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Talar Osteochondral Lesion

Paul M Ryan, Robert C Turner, Claude D Anderson, Adam T Groth
Background: The treatment of osteochondral lesions of the talus (OLTs) with a juvenile cartilage allograft is a relatively new procedure. Although other treatment options exist for large OLTs, the potential advantage of a particulated juvenile allograft is the ability to perform the procedure arthroscopically or through a minimal approach. No previous studies have looked at the results of an arthroscopic approach, nor have any compared an arthroscopic technique with an open approach. Purpose: To compare the outcomes of an arthroscopic transfer technique with the previously published open technique...
December 2018: Orthopaedic Journal of Sports Medicine
Magdalena Posadzy, Julie Desimpel, Filip Vanhoenacker
Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions...
December 16, 2017: Journal of the Belgian Society of Radiology
Andrija Jurina, Valentina Delimar, Damjan Dimnjaković, Ivan Bojanić
Lateral inverted osteochondral fracture of the talus (LIFT) is a rare variant of stage IV osteochondral lesion of the talus (OLT), where the fragment is inverted in situ by 180°. The management of LIFT lesion is very challenging and early recognition crucial, given that treatment options depend on the articular cartilage condition and sufficiency of the adjacent bone of the displaced fragment. We describe two LIFT cases referred from other institutions after unsuccessful conservative treatment of OLT. They presented with pain, swelling and tenderness over the anterolateral aspect of the right ankle...
June 2018: Acta Clinica Croatica
Boguslaw Sadlik, Lukasz Kolodziej, Mariusz Puszkarz, Hubert Laprus, Michal Mojzesz, Graeme P Whyte
BACKGROUND: Surgical treatment of osteochondral lesions of the talus affecting the medial aspect of the talar dome is typically performed using medial malleolar osteotomy to optimize access. This study compares clinical outcomes of lesions repaired using biologic inlay osteochondral reconstruction in patients who did or did not undergo medial malleolar osteotomy, depending on defect dimensions. METHODS: Patients treated for osteochonral lesions of the talus through a medial mallolar approach or arthroscopically-assisted approach were prospectively followed...
March 15, 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Francesc Malagelada, Miki Dalmau-Pastor, Jordi Vega, Raman Dega, Callum Clark
BACKGROUND: Access to the talar dome for the treatment of osteochondral lesions (OCLs) can be achieved via several different approaches to the ankle joint. The recent description of an anatomical nine-grid scheme of the talus has proven useful to localise OCLs but no studies have demonstrated which approaches are indicated to access each of these zones. The aim of this study is to demonstrate the access afforded to each zone by each approach. METHODS: Four standard soft tissue ankle approaches were performed simultaneously in ten fresh-frozen cadavers (anterolateral - AL, anteromedial - AM, posterolateral - PL, posteromedial - PM)...
July 18, 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Tiago Baumfeld, Daniel Baumfeld, Marcelo Prado, Caio Nery
INTRODUCTION: Various procedures have been used to treat osteochondral lesions of the talus. Among the new alternatives to treat these lesions, Autologous Matrix-Induced Chondrogenesis (AMIC® ) has proven to provide satisfactory results through medium-term follow-up. The aim of this study is to report early post-operative clinical results of patients submitted to the AT-AMIC® technique and autologous bone graft, when necessary, for OLT's at a eight-month minimum follow-up. METHODS: This is case series of 17 consecutive patients that were submitted to AT-AMIC® , between January of 2016 and April of 2017...
July 25, 2018: Foot
Kaj T A Lambers, Aimane Saarig, Hayley Turner, Sjoerd A S Stufkens, Job N Doornberg, Gino M M J Kerkhoffs, Ruurd Jaarsma
BACKGROUND: The aim of this study was to report the incidence of associated osteochondral lesions (OCLs) on postop CTs, which may benefit from arthroscopic treatment, in patients with rotational type ankle fractures with syndesmotic injury. The diagnosis and treatment of associated OCLs may be an additional benefit of the use of arthroscopy in the management of rotational type ankle fractures with syndesmotic injury. METHODS: We retrospectively reviewed data of a prospective cohort study of patients who underwent open reduction and surgical fixation of an ankle fracture with syndesmotic injury...
October 11, 2018: Foot & Ankle International
Tomoyuki Nakasa, Jiro Nakashiro Md PhD, Nobuo Adachi Md PhD
Arthroscopic repair of the lateral ankle ligament using the anchor system has been increasingly reported. We treated a 39-year-old woman who suffered from pain and instability in her left ankle joint. She was diagnosed with chronic ankle instability and an osteochondral lesion of the talar dome. For this patient, arthroscopic repair of the anterior talofibular ligament (ATFL) was performed. Standard anteromedial and anterolateral portals were placed, and excision of the osteochondral fragment and microfracture were performed...
September 19, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Rebecca M Irwin, Yoshiharu Shimozono, Youichi Yasui, Robin Megill, Timothy W Deyer, John G Kennedy
Background: The incidence of coexisting osteochondral lesions (OCLs) of the tibia and talus has been negatively correlated with successful clinical outcomes, yet these lesions have not been extensively characterized. Purpose: To determine the incidence of coexisting tibial and talar OCLs, assess the morphologic characteristics of these lesions, and evaluate whether these characteristics are predictive of outcome. Study Design: Case series; Level of evidence, 4...
August 2018: Orthopaedic Journal of Sports Medicine
Kyung Rae Ko, Won-Young Lee, Hyobeom Lee, Hee Seol Park, Ki-Sun Sung
PURPOSE: To compare the surgical outcomes of the two different ankle stabilization techniques. METHODS: This randomized controlled trial aimed to compare the outcomes of the modified Broström procedure with [calcaneofibular ligament (CFL) group] or without CFL repair [anterior talofibular ligament (ATFL) only group]. Of the 50 patients randomly assigned to two groups, 43 were followed up prospectively for ≥ 2 years (CFL group: 22 patients, 36.6 ± 13.1 months; ATFL Only group: 21 patients, 35...
August 6, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Evelyn P Murphy, Christopher Fenelon, Niall P McGoldrick, Stephen R Kearns
Osteochondral lesions of the talus refer to a chondral or subchondral defect of the articular cartilage and potentially the underlying bone. Ankle sprains are an extremely common injury; approximately 27,000 ankle sprains occur per day in America. Fifty percent of these can lead to a cartilage injury to the ankle. There has been a high quoted rate of failure with conservative measures of up to 45% in some series. Surgical options are largely broken down into 2 groups, namely, reparative or regenerative treatments...
April 2018: Arthroscopy Techniques
Sascha Beck, André Busch, Christoph Zilkens, Sebastian Warwas, Marcus Jäger
BACKGROUND: Osteochondral lesions of the medial talus (OLT) frequently lead to chronic ankle pain and osteoarthritis. Arthroscopic debridement, subchondral bone stimulation by drilling, and microfracturing are options for primary therapy in small lesions. In larger lesions, restoration of the talar dome contour seems to be a mandatory course of action. METHODS: In a case series, we followed up four patients being treated with a focal resurfacing prosthetic due to large osteochondral talar lesions...
August 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Altuğ Duramaz, Emre Baca
PURPOSE: Ankle arthroscopy is a useful tool for detection and treatment of accompanying intraarticular pathologies in acute ankle fractures. The purpose of this study was to compare the treatment results of talus osteochondral lesions (OLT) with debridement and microfracture in arthroscopy assisted surgery of acute ankle fractures. METHODS: Eleven consecutive patients who were treated with arthroscopic acute debridement and 14 consecutive patients who were treated with arthroscopic acute microfracture in the treatment of ankle fracture were included in the study...
October 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Connor Delman, John Wuellner, Chris Kreulen, Gregg Lundeen, Eric Giza
Osteochondral lesions of the talus often occur following ankle sprains and fractures. Operative intervention is typically required because of the diminished intrinsic repair capability of talar articular cartilage. Several techniques have evolved that emphasize replacing the defect with cartilage that closely mimics the biological properties of hyaline articular cartilage. The goals of operative treatment are resolution of symptoms, physiologic healing, and restoration of function while eliminating the need for further intervention...
August 2018: Foot & Ankle Specialist
Tomoyuki Nakasa, Yasunari Ikuta, Mikiya Sawa, Masahiro Yoshikawa, Yusuke Tsuyuguchi, Yuki Ota, Munekazu Kanemitsu, Nobuo Adachi
BACKGROUND: In the evaluation of osteochondral lesions of the talar dome (OLT), bone marrow lesions (BML) are commonly observed in the subchondral bone on magnetic resonance imaging (MRI). However, the significance of BML, such as the histology of the overlying cartilage, is still unclear. The purpose of this study was to investigate the relationship between the BML and cartilage degeneration in OLT. METHODS: Thirty-three ankles with OLT were included in this study...
August 2018: Foot & Ankle International
Melissa Corso, Christopher DeGraauw, William Hsu
Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. Case Presentation: A 17-year-old male competitive soccer player presented with a 6-7 month history of medial ankle pain after an inversion sprain. He presented with locking and giving way of the ankle with weight-bearing and pushing off the foot to the contralateral side...
December 2017: Journal of the Canadian Chiropractic Association
Riccardo D'Ambrosi, Camilla Maccario, Chiara Ursino, Nicola Serra, Federico Giuseppe Usuelli
BACKGROUND: To assess the functional and radiological outcomes after arthroscopic talus autologous matrix-induced chondrogenesis (AT-AMIC® ) in 2 groups: patients with and without bone marrow edema (BME). METHODS: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for symptomatic osteochondral talar lesion. Clinical and radiological parameters were evaluated with VAS score for pain, AOFAS and SF-12 at T0 (preoperatively), T1 (6 months), T2 (12 months), T3 (24 months) and MRI and CT-scan at T0 , T1 , T2 and T3 ...
June 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Eun Hae Park, Kwang-Bok Lee
RATIONALE: A nondisplaced chip fracture can be missed on MRI. Opposed-phase imaging from mDixon MRI produces an interesting artifact called black boundary artifact. This artifact can provide better contrast at the fracture line resulting in better depiction of a small chip fracture on MRI. PATIENT CONCERNS: We present a case of small nondisplaced chip fracture at the lateral talar dome that was well delineated only with the aid of a black boundary artifact after using T2-weighted opposed-phase imaging from turbo spin-echo two-point modified Dixon ankle MRI...
December 2017: Medicine (Baltimore)
Jessica J M Telleria, Lauren V Ready, Eric M Bluman, Christopher P Chiodo, Jeremy T Smith
BACKGROUND: Vitamin D deficiency affects over 1 billion people worldwide and is common in foot and ankle patients. The prevalence in those with osteochondral lesions of the talus (OLTs) is unknown. This study identified the prevalence and risk factors for hypovitaminosis D in patients with an OLT. METHODS: Serum 25(OH)D levels were obtained from patients presenting with an OLT from May to November during 2007 to 2016. Hypovitaminosis D was defined as 25(OH)D less than 30 ng/mL (75 nmol/L)...
April 2018: Foot & Ankle International
Sydney C Karnovsky, Bridget DeSandis, Amgad M Haleem, Carolyn M Sofka, Martin O'Malley, Mark C Drakos
BACKGROUND: The purpose of this study was to compare the functional and radiographic outcomes of patients who received juvenile allogenic chondrocyte implantation with autologous bone marrow aspirate (JACI-BMAC) for treatment of talar osteochondral lesions with those of patients who underwent microfracture (MF). METHODS: A total of 30 patients who underwent MF and 20 who received DeNovo NT for JACI-BMAC treatment between 2006 and 2014 were included. Additionally, 17 MF patients received supplemental BMAC treatment...
April 2018: Foot & Ankle International
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