An osteochondral lesion may also be known as an osteochondral defect. When there is a break, tear, separation, or disruption of the cartilage that could be referred to as an osteochondral lesion. Abstract. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. A history of ankle trauma The anaesthetist will discuss the anaesthetic involved. This surgery is recommended for patients who experience recurrent ankle sprains despite a course of physiotherapy treatment. However, If you continue to have instability despite a 2-3 month trial of physiotherapy treatment then surgery is indicated. Most candidates for articular cartilage restoration are young adults with a single injury, or lesion. Ankle arthroscopy is the technique of choice for treatment of. Osteochondral Injuries of the Ankle. The total number of included patients with osteochondral talar lesions in the 52 studies was 1361. 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). E-Book Chapters: Trauma eBook Ch 9: Osteochondral Fractures and Injuries of the Talus. INTRODUCTION. OATS uses bone-cartilage cylinder grafts from a non-weight bearing portion of another joint and transplants these on the site of the defect. • You may remove your dressing 48 hours after surgery, and then you may get your Patients can have three different kinds of complaints, whether or not in combination: 1. Surgery was therefore discussed. The optimum treatment for these injuries continues to evolve. They are thought to occur in up to 70 per cent of acute ankle fractures or ligament injuries, with trauma being by far the most common underlying aetiology . The bone right underneath the cartilage will also be injured. Ankle and shoulder problems may also be treated. This may take the form of a general anaesthetic with an ankle block. A physiotherapy protocol is provided for the patient’s physiotherapist. Patient to remain NWB for 6 weeks if larger lesion Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. ischaemia and idiopathic osteochondral ankle lesions do occur.10,11 The most common location of osteochondral defects is in the knee, followed by the talar dome.12 ODs can either heal and remain asymptomatic or progress to deep ankle pain on weightbearing, prolonged joint swelling, recurrent synovitis, diminished range of motion complications: a systematic review. Ankle Arthroscopy for Osteochondral Lesion Paul Cammack, MD 763-302-2226 WOUND CARE • You will be placed into a soft dressing at the time of surgery. This can cause pain when wearing shoes. It may also be possible to relax the leather on shoes to make room for a bunion. There are a number of other causes of pain in the big toe such as osteoarthritis, rheumatoid arthritis, infection and gout. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. This is possible due to less damage to the surrounding skin, ligaments and tendons. The ankle joint is an articulation of the end of the tibia and fibula (shin bones) with the talus (heel bone). The arthroscopic treatment of osteochondral lesions of the talus depends on whether or not the cartilage is intact inside the ankle joint. The patient may weight bear as tolerated after the operation. There is no single cause of bunions. This may cause complications of the donor site and the ankle. The article describes an all-arthroscopic technique, which includes debridement, marrow stimulation, and application of a micronized allograft cartilage matrix with fibrin sealant. The surgery is performed as a day surgery procedure. The pain tends to be worse in the first 3-4 days after surgery. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. Osteochondral autograft transplantation has shown positive clinical outcomes in the treatment of medium-sized osteochondral lesions of the talus, according to a … The goal of non-surgical treatment is to relieve pressure on the foot and to prevent pressure sores and foot ulcers. This is known as an osteochondral cyst. Methods: One hundred five consecutive patients with osteochondral lesions of the ankle who underwent ankle arthroscopy with microfracture were prospectively followed up for a mean of 31.6 ± 12.1 months. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Offering a thorough primer on treating osteochondral lesions of varying sizes and comcomitant presentations, this author discusses key diagnostic principles and optimal procedure selection. Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries.  This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. This was a relatively simple day-stay procedure. The right ankle was involved in 57%, the left in 43%. The talus is the bottom bone of the ankle joint. This surgery is performed by knee surgeon Dr Aaron O’Brien MD in St George and Utah. Symptomatic osteochondral ankle defects often require surgical treatment. FIGURE 71-1 Osteochondral lesion of the talus. The patient can usually localize the pain to the front (anterior), back (posterior), inner side (medial) or outer side (lateral) of the ankle. This is the technique of choice for treatment of joint surface damage (chondral or osteochondral lesions) and loose bodies. 2016 Mar;47(3):757-61. doi: 10.1016/j.injury.2015.10.029. The joint is visualised using a small (2.7mm, 2.3mm or 1.9mm diameter) telescope (fibre-optic camera) inserted through the small incisions. Lesion size was overwhelmingly correlated with successful outcome. Osteochondral lesions of the talus (OLTs) are characterized by damage to the articular cartilage of the talus and its underlying subchondral bone. Surgery can correct painful bunions. (435) 628-9393 Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. The osteochondral autologous transplantation (OAT) procedure done for large OCD lesions involves a single surgery and takes advantage of implanting mature autologous bone … This is accomplished by prescribing accommodative shoes with a wide toe box - sandals or extra depth shoes with soft moulded insoles. There is a very low risk of infection and the recovery is expected to be more predictable. An osteochondral lesion of the talus is often a difficult problem to treat. The patient may weight bear as tolerated after the operation. Before treatment of a painful bunion can begin, medical evaluation is needed. Specialised miniature instruments are then introduced into the joint through the other keyhole incision. A bunion is a prominence over the inside part of the foot where the big toe joins the rest of the foot. A talar osteochondral lesion (OLT) can develop after ankle sprains or ankle trauma. General Enquiries 08 9346 6000
Severe cartilage damage does not tend to heal very well on its own, so surgery is often necessary in these cases. Dr Lam can visualise the joint on a high definition screen. 106,120. An arthroscope (telescope to look into the ankle joint) is used. Symptomatic osteochondral ankle defects often require surgical treatment. At this point the doctors in Portugal suggest surgery to fraguemento extraction and treatment of osteochondral lesion of about 12mm in size with the microfracture process. Osteochondral lesions of the talus are an increasingly recognised pathology of the ankle joint and can lead to significant complications if not treated appropriately. The bulky dressing should remain in place for at least 2 weeks as this provides cushioning against the pressure of the brace on the wound. In keyhole surgery there are several incisions of approximately 3mm. An ankle stirrup brace or backslab would also be applied. 6. Patients are able to wear their own shoes after the dressing is removed. Perform the initial testing without contrast dye injection. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. High heel, pointed toe shoes are not the primary cause of the hallux valgus but they do cause it to be painful. Protect surgical ankle 2. The patient may walk straight after the operation. The average age was 31 years [18–75], 63% were male and 37% female. It is often associated with a traumatic injury such as a severe ankle sprain. Considering the disadvantages of MRI including the high cost and limited availability, the results of this study may help to ex … High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases Injury. The talar dome has no direct muscle attachments(2); during norm… The patient may fully weight bear on their feet with the aid of crutches after the surgery. Older patients, or those with many lesions in one joint, are less likely to benefit from the surgery. There is limited understanding of cartilage damage and its repair. A bad ankle sprain results in tearing or rupture of the lateral ligaments (ATFL and CFL). Some patients find that they are comfortable earlier than this and can discard their crutches at that stage. Minimising the time on one’s feet in the first week after leaving hospital helps recovery. Osteochondral lesion is a common cause of pain occurs in ankle and knee joint region. Begin Range of Motion 4. These injuries very commonly occur in running sports such as soccer, basketball and netball. Osteochondral Allograft Transplantation Surgery for Osteochondral Lesions of the Talus in Athletes. The anchors stay in the tip of the fibula permanently unless it causes irritation. Such lesions are fractures or tears in the cartilage that covers one of the bones within the joint. Physiotherapy exercises commence 1-2 weeks after the operation. Arthroscopy allows direct visualisation of the joint surface. The defects cause deep ankle pain associated with weightbearing. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Chuckpaiwong et al 15 studied 105 osteochondral lesions of the ankle (tibial and talar) treated with ankle arthroscopy, debridement, and microfracture. Foot Ankle Int, 26 (2005), p. 793‒802. … A study by Verhagen and colleagues found MRI has a greater sensitivity in comparison to computed tomography (CT). Patients often notice a painful lump on the top of the big toe joint (sometimes called a dorsal bunion). Once the big toe is in the corrected position, screws are implanted to fix the bone in this position. Radiographs are of very minimal use for osteochondral lesions but can sometimes show a cystic lesion or a flecked piece of cartilage. Specific changes in the program will be made by the Ankle Arthroscopy is the technique of choice for treatment of: Arthroscopic surgery is sometimes referred to as “keyhole surgery” as it is performed through very small incisions. Osteochondral lesions of the talus are an increasingly recognised and diagnosed pathology and can often be difficult to treat. This should remain in place for 5 days. You may wear ordinary shoes at the end of week six after surgery. The knee is the most common area for cartilage restoration. The talar dome has no direct muscle attachments(2); during norm… The major advantages of arthroscopic surgery are that it is associated with a faster recovery due to less pain and earlier mobilisation of the ankle than after conventional open surgery. This produces a spectrum of injuries to the lateral ankle. 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