osteochondral lesion of talar dome

Pettine KA, Morrey BF. This technique is a reconstructive bone grafting technique that use one or more cylindrical osteochondral grafts from the less weightbearing periphery of the ipsilateral knee [115, 116] or ipsilateral talus [117] with transplantation into the prepared defect site on the talus [118]. Troy Wentling York, PA. Codingline Responses: The arthroscopic code is CPT 29891 (arthroscopy, ankle, surgical; The effects of talar dome cartilage defects. Residual disability following acute ankle sprains. Patient with a Grade A-C had better outcomes when compared with Grade D-F as determined by the Modified Weber and AOFAS scoring systems (Table 5) [29]. Hakimzadeh A, Munzinger U. Osteochondrosis dissecans: results after 10 or more years. (Figure 3B). performed a prospectively randomized controlled trial (Level II study) with 33 ankles in 32 patients, showing no difference between chondroplasty, microfracture, and OAT technique with regard to Ankle-Hindfoot Scale (AHS) and the Subjective Assessment Numeric Evaluation (SANE) rating in patients with OLT [80]. Previous studies have reported significant improvement of functional outcomes and pain relief after performing this technique in patients who had failed primary bone marrow stimulation treatment [84, 85, 88]. Foot Ankle Int 2000; 21(2): 127-33. The signs and symptoms of a talar dome lesion may include: A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. Dragoni M, Bonasia DE, Amendola A. Osteochondral talar allograft for large osteochondral defects: technique tip. The largest series has been reported by Kumai et al. Int Orthop 2012; 36(11): 2279-85. Berlet et al. The ankle joint is first visualized with arthroscopy. J Am Acad Orthop Surg 2005; 13(3): 152-8. Peer-review of articles for the journal, which are in the area of expertise (2 to 3 times per year). Open access journals offer a good alternative for free access to good quality scientific information. Anders S, Goetz J, Schubert T, Grifka J, Schaumburger J. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. The purpose of autologous bone graft is filling the OLT defect and restoring the weightbearing properties of the transchondral lesions of the talus after excision and curettage [98]. [eng.]. Assenmacher proposed the term osteochondral lesions of the talus (OLTs). Foot Ankle Int 2004; 25(3): 168-75. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. 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. El-Rashidy H, Villacis D, Omar I, Kelikian AS. The techniques that can be performed include either mosaicplasty [67, 116, 119] or osteochondral autograft transplantation (OATS) procedures [115, 117, 118]. Previous studies have reported that osteochondral allograft transplantation demonstrates significant improvement of functional outcomes [129, 132-137]. [27] (Table 3 and Fig. The term “osteochondral lesion of the talus” (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In addition, posterolateral (PL) and posteromedial (PM) portals can be used for lesions located in the posterior half of the talus, as 54 percent of the talar dome can be visualized and accessed through the posterior ankle arthroscopy [63-65, 73]. (C) Particulated juvenile cartilage allograft pieces were placed into the lesion bed. “Osteo” means bone and “chondral” refers to cartilage. Forty-six patients (mean age 31.4 ± 7.6) affected by osteochondral lesions of the talar dome (OLT) received arthroscopic ACI between 2001 and 2006. The natural history of the OLT remains unclear due to paucity of longitudinal follow-up studies. This article summarizes the contemporary concepts in the clinical evaluation and treatment of OLTs with particular emphasis on surgical strategies. What code should we use for the excision, curettage, and drilling of osteochondral defect in the talus (i.e., osteochondritis dessicans of talus) while performing an ankle arthrotomy? Additionally several studies have noted the incidence of bilateral OLT to be around 10% [5, 7, 8]. Sports Med Arthrosc Rev 2014; 22(4): 215-8. [eng.]. Osteochondral allograft transplantation is an effective procedure for the treatment of large OLTs using mature hyaline cartilage allograft which provides an anatomically articulating surface and prevents ankle joint arthrosis by avoiding excessive weight on the remaining portion of the talus [128, 129]. The purpose of conservative treatment is to decrease or unload the injured cartilage, so bone edema can be resolved and necrosis can be prevented. The lack of these signs on physical exam does not exclude an OLT as often the physical exam signs are absent. Hangody L, Kish G, Kárpáti Z, Szerb I, Eberhardt R. Treatment of osteochondritis dissecans of the talus: use of the mosaicplasty techniquea preliminary report. For this reason, some now recommend the addition of SPECT-CT for the evaluation of OLT [25]. Professor Malemud is on the editorial board of several rheumatology, immunology and musculoskeletal journals and is Editor-in-Chief of the Journal of Clinical and Cellular Immunology and Global Vaccines and Immunology. February 1995; 1995. The top of the talus is dome-shaped and is completely covered with cartilage. Clin Orthop Relat Res 2011; 469(8): 2356-66. J Bone Joint Surg Br 2007; 89(3): 323-6. Usefulness of MR imaging in the detection of talar dome injuries. Foot Ankle Clin 2013; 18(1): 67-78. There is a currently limited literature to demonstrate the short-term and long-term outcomes of this technique. Bruns J. Botchwey EA, Dupree MA, Pollack SR, Levine EM, Laurencin CT. Tissue engineered bone: measurement of nutrient transport in three-dimensional matrices. Osteochondral fractures of the dome of the talus. Ragozzino A, Rossi G, Esposito S, Giovine S, Tuccillo M. [Computerized tomography of osteochondral diseases of the talus dome]. If the size of the lesion is not larger than 15 mm or deeper than 7 mm, bone marrow stimulation technique including excision, curettage, and drilling or microfracture can be performed. SPECT/CT in the management of osteochondral lesions of the talus. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Blevins FT, Steadman JR, Rodrigo JJ, Silliman J. Osteochondral lesions of talus associated with ankle fractures. 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). Schachter AK, Chen AL, Reddy PD, Tejwani NC. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). studied 12 patients with mean follow-up of 63 months, reporting that the improvement of AOFAS score was 43.5 to 88.5 and Hanover score was improved from 40.4 to 85.5 at final post-operative visit [110]. ", "Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The late results of surgical treatment. The presence of an osteochondral lesion may initially go undetected and may manifest many months after the initial ankle injury. It was later suggested to add a mortise view of the ankle with the ankle in maximal plantar flexion to evaluate lesions along the posterior medial dome [16, 17]. reported significant pain relief from 7.5/10 pre-operatively to 3.7/10 at 29-months post-operatively and the subjective function increased from 4.6/10 pre-operatively to 8.2/10 at 29-months post-operatively [92]. Arthroscopy 2008; 24(1): 106-12. Berndt and Harty proved this in a report in which anteromedial and posterolateral lesions were created using cadavers.4 They found that anterolateral lesions could be created by dorsiflexing and inverting the ankle, causing the anterolateral aspect of the talar dome to impinge on the fibula. 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. 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. Orthopade 1997; 26(6): 573-84. Indeed, the research articles span a wide range of area and of high quality. J Bone Joint Surg Br 2000; 82(3): 345-51. Osteochondritis dissecans: the question of etiology. J Bone Joint Surg Am 1980; 62(1): 97-102. Long-term follow-up. Moreover, Adams et al. [La Tomografia Computerizzata nella valutazione delle malattie osteocondrali della cupola astragalica. Raikin SM. “Osteo” means bone and “chondral” refers to cartilage. Hangody LT. H. Osteochondritis of the talus. The successful treatment of OCD lesion with drilling has been reported in the previous studies [60, 77]. Hermanson E, Ferkel RD. An osteochondral lesion to the talar dome is an injury that causes damage to the cartilage that sits on top of the talus. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Stage IIA: Cystic lesion with communication to the talar dome surface. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle. (100) In addition, Draper et al. Osteochondral Lesions of the Talar Dome. Hindfoot endoscopy for posterior ankle pain. They also reported the improvement of functional outcomes in patients who had failed primary microfracture and underwent repeated microfracture in 17 patients (mean improvement of AOFAS scores was 17.2 points) [50]. Foot Ankle Int 2011; 32(11): 1045-51. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. J Bone Joint Surg Am 2011; 93(7): 648-54. 1) and determined only by plain radiographs. Am J Knee Surg 1998; 11(1): 42-6. Am J Sports Med 2006; 34(9): 1450-6. However, Robinson et al. A novel metal inlay implant (Hemicap, Arthrosurface, Frankin, MA) technique was developed in 2007 for the lesion on medial side of the talus. J Bone Joint Surg Br 1973; 55(2): 319-26. Prone position has been reported for the arthroscopic treatment for the osteochondral lesion located on the posterior part of the talus [63-65]. Haene R, Qamirani E, Story RA, Pinsker E, Daniels TR. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. Ankle sprains and rotational rotational injury have been associated and reported as a potential mechanism of OLT pathogenesis. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community. Hoffmann M, Schroeder M, Rueger JM. The loose osteochondral fragment removal can alleviate ankle pain by preventing loose body irritation or blocking and preventing further damage by the loose osteochondral fragment to the normal cartilage tissue. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. Terminology. In patients with a large lesion or after a failure of previous bone marrow stimulation, biologic restoration techniques including the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation may have role. Symptomatic osteochondral ankle defects often require surgical treatment. Foot Ankle Int 2007; 28(2): 154-61. The etiology and mechanism of injury of the OLT remain unclear; however, it seems to be associated with either acute ankle injury/fracture or chronic ankle instability. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. 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]. Historically lesion position was considered to be anterolateral or posteromedial. The authors confirm that this article content has no conflict of interest. (Table 2). The ability to culture large numbers of cells for implantation is critical to the success of the procedure [107]. Previous studies with limited number of patients have demonstrated that the overall success rate of excision of OLT varied from 33 to 92 percent after using open techniques [47, 59, 74]. Foot Ankle Int 2009; 30(8): 723-7. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. 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