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Management of Osteochondral Lesions of the Talar Dome

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Abstract Osteochondral lesion of the talus OLT is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment.

The radiography demonstrates the osteochondral lesions of the talus OLT. Table 1. Radiographic classification of transchondral fractures of the talus. Transchondral fractures osteochondritis dissecans of the talus. J Bone Joint Surg Am.

MRI grading system with arthroscopic correlation for osteochondral lesions of the talus. Osteochondral lesions of the talus: Table 3. MRI staging system for osteochondral lesion of the talus.

Stage Definition 1 Articular cartilage damage only 2a Cartilage injury with underlying fracture and surrounding bony edema 2b Stage 2a without surrounding bony edema 3 Detached but nondisplaced fragment 4 Detached and displaced fragment 5 Subchondral cyst formation Hepple S, Winson IG, Glew D.

Foot Ankle Int. Table 4. CT staging system for osteochondral lesions of the talus. Arthroscopic treatment of osteochondral lesions of the talus: Orthop Trans. Table 5. Arthroscopic staging system for osteochondral lesions of the talus.

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Open Technique The anterolateral and mid-lateral lesions of the talus can be accessed either open or anterior arthroscopic techniques [ 61 , 66 ]. Excision 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.

Bone Marrow Stimulation Excision and curettage The loose chondral or osteochondral fragment is excised and unstable cartilage rim with the talar base is subsequently debrided and curetted using either open or arthroscopic techniques. A microfracture technique of osteochondral lesion of the talus is demonstrated. A mid-medial osteochondral lesion of the talus is demonstrated on Fig.

Anterolateral 2 , anteromedial 1 , and accessory portals 3 are demonstrated on Fig. The unstable cartilage rim was debrided using 4-mm shaver 3C. The chondral pick is used to create microfracture holes approximately 4-mm apart 3D-3E and the base of the osteochondral lesion after complete debridement and microfracture 3F.

After the tourniquet was deflated, the bleeding from the microfracture holes are demonstrated in Figure 3G-3H. Excision, Curette, and Particulated Juvenile Cartilage Particulated juvenile articular cartilage is prepacked allograft from donors aged younger than 13 years with viable human cartilage cells. Retrograde Drilling RD Retrograde drilling RD has been used in patients who have intact cartilage as it can avoid injury to the undetached talar cartilage as a non-transarticular procedure.

Excision, Curette, and Autogenous Bone Grafting 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 ].

A particulated juvenile cartilage technique has been demonstrated in the Fig. A mid-medial talar lesion is demonstrated in the Figs. The fibrin glue was subsequently laid on top of the juvenile cartilage 4F. Osteochondral Autograft Transplantation 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 [ , ] or ipsilateral talus [ ] with transplantation into the prepared defect site on the talus [ ].

Osteochondral Allograft Transplantation 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 [ , ]. The fresh osteochondral allograft transplantation technique is demonstrated. The lesion was measured by cannulated allograft OATS sizers and the K-wire was inserted on the center of the lesion 5B and the counterbore is then drilled to the lesion and subchondral bone to a depth of 6- to 8-mm 5C.

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The sizer is used to measure the depth 5D and the donor fresh talar allograft was secured in the allograft OATS workstation 5E. The talar allograft is implanted into the recipient talar bed until all edges are flush with the surrounding cartilage rim 5F. Metal Inlay Implant A novel metal inlay implant Hemicap, Arthrosurface, Frankin, MA technique was developed in for the lesion on medial side of the talus. Although the standard treatment of the OLT has remained controversial, a non-displaced Berndt and Harty Grade I and II lesion should be initially treated with conservative treatment with immobilization and restriction of the activity.

If conservative treatment fails, surgical treatment is indicated. An acute, displaced osteochondral lesion of the talus which is larger than 7. 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 via anterior or posterior arthroscopic technique.

Even though the bone marrow stimulation techniques have been proven to be effective treatment for symptomatic patients with small osteochondral lesions of the talus, the reparative tissue forming after the bone marrow stimulation is fribrocartilage Type 1 collagen predominant with less durability compared to normal hyaline cartilage Type 2 collagen predominant.

If the size of the lesion is larger and deeper or the sequela of failed previous bone marrow stimulation techniques, there is a good evidence to support the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation.

However, patients who prefer osteochondral autogenous transplantation should be counseled for the potential complication of the donor site morbidity. Osteochondral lesions of talus associated with ankle fractures. Foot Ankle Int ; 30 6: CrossRef PubMed. PubMed CrossRef. Submit Reference Number. Processing Time: Average publication time of 18 days between final acceptance of revised manuscript and its publication.

View Editorial Board. Readership Statistics: Join Our Editorial Board News release date: March 29, Description: Centre Antipoison-Centre de Pharmacovigilance, France. UCB S. Westat, USA. University of Oxford, UK. Almac Sciences, Northern Ireland.

Delft University of Technology, The Netherlands. Sapienza - University of Rome, Italy. Paris University, France. Instituto de Agroquimica y Tecnologia de Alimentos, Spain. University Clinic of Navarre, Spain. University of Vienna, Austria. Chiba University, Japan. National Central University, Taiwan. Flick AB, Gould N. Osteochondritis dissecans of the talus transchondral fractures of the talus: Review of the literature and new surgical approach for medial dome lesions.

Foot Ankle ; 5 4: Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br ; 82 3: Osteochondral lesions of the talus. J Bone Joint Surg Am ; 62 1: Berndt AL, Harty M. Residual disability following acute ankle sprains. Treatment of articular cartilage defects in athletes: Orthopedics ; 21 7: Hermanson E, Ferkel RD.

Bilateral osteochondral lesions of the talus. Foot Ankle Int ; 30 8: Orthop Trans ; Kappis M. Dtsch Z Chir ; Osteochondritis dissecans: J Trauma ; 6 2: Foot Ankle Int ; 28 2: Current concept review: Foot Ankle Int ; 31 1: Prospective study on diagnostic strategies in osteochondral lesions of the talus. J Bone Joint Surg Br ; 87 1: Osteochondritis dissecans of the talus.

J Bone Joint Surg Am ; 29 3: Osteochondral lesions of the talus in a sports medicine clinic. A new radiographic technique and surgical approach. Am J Sports Med ; 12 6: Osteochondral fractures of the dome of the talus.

J Bone Joint Surg Am ; 71 8: Usefulness of MR imaging in the detection of talar dome injuries. MR imaging of osteochondral lesions of talus.

J Comput Assist Tomogr ; 11 2: Follow-up study of MRI for osteochondral lesion of the talus.

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Foot Ankle Int ; 21 2: Value of MR imaging in staging osteochondral lesions of the talus osteochondritis dissecans: Characterizing osteochondral lesions by magnetic resonance imaging.

Arthroscopy ; 7 1: Radiol Med Torino ; 92 6: Foot Ankle Int ; 32 3: Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus. Nuclear medicine communications Apr Arthroscopy ; 19 4: A revised classification. Foot Ankle Int ; 20 A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc ; 16 Arthroscopic treatment of chronic osteochondral lesions of the talus: Am J Sports Med ; 36 9: Arthroscopic treatment of osteochondral lesions of the talus.

J Bone Joint Surg Am ; 68 6: February ; J Am Acad Orthop Surg ; 13 3: Systematic review of treatment strategies for osteochondral defects of the talar dome.

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Foot and ankle clinics ; 8 2: Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am ; 95 Surgical treatment of osteochondritis dissecans of the talus: Arch Orthop Trauma Surg ; 9: Arthroscopic treatment of osteochondral defects of the talus: J Bone Joint Surg Am ; 95 6: Treatment principles for osteochondral lesions in foot and ankle.

Int Orthop ; 37 9: Treatment strategies in osteochondral defects of the talar dome: Fracture stage 4 of the lateral talar dome treated arthroscopically using Biofix for fixation. Arthroscopy ; 6 3: Osteochondritis dissecans of the talus: Clin Orthop Relat Res ; Transchondral talar dome fracture.

Arch Orthop Trauma Surg ; 4: Lesions of the trochlea tali. Osteochondral fractures and osteochondritis dissecans of the trochlea tali.

Radiol Clin Basel ; 44 5: A review of twenty-one cases of transchondral fracture of the talus. J Trauma ; 7 3: Treatment of osteochondral lesions of the talus: Knee Surg Sports Traumatol Arthrosc ; 18 2: Dome fracture of the talus. A report of ten cases. J Bone Joint Surg Br ; 55 2: Osteochondral fractures of the talus.

A long-term follow-up. J Bone Joint Surg Br ; 69 1: Gustillo RB. Osteochondral fractures of the talus Osteochondritis Dissecans. Minn Med Hakimzadeh A, Munzinger U. Osteochondrosis dissecans: Osteochondrosis dissecans of the ankle joint: Der Orthopade ; 2 1: Microfracture for osteochondral lesions of the ankle: Arthroscopy ; 24 1: Foot Ankle Int ; 32 Foot Ankle Clin ; 18 1: Arthroscopic drilling for the treatment of osteochondral lesions of the talus.

J Bone Joint Surg Am ; 81 9: Osteochondral lesion of the talus: Arthroscopic bone marrow stimulation techniques for osteochondral lesions of the talus: Am J Sports Med ; 41 3: Prognostic significance of the containment and location of osteochondral lesions of the talus: Am J Sports Med ; 41 1: Giannini S, Vannini F.

Operative treatment of osteochondral lesions of the talar dome: Foot Ankle Int ; 25 3: Gilbert JE. Current treatment options for the restoration of articular cartilage. Am J Knee Surg ; 11 1: The late results of surgical treatment. J Bone Joint Surg Br ; 64 4: Surgical treatment of transchondral talar-dome fractures osteochondritis dissecans. Long-term follow-up. J Bone Joint Surg Am ; 62 4: Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus.

Foot Ankle Int ; 26 8: Parisien JS. Am J Sports Med ; 14 3: Postoperative complications of posterior ankle and hindfoot arthroscopy. J Bone Joint Surg Am ; 94 5: Lui TH.

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Arthroscopic bone grafting of talar bone cyst using posterior ankle arthroscopy. The Journal of foot and ankle surgery: Fixation of a posteromedial osteochondral lesion of the talus using a three-portal posterior arthroscopic technique. Operative ankle arthroscopy. Long-term followup The American journal of sports medicine ; 17 1: Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: Am J Sports Med ; 34 1: The juxtoretroperoneal route in the operative treatment of fracture of the malleolus with posterior margin fragment.

Surg Gynecol Obstet ; Hindfoot endoscopy for posterior ankle pain. Instr Course Lect ; Am J Sports Med ; 21 1: Stone JW. Osteochondral Lesions of the Talar Dome. J Am Acad Orthop Surg ; 4 2: Arthroscopic treatment of transchondral talar dome fractures: Arthroscopy ; 15 2: Posterior ankle arthroscopy: Arthroscopic treatment of transchondral lesions of the talar dome. J Am Podiatr Med Assoc ; 77 8: J Bone Joint Surg Br ; 85 7: Microfracture for chondral defects of the talus: Knee Surg Sports Traumatol Arthrosc ; 18 5: Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture.

Knee Surg Sports Traumatol Arthrosc ; 23 3: Arthroscopy ; 22 Advancements in ankle arthroscopy. J Am Acad Orthop Surg ; 16 Clinical and MRI results after microfracture of osteochondral lesions of the talus.

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Arch Orthop Trauma Surg ; Treatment of osteochondral lesions of the talus with particulated juvenile cartilage. Foot Ankle Int ; 34 9: Arthroscopy techniques ; 3 4: Arthrosc Tech ; 4 2: Arthroscopic treatment of talus osteochondral lesions with particulated juvenile allograft cartilage.

Foot Ankle Int ; 35 Journal of pediatric orthopedics Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int ; 20 8: Retrograde drilling for osteochondral lesions of the talar dome. Am J Sports Med ; 34 9: Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus.

Int Orthop ; 36 8: A novel computer navigation system for retrograde drilling of osteochondral lesions. Sports Med Arthrosc Rev ; 22 4: Accuracy analysis of Iso-C3D versus fluoroscopy-based navigated retrograde drilling of osteochondral lesions: J Bone Joint Surg Br ; 89 3: MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: Eur Radiol ; 24 7: Richter M, Zech S. Oper Orthop Traumatol ; 23 5: Arthroscopy-assisted retrograde drilling of osteochondral lesions of the talar dome.

J Am Podiatr Med Assoc ; 95 1: Autogenous bone grafting for the treatment of talar dome lesions Bruns J. Orthopade ; 26 6: Results of surgical therapy]. Unfallchirurg ; 96 2: Fixation of osteochondral lesions of the talus using cortical bone pegs.

J Bone Joint Surg Br ; 84 3: Osteochondral fracture of talus treated with bioabsorbable pins Talar dome fracture repaired using bioabsorbable fixation. J Am Podiatr Med Assoc ; 96 3: Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: Am J Sports Med ; 36 5: Cartilage transplantation techniques for talar cartilage lesions.

J Am Acad Orthop Surg ; 17 7: Tissue engineered bone: J Biomed Mater Res A ; 67 1: Early results of autologous chondrocyte implantation in the talus. J Bone Joint Surg Br ; 87 2: