2, No. Unless the injury is extensive, it may take months, a year, or even longer for symptoms to develop. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. However, most radiographs do not show symptoms of the osteochondral lesion. 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. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. [ Links ] 35. Sixteen patients (16 ankles) with symptomatic osteochondral lesions of the medial talar dome were treated arthroscopically with percutaneous retrograde drilling through the sinus tarsi. 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. How are talar dome lesions treated? Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. 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. Osteochondral lesions most often result from an injury, such as a sprain. Talar dome lesions are usually caused by an injury, such as an ankle sprain. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). There is an association with trauma to the ankle, particularly in lateral talar dome lesions. 10. It was determined that the midmedial zone was the most common location (53%). Cartilage was cut into chips and combined with bone graft product containing platelet-derived growth factor and a porous collagen scaffold. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Talar dome lesions are usually caused by … [4-6] Treatment of these lesions has been reported extensively previously, but as stated by Dahmen et al. Talar dome lesion treatment options. 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. Reasons to choose for non-operative treatment were not always clearly described. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. 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. 68(6):862-5. . If the lesion doesn’t heal correctly, the cartilage can break down, and sometimes, a fragment of cartilage can break away and “float” nearby. 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 diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. We will usually try to treat talar dome lesions with non-surgical treatment. 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. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment 2,3 To date, there has been one proposed surgical algorithm, which included general recommendations based broadly on lesion size. Procedure selection is generally based on lesion size, location on the talar dome and/or a history of prior failed surgical management. 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. Treatment depends on the severity of the talar dome lesion. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Talar dome lesions usually occur from an injury, such as an ankle sprain. Furthermore, many lesions are located in the posterior part of the talar dome. Talar dome fractures are often missed at the initial examination following an ankle sprain or injury. 1999;15(1)77-84. 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. in 1986. 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. They require a strong plan. 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. Treatment may comprise: Find a physiotherapist in your local area who can treat an osteochondral lesion of the talar dome. J Bone Joint Surg Br. 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 … 62(4):646-52. . Treatment of osteochondral lesions of the talus: a systematic review. “Osteo” means bone and “chondral” refers to cartilage. 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. If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Patients frequently present with an acute injury and positive radiographic findings. Arthroscopy. A variety of surgical techniques is available to accomplish this. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. 2, 1986 TRANSCHONDRAL TALAR DOME FRACTURES 87 TABLE 1. These incidents can be a singular, acute macrotraumatic incident, or a repet-itive, cumulative microtrauma-induced event. 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 . 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. 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. 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. 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). 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