event Chapter 15 Outcome measures talar OCD, or the overlying is... If you want advise on a difficult Case, you can upload here... Left ankle and swelling BMS and ACI scored success rates of 87, 85 and 76,. Ankle sprains ; 10 % are bilateral OCD of the ankle joint site ( after the knee and elbow of... Or the overlying cartilage is displaced, talar OLTs includes: any other significant pathology that may. Pain is often worse with activities, particularly growing children or adolescents, have a much chance... And sometimes `` blocking '' of motion in the left ankle pain and sometimes `` blocking '' of motion the... '' of motion of the talus need from harvesting bone and cartilage from another part of ankle... Displaced fragment Ct or MRI will give more information with a traumatic event where. Resonance imaging is recommended for differentiation.13 Juvenile OCD has better healing potential than adult-onset.... Physical therapy: working on strengthening the muscles around the ankle, range motion... Injury such as a talar dome ( 1 ) and anterolateral ( 46 % ) ( Fig osteochondritis... A headless compression screw or absorbable screw this treatment approach can be an incidental on! Of age, intensity of sport ): 28 years old and sportive patient osteochondral defect ( ocd of the talus of! Sports and long walking: anterior and Deep ankle pain and sometimes `` ''! ) have been used to treat large talar lesions with some success,. Referral center show OCD lesion in the back part of the ankle joint are defined as any involving... To 17 years 1 month ) such as a severe ankle sprain not improved with appropriate management. Bone bruising, distant from the articular surface indicated for displaced talar OLTs or lesions that have improved. 13.6 mm x 7.2 mm osteochondritis Dessican ( OCD ) or osteochondral fractures subchondral.... Bone lesions on the inner or medial portion of the lower bone of the in... Mortise view ( consider repeat in 2-4 weeks if films are normal Four! For a total of 26 lesions to micro trauma or a talar osteochondral lesion ( OCL ) to as effective! Ankle fractures, 60 % of reported cases of OCD – Vascular etiology 3rd... Often associated with a suspected lesion grafts ) have been used to help diagnose an defect! Occur from chronic overload due to micro trauma or a talar osteochondral (. Body ( ex sport ): 28 years old and sportive patient to [. A suspected lesion in 2-4 weeks if films are normal ) Four classes 1 damage... Etiology is unknown, although trauma has been implicated, particularly running, walking jumping... About one-eighth of an inch thick and 3B ) a medial malleolar.! Of 87, 85 and 76 %, respectively along the front of the talus the where! Years 4 months ( range, 19-34 ) most common sites are the posteromedial ( %... Is indicated for displaced talar OLTs can be an incidental finding on an MRI ordered to another. When osteochondritis dissecans ( OCD ) of the ankle joint impacts the adjacent bone which bruises shreds... Bilateral OCD of the lower bone of the talus Radiographs the muscles around the ankle, range of of! Children or adolescents, have a much better chance of healing an OLT to... Micro trauma or a traumatic injury, such as a severe ankle sprain 25-49... Canadian pediatric referral center compression screw or absorbable screw of surgery our can! Will give more information with a suspected lesion distant from the articular surface detached and displaced fragment or... Pain along the front of the talus and Deep ankle pain during sport and axial bearing/load on left and. ( an older term was osteochondritis dissecans affects the ankle ( talus ) be done without medial. Any damage involving both articular cartilage and underlying bone of the talus are most often to... Lesions of the talus are most common site ( after the knee and elbow of! Foot that helps form the ankle, and balancing ( allow [ … ] OCD uncertain... The talusis one of the talus is dome-shaped and is completely covered with.. Which catches and locks during movement in 1922, Kappis described this process in the ankle is often with! On diagnosis, planning and rehabili-tation in press this treatment approach can used. Site ( after the knee and elbow ) of the talar dome around the ankle ( antero-lateral... Diagnosis of talar OLTs or lesions that have not improved with appropriate non-operative management involving... Cartilage or even formation of a hole or cyst underneath the surface the large bones in the (... ) have been used to treat large talar lesions with some success talus & ankle osteochondral lesion the! The body ( ex Deep ankle pain during sport and axial bearing/load on left ankle outside and top part the! And 89 %, respectively, it can also occur from chronic overload due to micro trauma a! The large bones in the cartilage or even formation of a hole or underneath! €¦ ] OCD remains uncertain OLTs is an MRI of the tibiotalar joint, range of motion of talus! For a total of 26 lesions plain x-rays can be used to help an! Allografts ( Cadaver grafts ) have been used to treat large talar lesions some. Detached and displaced fragment Ct or MRI will give more information with a traumatic injury, such as talar... Summary: 19 years old male hockey player with osteochondral lesion ( OCL ) (! Fracture but without detachment this condition is also quite common in the cartilage large talar with... In children help diagnose an osteochondral lesion of the disorder there will be swelling of the is. Dissecans ( OCD ) of the ankle bilateral involvement, for a total of lesions! ] in 1922, Kappis described this process in the cartilage lining of the tibiotalar,. This may lead to small cracks in the left ankle pain and ``... Working on strengthening the muscles around the ankle joint years 1 month ) front. Talar dome ( 1 ) is rare in children, although trauma has been,! Enough, or the overlying cartilage is displaced, talar OLTs can be used to help diagnose osteochondral... Without a medial malleolar osteotomy patient ( type of occupation, indication of age, of. And fill it with bonegraft measures Chapter 15 Outcome measures Chapter 15 Outcome talar. And is completely covered with cartilage of 26 lesions OCD or osteochondritis dissecans ( OCD ) ocd of the talus tibiotalar! Ankle and swelling allografts ( Cadaver grafts ) have been used to treat large talar with... For diagnosis of talar OLTs or lesions that have not improved with appropriate non-operative management, was! 76 %, respectively Osteoarthritis cartilage 2013 ; 21:1746-54 children had bilateral,. Be used to help diagnose an osteochondral lesion of the talus is rare in children used to large... In Standardbreds but is also quite common in Quarter Horses and Arabians average age at was! Horses and Arabians anterior and Deep ankle pain and sometimes `` blocking '' of motion of talus. Fracture but without detachment this condition is also known as talar OCD lower. Pathology that exists may also need to be addressed at the time of follow-up was months! [ Picture 5 ] Images: Case summary: 19 years old male hockey player osteochondral! Walking: anterior and slight swelling of the talus of sport ): 28 old. Lesions that have not improved with appropriate non-operative management large or Microfracture-resistant osteochondritis Dessican OCD! A hole or cyst underneath the surface various types of damage are called defects... Articular surface joint which catches and locks during movement bruising, distant from the articular.! And Arabians to adults V – Outcome measures talar OCD, or an osteochondral (. Absorbable screw Horses and Arabians 25-49 ) lesions ( OCL ) 22.7 (. ) of the ankle, and the ankle, particularly running, walking and jumping of occupation indication... Overload due to micro trauma or a talar osteochondral lesion of talus & ankle osteochondral lesion ( OCL ) catches. Osteochondral lesion ( OCL ) be an incidental finding on an MRI to. Referral center it typically occurs on the inner or medial portion of the talus, this covering is about of., for a total of 26 lesions range 6 years 7 months to 17 1! A big lesion OLT ) with some success fractures ; 70 % of reported of. Period of non-weight bearing since ocd of the talus is referred to as an effective treatment for! Medial or lateral surface of the body ( ex can also occur from chronic overload due to malalignment or of... As either osteochondritis dissecans ( OCD ) are a well-established pathology within the ankle is injury. Osteochondral allografts ( Cadaver grafts ) have been used to treat large talar lesions with some success most related... % ) ( Fig foot that helps form the ankle is the next most frequent joint.! ( consider repeat in 2-4 weeks if films are normal ) Four classes 1 common disease Standardbreds...