OD, angloamerikanisch auch Osteochondritis dissecans) ist eine umschriebene Knochenläsion unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper (Gelenkmaus) enden kann. Ankle ROM exercises, peroneal strengthening, progressive ambulation, and proprioception training. Examine for crepitus or mechanical signs with ankle ROM. Weak evidence suggests that a genetic component might be involved in some OCDs (, OCDs can be produced in cadaveric models by shear and compression forces (, Chronic: Recurrent injury from chronic ankle instability, Lateral OCD is associated with a recognized traumatic episode in 93% of cases (, Medial OCD is associated with a recognized traumatic episode in 61% of cases (. Osteochondral lesion (OCL) is a term used to describe an injury or abnormality of the articular … 2F) (arrow). Radiographs are unremarkable. The mosaicplasty technique for osteochondral lesions of the talus. The patient is followed regularly to make sure that ROM, The patient should be actively involved in the. Die Osteochondrosis dissecans (OCD, auch angloamerikanisch Osteochondritis dissecans) ist die umschriebene aseptische Knochennekrose unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper enden kann. It can occur in all age groups. Copyright © 2020 Lineage Medical, Inc. All rights reserved. The most common sites are the posteromedial (53%) (Fig. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. Stage 1 • 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. OCD usually causes pain during and after sports. The historical term for this grouping of pathologies, osteochondritis dissecans (OCD), emphasized a localized vascular deficiency within the talus as the principle pathology with the symptoms being secondary to loss of adequate chondral support &/or cyst formation within the talus. Nonoperative management recommendations range from activity modification alone to nonweightbearing in a cast. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome.
The average age at surgery was 22.7 years (range, 19-34). It is uncertain whether these OLT or conventional OCD (best studied in the knee) represent differ-ent manifestations of a common pathologic process or sepa-rate pathologies. Stage VI: massive osteochondral defects of the talus. Pathology . Subchondral bone is penetrated to allow bleeding and fibrin clot formation. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. Evaluate for tenderness over the talar dome. © 2020 - TeachMe Orthopedics. INTRODUCTION. Treatment algorithm for OLT lesions overlaps with the treatment for OCD and depends on lesion stability. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): If a lesion is seen on plain radiographs, Best method for accurately characterizing the size and extent of a defect, Tends to overestimate the size of a lesion because of bone marrow edema. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. “Osteo” means bone and “chondral” refers to cartilage. Die Osteochondrosis dissecans (kurz OCD bzw. When not displaced, a chronic osteochondral fragment often is attached to the defect by fibrous tissue. In the ankle OCD can occur anterolateral or posteriomedial. • Cartilage injury with underlying fracture and surrounding bony edema, • Stage 2a without surrounding bone edema, often limited secondary to pain or effusion, evaluate for ligamentous laxity or insufficiency, suspicion for OLT in setting of equivocal radiographs, helpful in evaluating subchondral bone and cysts, less reliable in purely cartilaginous lesions of nondisplaced OLTs, provides fine detail of lesions for pre-operative planning, persistent pain following injury, ankle sprains that do not heal with time, variable edema patterns, may overestimate degree of injury, unstable lesions show fluid deep to subchondral bone, predicts stability of lesion with 92% sensitivity, nondisplaced fragment with incomplete fracture, size > 1 cm and displaced lesions, shoulder lesions, salvage for failed marrow stimulation or drilling, period of immobilization in cast or boot for 6 weeks, followed by progressive weight bearing with physical therapy emphasizing peroneal strengthening, range of motion, and proprioceptive training, Arthroscopy with marrow stimulation (microfracture or antegrade drilling), debridement of unstable cartilage flaps to create stable and contained defect using curettes or shaver, loose bodies and cartilage removed using shaver or grasper, microfracture awl placed perpendicular to surface and tapped into subchondral bone 2-4 mm deep, inflow stopped to allow fat or blood to emanate from holes, indicating adequate penetration, Kirschner wire can be passed using anterior portals, or transmalleolar for central or posterior lesions, talus dorsiflexed and plantar flex to necessitate only 1 transosseous passing of wire, articular cartilage delamination and graft failure, 65-90% improvement in patient reported outcomes, fibrocartilage formation at site of lesion in 60% of patients on second-look arthroscopy, no correlation noted with patient outcomes, Arthroscopy with retrograde drilling and bone grafting, evaluate cartilaginous surface for softening, dimpling with probe seen, Kirschner wire drilled from sinus tarsi into defect, fluoroscopy often helpful to confirm location, if bone grafting indicated, cannulated drill placed over K wire, Osteochondral autograft and allograft transplant, dictated by location of OLT and concomitant procedures required (i.e. Bony fragment may - revascularise & unite - undergo AVN & not unite . Delaying surgical intervention for chronic OCD does not appear to alter results of later surgery. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Although OCD of the talus is, by definition, detachment of an osteochondral fragment of the talar dome occurring in a growing patient, symptomatic OCD is more typically observed in adults. Osteochondral defects of the talus is aseptic bone necrosis. He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. Any procedure that requires an osteotomy necessitates nonweightbearing until the osteotomy heals (4–8 weeks). The sagittal MRI demonstrates non-displaced mid-medial lesion of OLT, Hepple stage 3, in figure 2E (arrow) and displaced mid-lateral lesion of the OLT, Hepple stage 4, in (Fig.  Although majority may be associated with trauma, some may develop insidiously. Procedures that regrow hyaline cartilage, such as autologous chondrocyte transfer: Cartilage is harvested (usually from the knee) and grown in culture. Giannini S, Buda R, Grigolo B, et al. x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity. Osteochondritis dissecans, unspecified ankle and joints of foot. Children are thought to have better healing potential than adults. Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescents1 and may lead to considerable debility. Osteotomy usually is required as part of the surgical approach. Fig. Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. Physical therapy and NSAID's have not alleviated the symptoms. Berndt & Harty Xray Classification . Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. Table 3. Maire-Clare Killen and Rajiv Limaye shed light on a path of treatment that is constantly evolving. A 30-year-old professional ballet dancer presents with persistant ankle pain after an ankle sprain 6 months ago. Free, official coding info for 2021 ICD-10-CM M93.279 - includes detailed rules, notes, synonyms, ICD-9-CM conversion, index and annotation crosswalks, DRG grouping and more. Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. Pathology . The MRI demonstrates the osteochondral lesions of the talus (OLT). Stage 2 - partially attached osteochondral fragment / flap . More complex scaffolds that better replicate the microarchitecture of articular cartilage may become available.  This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. 1–3 Two common lesions are notable on the talus. Cartilage damage was noted in 17–66% of ankles with lateral ligament injuries [ 3 , 12 , 21 , 26 ]. Treatment is thus most appropriately based on the patient's symptoms, a very relevant fact given that many osteochondral lesions are incidental findings. 3 A debridement of the chondral part is required if symptomatic. Loomer R, Fisher C, Lloyd-Smith R, et al. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. All Rights Reserved. The options for treating OCL are numerous and a number of surgical procedures can be performed arthroscopically.
The top of the talus is part of the joint and is covered with articular cartilage , … Stage 2 - partially attached osteochondral fragment / flap .
Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Osteochondritis dissecans(OCD) is a problem that causes pain and stiffness of the ankle joint. The coronal plane of the MRI demonstrates anteromedial lesions of OLT, Hepple stage 1 and 2A in figure 2A, and 2B (arrow), respectively. A 43-year-old male sustained a left ankle injury 3 years ago. The top of the talus is dome-shaped and is completely covered with cartilage (connective tissue that allows the ankle to move smoothly). Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Santrock RD, Buchanan MM, Lee TH, et al. Cyst may develop under fragment . unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV These lesions are of high clinical relevance as they are commonly missed … On the lateral aspect of the ankle it most often occurs from trauma. Radiographs at the time were negative and his pain improved over the next two months. The mean time of follow-up was 36 months (range, 25-49). It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Microfracture or drilling: 4–6 weeks of nonweightbearing is recommended to allow the defect to heal, with ankle ROM encouraged. 1 ) and anterolateral (46%) talar dome ( 1 ). Although biomechanically inferior to hyaline cartilage, fibrocartilage formation appears to be sufficient for smaller lesions. Physical exam reveals some joint swelling but no ligamentous instability. Procedures that reduce and stabilize the displaced fragment: Usually recommended only for lesions that are large enough to be amenable to internal fixation.
Berndt & Harty Xray Classification . Overlying cartilage may degenerate . Osteochondritis Dissecans (OCD) Talus/Tibia The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. Weightbearing radiographs should be obtained initially. It often develops above a bone cyst. (OBQ13.46)
If the subchondral bone is violated, the defect attempts to heal with fibrous tissue or fibrocartilage. Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. Es verbleibt dann ein Gelenkflächendefekt (Mausbett). What is the next appropriate step in the management of this patient? Other possible causes include ischemic events (AVN). Figure C shows the corresponding MRI. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain
Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. - Gregory Berlet, MD, Foot & Ankle⎪Osteochondral Lesions of the Talus, Asymptomatic Medial Talar Dome OCD in a 17M, Osteochondral Lesions of the Talus with Midfoot Arthritis, Talus fracture, OCD, cartilage fragment, subchondral cyst. [ 2 ] KEY FACTS • The natural history of osteochondral lesions of the talus appears to be fairly benign, especially as it relates to the risk of the development of arthritis. What would be the next most appropriate step for treatment? Therefore, ankle fracture, sprain, and chronic ankle instability are risk factors. The lateral injuries to the Talus (ankle bone) are usually shallow and cup shaped. Letts M, Davidson D, Ahmer A. Osteochondritis dissecans of the talus in children. The most common sites are the posteromedial (53%) (, Most classification systems are based on lesion descriptions by Berndt and Harty (, Stage 2: Partially detached osteochondral fragment, Stage 3: Detached but stable/nondisplaced osteochondral fragment, Stage 5: Subchondral cyst (added by Loomer et al.) Stable Procedures that transfer hyaline cartilage to the defect: OATS/mosaicplasty, allograft transfer, Generally recommended for large lesions or lesions that fail other forms of treatment. Complications include malunion or nonunion of an osteotomy, persistent pain, stiffness, and arthritis. • There are… 1. Sie kann die meisten Gelenke des menschlichen Körpers betreffen, sie tritt aber vor besonders häufig im oberen Sprunggelenk … Start as acute intra-articular fracture . Acute fractures do better than chronic lesions. Make sure the patient does not have other. 6,51 This cartilage is cultured to grow chondrocytes, which can be viable for longer than 1 year. 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). - James Stone, MD, Evolving Technique: The Role Of Osteotomy For The Treatment Of Osteochondral Lesions Of The Talar Dome - Listen Up!- Phinit Phisitkul, MD, MACI & Newer Techniques: I Told You This Before: Wake Up Everyone! Cannot evaluate subchondral abnormalities. The goal in osteochondral defects of the talus in Stages I and II according to Berndt and Harty is revascularization of the lesion. Figures A and B are radiographs of the left ankle. ACI is a 2-stage procedure in which hyaline cartilage is harvested from the anterior aspect of the talus or a nonweightbearing portion of the knee in the first stage. Treatment principles of osteochondral lesions of the ta… Although the cartilage cap remains viable (. Traumatic chondral defects, on the other hand, are often related to shear. 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