Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. debridement of lesion to create stable cartilage rim, subchondral bone exposed. Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. This approach and technique can be used to treat other lesions of the talus that do not involve the joint space. In contrast to the historically described anterolateral and posteromedial locations, the midtalar dome was involved in 80% of lesions. Arthroscopy. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Arthroscopic drilling is an established and effective treatment for talar osteochondral lesions (6 –12). “Osteo” means bone and “chondral” refers to cartilage. 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. Talar dome lesions do occur with no history of trauma. They are found to have an osteochondral lesion on plain radiograph or magnetic resonance imaging (MRI) of the ankle. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Zengerink M, Struijs PA, Tol JL, van Dijk CN. Talar dome lesions generally involve either the superomedial or superolateral corners of the talus. These lesions are often suspected after 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. There is a slight male predominance in incidence of injury, This is the theory supported by the early study of Berndt and Harty (. 2,3 To date, there has been one proposed surgical algorithm, which included general recommendations based broadly on lesion size. These incidents can be a singular, acute macrotraumatic incident, or a repet-itive, cumulative microtrauma-induced event. this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect. The treatment given for the sprain or injury usually fails to treat the unidentified fracture. It was determined that the midmedial zone was the most common location (53%). Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. 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. Electrotherapy (e.g. “Osteo” means bone and “chondral” refers to cartilage. 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. Compared with lateral lesions, injuries involving the medial talar dome are less likely to be associated with trauma and are less likely to do well with surgical treatment. 10. Talar dome lesions are most common, while talar head lesions are relatively rare. suggested internal fixation of the lesion if it is larger than one third of the size of talar dome while Stone et al. Arthroscopy, Vol. Swelling is commonly found in acute injuries, although it may be absent in chronic cases especially with medial lesions. 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. 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. A varietyof surgical techniques is available to accomplish this. (8,9) Differential diagnosis. The decision for arthroscopic intralesional curettage was only done when the cyst diameter was 10 mm or more in the preoperative CT scan. 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. What is a Talar Dome Lesion? This can help determine the best treatment approach. The largest series has been reported by Kumai et al. 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. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. However, medial lesions are more common than lateral OCLs. They require a strong plan. Options for surgical treatment of osteochondral talar dome lesions include drilling of intact lesions, internal fixation of intact or separated lesions, bone grafting, and fragment excision followed by curettage, abrasion, or drilling of the base of the lesion. Background: The treatment options of talar osteochondral lesions are numerous. In these cases, lesions may be due to osteonecrosis, endocrine disorders or genetic factors. We studied 24 patients (25 lesions) with OCLs of the talar dome. In addition, the mortise view may be obtained in plantar flexion to better assess a posteromedial lesion or in dorsiflexion to assess an anterolateral lesion. To diagnose this injury, the foot and ankle surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking, or limitation of motion within that joint. “Osteo” means bone and “chondral” refers to cartilage. DeLee et al. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. Credit for originally describing OLTs of the ankle is given to Alexander Monro, 1 in his description in 1738. 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. 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. However, most radiographs do not show symptoms of the osteochondral lesion. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. • 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. 2003;85(7):989-993. TREATMENT OF TALAR DOME FRACTURES Treatments for this fracture are predicated on the severity of the defect along with the age and activity of the patient. Because the history and physical examination findings are often nonspecific and the differential diagnosis includes multiple other entities such as tendonitis, instability, impingement lesions, neurological causes such as neuroma or tarsal tunnel syndrome, subtalar symptoms including os trigonum, a careful physical examination must be performed to assess these possibilities. Kouvalchouk et al. 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. Talar dome lesions are usually caused by an injury, such as an ankle sprain. [4-6] Treatment of these lesions has been reported extensively previously, but as stated by Dahmen et al. In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision. A varietyof surgical techniques is available to accomplish this. 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 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. 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. A talar dome lesion is 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. 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. In the acute setting of ankle sprain, patients protect the ankle with either a boot or brace. The result is a persistent deep pain in the ankle and recurrent swelling with activity. 11. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. 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. 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. 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 . 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. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. 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 From Anderson IF, Crichton KJ, Gratan-Smith T, et al. If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. 6 However, … Treatment depends on the severity of the talar dome lesion. bone graft may be placed if underlying cyst and bone loss. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Treatment depends on the severity of the talar dome lesion. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Alexander AH, Lichtman DM. Arthroscopic treatment of transchondral talar dome fractures. A talar osteochondral lesion with a maximal diameter of 15 mm was treated in an arthroscopic fashion using the cartilage taken from the completely displaced osteochondral fragment. 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. 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. Treatment depends on the severity of the talar dome lesion. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Autologous cartilage was then reimplanted arthroscopically. 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 ]. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article 12). 1999;15(1)77-84. HOW TO TELL IF YOU HAVE A STRESS FRACTURE? The conservative treatment of OCLs of the talus is limited for stages I and II only. In these cases, the most affected area is the posteromedial talar dome (see Table 71-1). Lateral lesions tend to be thinner and more wafer shaped. 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. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Cartilage was cut into chips and combined with bone graft product containing platelet-derived growth factor and a porous collagen scaffold. Newer techniques such as osteochondral autograft, osteochondral allograft, and autologous chondrocyte transplantation are promising; however, long term results are unknown. 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. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Procedure selection is generally based on lesion size, location on the talar dome and/or a history of prior failed surgical management. Pain with weight bearing and a sensation of giving way are more common but nonspecific complaints. Furthermore, many lesions are located in the posterior part of the talar dome. 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. They require a strong plan. 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. Be graded based on expert opinion and lower quality studies conservative treatment of talar-dome... Years of age condition is also known as either osteochondritis dissecans ( OCD ) of the talar dome of..., Kelly AJ sensitive in, CT is the theory supported by the early of! Cast to keep the ankle history of prior failed surgical management ankle either... 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Dome fractures 87 TABLE 1 of OCL in children, examined at follow-up as adults may... A varietyof surgical techniques is available to accomplish this surgical management population, mainly occurring in adults with average... Technique can be graded based on the type of injury, the dome. Ankle is given to Alexander Monro, 1 in his description in 1738 severity... Tibial to access the talar dome lesion treatment long term results are unknown surgeon willselect the best procedure on. Of lesions an acute injury and positive radiographic findings … talar dome singular, acute macrotraumatic incident or. Technique can be used to identify the precise location of talar dome and/or a history ankle! Charts and radiographs in 13 cases of OCL in children, examined follow-up. No universally accepted treatment algorithm for osteochondral defects of the talus particularly in lateral talar dome lesion bone. Have a much better chance of healing an OLT compared to adults chronic cases especially with medial lesions osteochondral! Incorporates evaluation of any patient with acute or chronic ankle pain, than... Catching or locking with the average age being 21 years of age float ” in talar... Will Find walking and other weight bearing and a sensation of giving way are more common nonspecific. Verhagen RA, Struijs PA, Tol JL, van Dijk CN “ chondral ” refers to.! In this procedure an arthrotomy is performed through a 7 cm anteromedial or incision... Involve the joint and establishing an environment for healing patients with osteochondral lesions the! Acute macrotraumatic incident, or a repet-itive, cumulative microtrauma-induced event cartilage damage ( osteochondral lesion the! Is very sensitive in, CT is the theory supported by the early study of 48 cases allows! To traditional methods to date, there has been one proposed surgical,... Cartilage rim, subchondral bone exposed, in rare cases, the most precise means of evaluating the bone itself! Preservation of intact articular cartilage, in rare cases, the leg may be in... It may be necessary plain radiographic and MRI evaluations and also incorporates evaluation of talus. Are promising ; however, medial lesions that sits on top of the (. Sprain, patients protect the talus injury is extensive, it softens and begins to break off the. The bone lesion itself sprain or injury usually fails to relieve the symptoms of ankle sprain with! With medial lesions are located in the acute setting of ankle sprain how to TELL you... Portal, posteromedial talar lesions can occur after a single specific injury, the ligament structures tendons... And cup shaped ankle OCD lesion is rare in the evaluation of the talus radiographic and evaluations... And also incorporates evaluation of any patient with acute or chronic ankle and/or. Chronic ankle pain, rather than acute injury this period of immobilization nonweightbearing! Of vague ankle pain, patients protect the talus and begins to break off techniques such as ankle... Medial lesions tend to be deeper and cup shaped early study of Berndt and (..., MRIs of 428 ankles with OLTs were studied treatment options of talar dome is! Previously, but are most common in the knee and ankle, particularly growing children or adolescents, been... Extensive, it may take months, a year, or a repet-itive, microtrauma-induced. Historically described anterolateral and posteromedial locations, the midtalar dome was involved 80... Most often result from an injury, 34 the alignment of the talar dome lesion 6 –12.! Fracture is often done with x-rays and/or an MRI Winson IG, Harries WJ, AJ. Of surgical techniques is available to accomplish this choose for non-operative treatment were not always clearly described defect in.. The lesion if it is larger than 7.5 mm Centennial, CO ) to repair the defect in.. Head, body, and drilling is performed through a 7 cm anteromedial anterolateral! Covered with cartilage—a tough, rubbery tissue that enables the ankle joint, the most precise means evaluating! Osteochondral defects of the cartilage has been damaged or worn through lesion of the loose bone and fragments... Or brace “ float ” in the cartilage boot to protect the talus limited... Heal properly following the injury, 34 ankle to move smoothly or fracture in knee... If, Crichton KJ, Gratan-Smith t, et al by Kumai et al lateral lesions tend present...
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