The AOFAS ankle-hindfoot score was the most frequently used functional outcome measure. One would use a non-invasive ankle distractor to distract the joint and check the lesion. Medial lesions tend to be located posteriorly and have been described as cup-shaped, because they are often deeper with a more significant osseous component. Physiotherapy is then recommended to rehabilitate the affected knee or ankle. This finding is not a consistent rule, because OLTs can have variable appearance throughout the talar dome. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. Sometimes this synovitis is more symptomatic to the patient than the lesion itself. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. � Injured bone and cartilage are removed in this treatment for promoting healing stimulation. Ancillary imaging studies are useful when a high clinical suspicion exists or further clarification of the extent and nature of the lesion is needed. 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. “Osteo” means bone and “chondral” refers to cartilage. Hyaline cartilage, however, cannot be regenerated once injured. Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. 3-C). Lateral lesions, however, are more often associated with trauma, specifically an inversion and dorsiflexion ankle injury. Niemeyer et al. The orthopaedic surgeon makes incisions on the ankle to access the injured area. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans Surgical treatment is required if the symptoms persist. Surgery most commonly involves an ankle arthroscopy. In their recent work exploring why only some osteochondral defects in the ankle are painful, van Dijk and colleagues. These features should be noted and may offer clues as to the physiologic process and appropriate treatment (Fig. Several imaging specific classification systems have been developed with this goal in mind. The vast majority of patients experience no pain or swelling even 10 years after surgical treatment of such lesions in the ankle. At earlier stages (stage 1 to 4), a number of options … “Osteo” means bone and “chondral” refers to cartilage. The extent of surgery is determined by the size of the lesion, the presence of ankle instability and the location of the lesion. The cartilage is nourished by the synovial fluid, but it does not have its own blood supply and is not innervated.5,6 Articular cartilage can be divided into four zones.7 The fibrillar sheet and lamina splendens make up the most superficial layer; this is the thinnest layer with the greatest ability to resist shear stress. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). The subchondral plate may be fractured or compacted and the underlying bone may have become sclerotic. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Marrow-stimulating techniques, particularly microfracture, have shown good to excellent results in most patients with small (<15 mm) acute lesions, and have a low complication rate. Box 1 Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Only gold members can continue reading. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. 1. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral; medial talar dome lesions more common; location medial talar dome. 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. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. Native articular cartilage consists of hyaline cartilage. By doing this, the bone defect is treated without causing any damage to 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). A great deal of variance exists; however, several patterns have been described. 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.8 T2-weighted and ProSet T1 fat-suppressed images have both been recommended because of their superior sensitivity for detecting cartilage abnormalities.8 The stability of a lesion can also be assessed on the MRI through observing surrounding inflammation and edema (see Fig. 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… Surgeons are cautioned that MRI may exaggerate the extent of osseous involvement in OCLs.8 A threshold beyond which arthroscopy is unlikely to yield satisfactory results has been shown to exist around lesions greater than 1.5 cm2.10–12. Sometimes this synovitis is more symptomatic to the patient than the lesion itself. Procedures incur additional risks to the patient than the lesion itself a revolution of treatment options for was! Extent of osseous involvement in OCLs joint and check the lesion itself T2-weighted images, increased signal intensity can described. Cautioned that mri may exaggerate the extent of surgery is determined by the size of the lesion clues. 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