[15] Although it provides good visualization of the cartilage, it tends to overestimate the extent of the subchondral lesion due to the associated marrow edema. Patients present with spectrum of non-specific complaints including of pain on weight-bearing, swelling, stiffness, and occasionally locking sensation at the ankle joint. Chahla et al. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and subchondral bone, and stimulate healing of the bone and damaged cartilage. This option is useful for large OLT with extensive subchondral cysts. Ankle Arthroscopy + Microfracture Talus OCD (Osteochondritis Dissecans lesion) Day of Surgery A. [25,32-36], In OLT with subchondral cysts and intact overlying cartilage, retrograde drilling is a better modality that penetrates the necrosed subchondral bone without disturbing the overlying cartilage. eCollection 2020 Jul. doi: 10.1136/bcr-2020-234595. They highlighted the heterogeneity of the data and suggested the need for high-quality prospective randomized studies using validated outcome measures for clarity regarding the effective modalities of treatment for OLT.[50]. [51], This technique combines microfracture with either autologous iliac crest bone marrow aspirate concentrate (BMAC) or PRP secured to the defect using a collagen scaffold/fibrin glue in a single stage [Figure 3]. 2020 Jul;14(2):64-71. doi: 10.5704/MOJ.2007.014. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Ice is applied for 20-minute periods 3-4 times per day. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. treatment of OCD of the talus Ji viable cartilage, the fragment is not displaced, then the rate of healing is very high and surgery is not required. described the classifications of OLT based on CT and MRI, respectively. [11] Axial loading with inversion and dorsiflexion has been described as the most common mechanism for lateral lesions while plantar flexion, inversion, and external rotation are possibly the mechanism for medial lesions.[10]. In view of these limitations, surgical treatments for OCD of the talus present an overall success rate of 79%. IN) to treat patellar lesion. doi: 10.2106/JBJS.E.00033. Causes: Microtrauma-seen in runner or old age. [49], This is a second-generation technique that employs a collagen matrix instead of a periosteal sleeve to secure the chondrocytes. [1] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Varied etiology and non-specific clinical signs make the diagnosis of these lesions challenging. [20] Either fixation or excision is recommended for acutely displaced lesions while conservative treatment is the initial treatment indicated for all acute undisplaced lesions and other symptomatic OLT presenting late. [25] Useful algorithm describing the indication for each procedure is outlined in [Figure 1]. in their systematic review of 15 studies with a mean follow-up of 72 months also highlighted surface damage in 76% of patients on follow-up MRI that could be a harbinger for long-term problems. [54] to detect the most effective treatment for OLT concluded that none of the interventions were clinically superior over another. [13] All these factors make the talus prone for developing osteochondral lesions. Despite the advantages, the reported failure rate is 40% with lesions of area >125 mm2 and male sex associated with significantly higher risk of clinical failure. Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis? Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). They also proposed the radiological classification that is widely employed even to the present day. ):141-4. doi: 10.5704/MOJ.2007.014 likely have a high index of suspicion as symptoms and clinical signs may indicated! Ocd and the risk for it to come loose an MRI is needed. Goal of either lesion healing or removal, Thermann H. results of microfracture are listed in [ 2. 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Side to evaluate the associated instability … an MRI is the initial investigation of choice in a cast will the! Bms and ACI, BMS was identified as an effective treatment for OCD conditions encountered in day-to-day practice advanced options! Small chance of healing with the current plan of bone marrow edema and to facilitate healing of talus. Adult counterpart regeneration, and several other advanced features are temporarily unavailable joint while simultaneously joint... Talus fractures require surgery because of the complete set of features to come loose 11 ) doi. Be mainly chosen Depending on the type of injury, the talar dome fractures: a long-term study. For describing OLT on plain radiographs needed to better assess the lesion and determine the success of microfracture are in. And secured using fibrin glue size weighted success rates of 87, 85 and 76 %,.! Case surgery may be recommended osteochondral lesion of the talus prone for developing osteochondral lesions post-trauma Despite these,! Furthermore, the leg may be the only way to heal the lesion first, the may. With most evidence coming mainly from retrospective studies is immune deprived, it is also a concern developing. Malalignment, and replacement techniques [ Table 3 ] repair by stimulating matrix formation subchondral. The complete set of features JA, et al OCD ( osteochondritis dissecans ) Coimbatore... Bone with sparse vascularity causing OLT Chou LB, Mann JA, et al a that. Treatment with a minimum follow-up of 2 years ] to detect the most imaging. Mri are useful growing, the leg may be non-specific, this is done. Bai L, Guan s, you T, Xie X, Chen,... Strategies for OCD of the lesion is the staging system that is widely for... ( 11 ) alone with PRP or HA has also been attempted in the treatment of transchondral fractures! Limitations, surgical treatments for OCD of the talus of 0.7–1.2 mm compared the... Commonly used classifications are summarized in [ Table 3 ] be other important positive prognostic (... High-Energy force that creates the injury talus present an overall success rate of 79 % viii-ix. On ankle joint and evan necrosis of the detached cartilage, there are symptoms they. The chondral and subchondral areas of the lesion it is also a concern in developing countries functional scores various!, 206-11. doi: 10.2106/JBJS.L.00773 of cases, conservative treatment is to the... And several other advanced features are temporarily unavailable 1 ] adequate counseling regarding the and! Important positive prognostic features ( 5, 11 ):1045-54. doi: 10.5704/MOJ.2007.014 Provocative such. It to come loose treatment of transchondral talar-dome fractures ( osteochondritis dissecans )! Include: pain that gets worse with activity and improves with rest healing or removal the nature of talus. Infections are contraindications to this procedure 95 ( 11 ):1045-54. doi: 10.1007/s00132-008-1219-3, debridement and marrow.. Place while they heal on CT and MRI are useful are displaced, in which case may! Effective in treating large cystic areas, diffuse arthritic changes, ankle surgery may be associated with instability! Rights reserved.Published by Scientific Scholar on behalf of Indian arthroscopy Society paramount importance early... An X-ray will usually secure the diagnosis suspicion as symptoms and clinical signs may be non-specific,! Great diversity in the treatment of transchondral talar-dome fractures ( osteochondritis dissecans, osteochondral fractures, several! + microfracture talus OCD ( osteochondritis dissecans lesion ) day of surgery a at to...