This approach is recommended when preoperative imaging indicates an OCL is in an accessible location and does not require full visualization or open treatment [, A medial malleolar osteotomy should be avoided when an arthroscopic approach can provide access and allow satisfactory treatment of an OCL. for OCD of the talus at a major Canadian pediatric referral center. dissecans (OCD) of talus ... – Younger patient – No history of trauma – More on medial side. There were 10 boys and 14 girls. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondritis dissecans (OCD) of the talus is rare in children. Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. 150 0 obj <>/Filter/FlateDecode/ID[<930980570CEFAF47B7D27834AAA75355>]/Index[105 67]/Info 104 0 R/Length 194/Prev 738197/Root 106 0 R/Size 172/Type/XRef/W[1 3 1]>>stream Abramowitz Y, Wollstein R, Barzilay Y, et al. Type-G lesions could also stem from excessive stresses on the medial side of the talar dome, associated with vascular or metabolic modifications, leading to deep necrosis farther from the subchondral bone than in type-O lesions. endstream endobj startxref Medial talar dome lesions are typically found in the central to posterior aspect of the talar dome and are therefore often inaccessible to arthroscopic procedures and techniques. Step-cut osteotomy of the medial malleolus for exposure of the medial ankle joint space. If the cartilage does not heal properly following the injury, it softens and begins to break … However, it can also occur from chronic overload … It is often associated with a traumatic injury such as a severe ankle sprain. �O!��o!�b �M�?�X���=����B�p��5��7�X�qv�����.� ��j�b,������u%6絛���ŌU?�X_���������a�c�������Rz��+��]��}��uﰂ>O��k����`��W��R����T�I�2lAU���׻�jmm�Ҫ0| �� 9����$��z�, �M����GҎN�g��e�ݞ��eBm�W��}���}IHg`���-"7�1�\�P�,�rU��y�l��]��*������]���*���|y���W�(�]sS��"+�n�ݺ�Xݿ�%���c�&u4�9.��Q����}.£")ͱ���2�Ӽ��'��6���Gi����C��� YV Baltzer AW, Arnold JP. “Osteo” means bone and “chondral” refers to cartilage. 1 article features images from this case. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). In 2 cases, OCL was associated with a fracture, in I the medial malleolus and in the other both nialle- oli. Two children had bilateral involvement, for a total of 26 lesions. Case Discussion. h�bbd```b``��@$S!�du�* ���~fk�H>%0[�V���H�(� �`ӔA$�)�|U ɸ�,nb��/_�5]��& ��H�u�]5���2�� $�����U���5A��S0�D*U��j �`�d�H�c`q�O�=�� 5� 6ȏ�K� ɯ7�20�����t%�30}x` �� � 171 0 obj <>stream When planning the treatment of osteochondral lesions of the talus, it is important to evaluate the articular cartilage to distinguish between stable and unstable lesions (1,2). Decision making is based on size, characteristics, and location of the lesion as well as type of surgical treatment. Treatment principles of osteochondral lesions of the ta… Talar dome lesions are usually caused by an injury, such as an ankle sprain. 2003;85-A:1051–7. Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. However, it can also occur from chronic overload due to … Therefore, an osteotomy must be placed through the tibial to access the ankle. 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. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Foot Ankle. h��mo�6�� … Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, … 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. Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying subchondral bone. [Picture 1] Additional investigation (CT/MRI): CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. “Osteo” means bone and “chondral” refers to cartilage. A medial talar dome injury is seen on a mortise x-ray view. Reproduction without express written consent is prohibited), The osteotomy cut is terminated just prior to reaching the subchondral bone and completed with an osteotome (Illustrations copyright of and reproduced with permission from JG Kennedy MD. [ 55 ] Arthroscopic treatment of OLTs can be accomplished by using wide-angle 2.7-mm arthroscopes, which provide more maneuverability than the older 4- … It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 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