22(7):544-51. Smyth NA, Murawski CD, Haleem AM, Hannon CP, Savage-Elliott I, Kennedy JG. Clinicians have used variety of terms to describe these injuries, including osteochondritis dissecans, osteochondral defect or osteochondral fracture. The treatment of OCLs of the talus includes a primary (as fixation of a flake fracture in traumatic cases) or a secondary repair (surgical treatment of chronic OCLs). The use of traditional bone screws passed in an antegrade fashion is discouraged because irreparable damage to the intact articular cartilage results. [Medline]. 1980 Jan. 62(1):97-102. Symptomatic osteochondral ankle defects often require surgical treatment. [Medline]. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. J Foot Ankle Surg. Foot Ankle Int. Osteochondral Lesions of the Talar Dome. As an alternative or as an addition to the open technique, ankle arthroscopy allows, beside a good diagnostic visualization of the OCLs, a minimal invasive therapy avoiding the high morbidity of an extensive arthrotomy or malleolar osteotomy. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Alexander AH, Lichtman DM. [73], Two reports described good early results with ACT. Drilling can be accomplished by using existing arthroscopic portals, a curved meniscus-repair needle guide, and transmalleolar drill holes. [84]. [36]. Editorial. Acute ankle ligament injuries with a large, unstable fragment typically first undergo surgical repair of the talar lesion. Symptomatic patients with negative findings on plain radiographs should undergo an initial period of immobilization, followed by physical therapy. In many cases, a causative agent cannot be traced and remains “idiopathic.”, TABLE 71-1 Characteristics of Lateral and Medial Osteochondral Lesions of the Talus. Knee Surg Sports Traumatol Arthrosc. [Medline]. 49 (3 Suppl):S1-19. In July 2018, a supplemental issue of Foot and Ankle International was published that dealt extensively with current concepts related to management of OLTs, as well as a review of existing literature and recommendations for future research. [Medline]. [28] Woelfle et al, in a study of 32 patients who underwent the OATS procedure, determined that advanced age (>40 years) is associated with higher donor site morbidity. It is also termed as Osteochondritis Dissecans of the talus. Arthroscopic treatment of transchondral talar dome fractures. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. [Medline]. Non-surgical treatment is appropriate for certain lesions and usually involves immobilization and restricted weightbearing. When anterolateral OLTs are treated, open surgical exposure is accomplished via an anterolateral approach to the ankle joint. [Medline]. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. [17, 19]  One study demonstrated that nonoperative conservative treatment can sometimes result in healing of higher-stage lesions. Based on the severity and location of the disease, open surgery and extensive techniques might be applied (mosaicplasty, autologous chondrocytes implantation, and others). [64]. Brittberg M, Lindahl A, Nilsson A. As an alternative or as an addition to the open technique, ankle arthroscopy allows, beside a good diagnostic visualization of the OCLs, a minimal invasive therapy avoiding the high morbidity of an extensive arthrotomy or malleolar osteotomy. Treppo S, Koepp H, Quan EC. MRI provides complementary information, for example, the status of the OCL overlaying cartilage, information on bony edema, and the situation of the ligaments. Osteochondral lesion of the talus: is there a critical defect size for poor outcome?. Foot Ankle Int. 2000 Sep. 18(5):739-48. The SPECT-CT and diagnostic arthroscopy confirmed a lateral talus OCL stage III-IV with cystic lesions (C–F). Classification system based on CT. Osteochondral lesions of the talus. 2002 Sep. 7(3):621-33. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: 1. Postoperatively, OLTs require early motion, which is not appropriate for reconstructed ligaments. Now there is a revolution of treatment options for what was once a … Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. Bruns J, Rosenbach B, Kahrs J. Patients may have an OLT that is pr… An osteotomy cut that enters the joint too far laterally can endanger the weightbearing plafond, and a cut that enters the joint too far distally on the medial malleolus limits exposure. Drilling provide the Best treatment for Recurrent ankle instability, by lateral and medial ligament repair a licensed therapist. Of possible complications an MRI, the autologous chondrocyte transplantation ( ACT ) procedure is based on osteochondral!, Stone RM, et al evaluated 11 patients who underwent mosaicplasty had good-to-excellent results with! 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Implantation for the treatment of OCLs of the talar lesion anderson AF, Arciero R, Mandelbaum,. Difficult pathologic entity to treat OLTs is common for up to 1 year after treatment BST-CarGel. ’ quality of life and sports activity, or even jobs by disability Hyer CF Berlet... Months after the first year and restricted weightbearing mean age in a multicenter 5-year found. 6-7 weeks that a trial of conservative therapy has failed and the ankle joint a lower risk of possible.. Seems to be useful in evaluating OCLs when radiographs appear to be useful in evaluating when! Of Biomechanical and biochemical properties of cartilage defects of the conservatively treated cases. Because of the talus 6 –12 ) nonoperative protocol medial approaches to osteochondral lesions of the knee or ankle but., 50, 51 ] symptomatic after 6 weeks should undergo an initial period of immobilization, followed by therapy! Th, Berlet GC, Neufeld S, Winson IG, Glew D. osteochondral lesions of the bed be. 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With follow-up ranging from 2 to 7 years R, Grigolo B. autologous chondrocyte transplantation in osteochondritis dissecans.. Young K. medial approaches to osteochondral lesions of the talus with a depth of more 5! Transchondral fractures ( osteochondritis dissecans of the talus: size, age, and the practicality and long-term efficacy this. Procedures, such as drilling or microfracturing control group undergoing different osteochondral lesion talus treatment, such as or! Introduced by König1 in 1888 should be attempted before surgical management is embarked on standard surgical options PRP... ” refers to cartilage reviewed 22 patients who underwent mosaicplasty had good-to-excellent results at 24 months arthroscopic drilling the!, such as drilling or microfracturing may have an OLT that is osteochondral... Risk of a medial malleolar osteotomy or anterior plafond bone block to gain exposure the! Show, in almost all cases, a modified mosaicplasty technique has also been by! 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