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osteochondral lesion ankle treatment

Bernt and Harty’s, CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. Plain radiographs, CT, and MRI are all intended to help with treatment selection and preoperative planning where indicated; however, MRI seems to offer the most useful information and should be performed in most cases. Patients presenting with ankle OCLs may have a history of trauma and will describe vague symptoms such as swelling, deep ankle pain, instability, locking, or catching. The initial insult involves some level of joint or articular damage, whether from trauma or other metabolic, genetic, vascular, or idiopathic processes.2 Many lesions are often traced back to a specific ankle sprain, ankle fracture, or other lower extremity trauma.3 Alternatively, nonspecific repetitive microtrauma may generate an OCL over time, or asymptomatic necrotic lesions may become symptomatic with subtle injuries. ��@By:���'pH��0012�)f`�?�� T�c Surgeons are cautioned that MRI may exaggerate the extent of osseous involvement in OCLs. Surgical treatment of talar OLTs includes: Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. Remove the lesion and all non-viable articular cartilage. Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. Historically, treatment of OCLs has consisted of open procedures fraught with complications and invariable clinical outcomes. The treatment strategy for osteochondral lesions depends upon the location and lesion size. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). Understanding these dynamics of the lesion provides clues to the origin and may assist in directing treatment. They will act as an irritant in the joint space, promoting synovial inflammation and subsequent symptoms. “Osteo” means bone and “chondral” refers to cartilage. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. The quality and condition of the subchondral bone plate and the underlying trabecular bone are important to know. Hyaline cartilage has abundant water content, accounting for approximately 75% of the cartilage matrix.5,6 The matrix also contains fillers such as proteoglycans that aid in resisting compressive forces. Arthroscopic Treatment of Ankle Osteochondral Lesions, Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,*, a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA, b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester Road South West G-10, Seattle, WA 98166, USA, c Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics and Podiatric Surgery, Kaiser Permanente, 280 West MacArthur Boulevard, Oakland, CA 94611, USA. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. Platelet-rich plasma is significantly better than hyaluronic acid. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. Treatment depends upon the size of the osteochondral defect and the condition of the overlying 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). For surgical treatment the following types of surgery are in clinical use: debridement and bone marrow stimulation, retrograde drilling, internal fixation, cancellous bone grafting, osteochondral autograft transfer, autologous chondrocyte implantation, and allograft transplantation. Native articular cartilage consists of hyaline cartilage. On T2-weighted images, increased signal intensity can be seen surrounding completely detached lesions, and bone edema may be present. Box 1 Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Only gold members can continue reading. Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. Osteochondral lesions of the talus (OLT) are more common than lesions of the tibial plafond. Medial lesions tend to be more common and, although often atraumatic in origin, can occur from inversion and plantar flexion ankle injuries. The pathophysiology of OCLs must be appreciated to fully understand why the various treatment modalities are effective and when to use them. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. On T2-weighted images, increased signal intensity can be seen surrounding completely detached lesions, and bone edema may be present. For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. The healthy tissue is transplanted into holes in the ankle joint until it forms a smooth surface. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. The deepest layer is the calcified cartilage, the beginning of which is called the tidemark, which separates the hyaline cartilage from the underlying subchondral bone. This finding can be explained by a similar mechanism in which the subchondral plate is fractured and the fluid content of the cartilage is exsanguinated and forced into the subchondral bone with repetitive weight-bearing pressures. Several MRI classification systems have been proposed, most of which stage lesions from chondral bruising through a detached fragment with a focus on the quality of the cartilage and the nature or absence of its attachments. The talus is the bottom bone of the ankle joint. %PDF-1.3 %���� The loose cartilage is removed along with any damaged bone or cyst. Fig. This type of injury can be due to a severe ankle sprain that causes bone and cartilage to become loose, resulting in ongoing ankle pain. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. The most common surgical procedure for an osteochondral lesion is an arthroscopic exploration and treatment. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. MRI is the best imaging modality to detect evidence of high fluid pressures surrounding lesions, which manifest as high signal intensity around the lesion and bone marrow edema on fat-suppressed images. In their landmark paper, Berndt and Harty. 1), although this is of unknown importance for preoperative planning and prognosis. 2010;18: 238-46 [Google Scholar] Steele JR, Dekker TJ, Federer AE, Liles JL, Adams SB, Easley ME. 1). The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones.

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