An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. Actual surgical treatments for osteochondral lesions and early knee osteoarthritis seem to be promising. It is not a preferred option for younger patients, since failure of the knee replacement and the need for revision is more likely in younger patients. The treatment of an osteochondral lesion is based on the stability of the lesion. In some cases a cast must be worn for part or all of that period. the lateral osteochondral defect. One may use radiographs to check for a cyst formation or cartilage damage but this imaging rarely shows definitive involvement. Operative treatment might also be necessary if … 108. Pain often occurs with an increase in activities such as sports and is not present with rest. Our preferred technique is to use a 0.62 K-wire and drill lesions in the posterior medial region that cannot be reached with a chondral pic through a medial incision approach. Usually, an osteochondral lesion occurs when there is an injury to the joint, especially if there is an ankle sprain or if the knee is badly twisted. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. After performing this procedure, one should emphasize non-weightbearing for six to eight weeks and again use a CT scan to check healing. For stable lesions, non-operative management is usually the first step including: What Bunion Procedures Does A Surgeon Need To Master? The type of surgery that is most effective depends on the size, location and severity of the lesion. 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. Repetitive trauma has also been associated with the development of such lesions. Once the diagnosis has been confirmed, treatment may be surgical or non-surgical, depending on the nature of the OLT, presence of other injuries and patient characteristics. Non-operative treatment can be successful for non-displaced talar OLTs, especially if the condition is recognized and treated early, and the lesion is relatively small. © 2020 Cedars-Sinai. Scranton PE, Jr., Frey CC, Feder KS. An osteochondral lesion may also be known as an osteochondral defect. [] Although majority may be associated with trauma, some may develop insidiously. Although wearing a brace or cast may ease the discomfort of an osteochondral lesion, they are usually not enough to remedy the problem permanently, except in children, who can respond well to non-surgical treatment. Treatment options include: non-operative conservative therapy (including but not limited to modification of activity, injections, casting, or boots), various surgeries like “microfracturing” the affected bone which brings new cells to the area in hopes building new cartilage, or transplantation of cartilage/bone from a donor or different body part. the lateral osteochondral defect. Employ CT scanning to check for a solid repair at the six- to eight-week point. Within the knee, cartilage damage can happen between the thigh bone and the shinbone. It is at this point that the patient will present for further consultation. this is sutured … For most kids and young teens with osteochondritis dissecans, the … The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Nonsurgical Treatment Approaches. What Are The Vascular Ramifications Of COVID-19? If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical … In some cases, both an MRI and CT are needed to diagnose an osteochondral lesion. Three Easy Steps For A Simple And Reproducible Lapidus Procedure, When A Patient With A Sesamoid Fracture Develops Uncontrolled Pain And Swelling, Current Insights On The Diagnostic Algorithm For Charcot Neuroarthropathy, Keys To Deltoid Ligament Repair After Ankle Fracture, Protocols for the Prevention and Treatment of Pressure Injuries: Sustaining Outcomes at the Point of Care, Modern Techniques to Manage Infected Wounds in the Diabetic Patient: Integrating Advanced Technologies to Optimize Healing, Examining the Use of Purified Collagen Matrix with Antimicrobial for Treating Chronic Wounds. For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. All Rights Reserved. Microfractures, are often considered the first-line surgical treatment option due to the low costs and ease of the technique (34-38), while ACI is rather reserved as a salvage procedure (39-41, 45). As always, it is essential to check for ligament laxity and tendon injury, and address both of these issues at the time of surgery if they are problematic. When the latter is present, then joint replacement is often the only feasible treatment. This surgery may be performed open or arthroscopically. Cedars-Sinai has a range of comprehensive treatment options. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and subchondral bone, and stimulate healing of the bone and damaged cartilage. This is very simple to perform and one would make several drill holes into the lesion to allow for bleeding and fibrocartilage formation. We have found equally good outcomes with the use of autograft and fresh allograft, and therefore use the fresh allograft as our primary option. INTRODUCTION. The affected joint may also seem to be loose. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. “Osteo” means bone and “chondral” refers to cartilage. debridement of lesion to create stable cartilage rim, subchondral bone exposed. As the size of the lesion and, more importantly, the depth of the lesion increase, drilling and removal of the lesion show less than perfect outcomes. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Cartilage is a connective tissue that covers the bones between joints. This type of treatment is best in large lesions with a major defect of over 1 cm with extensive depth. Dr. Baravarian is the Co-Director of the Foot and Ankle Institute of Santa Monica. We have dealt with the actual ligament injury and its repair, treatment of peroneal tendon injuries and also conservative care of ankle injuries. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Scranton PE, Jr., Frey CC, Feder KS. Peroneal Tendon Dysfunction: Why Peroneal Tendon Tears Should Be Treated Like Posterior Tibial Tendon Tears. The final and most difficult type of lesion to treat is the subchondral cystic lesion with intact overlying cartilage and bone. Yet a more sedentary patient with the same lesion may do well with drilling. One can use two allograft regions that mimic the normal makeup of talar cartilage. A medial lesion was reproduced by plantarflexing the ankle in combination with slight anterior displacement of the talus on the tibia, inversion, and internal rotation of the talus on the tibia. By Jeffrey E. McAlister, DPM, FACFAS, and Eric So, DPM, AACFAS |. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. There is no cure as such, but the condition can be treated by a variety of means depending on the size and location of the lesion as well as the age of the patient and the degree of symptoms. Medial lesions … Most commonly, a surgeon will perform an arthroscopic exploration and treatment. Know what is Osteochondral defect, its causes, symptoms, treatment and prevention. Often, it is difficult to reduce pain permanently with bracing or casting. In order to treat the problem properly, one must diagnose the cause, the amount of injury and the residual problem present. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions … The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. The size of the lesion … Podiatry Today is a trademark of HMP. Conservative care of osteochondral lesions is difficult. Dr. Baravarian may be reached at bbaravarian @mednet.ucla.edu. If an osteochondral lesion has occurred, however, everyday activities that put pressure on the joint, may lead to pain and swelling, although the joint usually is fine when at rest. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. This may be followed with gradual progression of weightbearing and physical therapy. The goal of treatment is to ease pain and get your child back to using their joint normally. Diagnosing an osteochondral lesion is very difficult on a physical exam and one rarely diagnoses this without further testing. Nonsurgical options include: Rest; Modification of activities to reduce stress; Brace, boot or cast to immobilize the affected joint; Healing of the osteochondritis dissecans lesion should be monitored by routine follow-up imaging tests. In certain cases, we will try drilling as a first-line treatment option in a more sedentary patient and give complete information to the patient about the possible need for further treatment. Patients may have an OLT that is present a… Although the treatment of osteochondral lesions of the talus has evolved and improved, there is a need to understand the full spectrum of treatments and be well-versed in all forms of treatment in order to have a complete bag of tools necessary to treat these complicated occurrences. Surgical options differ according to the size, depth and amount of damage associated with an osteochondral lesion. Individuals who play sports such as soccer, football, rugby and golf may be at risk of an osteochondral lesion. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Then you fill the region with either allograft or autograft. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. In order to protect the soft tissues, one should drill through the medial malleolus with the use of a microvector guide. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint. A medial lesion was reproduced by plantarflexing the ankle in combination with slight anterior displacement of the talus on the tibia, inversion, and internal rotation of the talus on the tibia. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. However, the majority of osteochondral lesions do not show themselves at the initial time of injury. Within the ankle, these lesions … A physician will examine the joint for instability and range of motion. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. periosteum from tibia taken and fitted to defect. Non-surgical: Osteochondral lesions of the ankle can be treated with injections of Platelet-rich plasma and hyaluronic acid, which results in a decrease in pain scores and an increase in function for at least 6 months. When there is a break, tear, separation, or disruption of the cartilage that could be referred to as an osteochondral lesion… If radiographs show an osteochondral injury at the initial visit for an ankle sprain, treatment will require either casting of the ankle to allow the fracture site to heal or pinning and open reduction of the fracture in cases of a loose lesion. If the fragment is unstable or loose in the joint, surgery may be necessary to remove and repair the injured area. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte … If the patient presents such kind of changes, the most recommended form of intervention is represented by the complete replacement of the joint. There is a great deal of debate as to whether you should use autograft, fresh allograft or graft substitutes. Nonoperative treatment for acute, nondisplaced osteochondral lesions of the talus and cystic lesions has been associated with successful clinical results in about 50% of cases 5, 24, 25. Scranton PE and McDermott JE. In this type of lesion, the pain is from the constant compression of the cyst with activity but there is no overlying damage to the cartilage and bone. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and … In the ankle, osteochondral lesions usually occur on the talus, which is the bone that connects the leg to the foot. Radiographs showed a suspicious area on the lateral talar dome. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. OCD usually causes pain during and after sports. There is also a problem with mild sclerosis of the walls of the cyst that one must treat. © 2020 HMP. If the fragment is unstable or loose in the joint, surgery may be necessary to remove and repair the injured area. This allows us to treat the bone defect without affecting the cartilage. Although wearing a brace or cast may ease the discomfort of an osteochondral lesion, they are usually not enough to remedy the problem permanently, except in children, who can respond well … Treatment depends on the severity of the talar dome lesion. What Orthotic Modifications Do Podiatrists Use The Most? I hope the information presented is helpful for your patient care. Each type of injury will have different treatment options and require a different type of workup. Operative Treatment . Most of the lesions requiring surgical treatment are posteromedial in location, have poor quality articular cartilage, a loose bone fragment, necrotic bone beneath the lesion, and are poor candidates for healing with internal fixation. An X-ray may be ordered, but a cartilage tear is difficult to see on an X-ray, so a magnetic resonance imaging (MRI) or computed tomography (CT) scan may be required. Treatment. The second most common type is an injury to the superficial cartilage surface with a crush cartilage injury or shear tear of the cartilage surface. Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4 … Foot and Ankle International, May 2001; 22(5): 380-384. ➢ Operative treatment should be reserved for patients who have mechanical symptoms following an acute osteochondral lesion of the talus or who are not satisfied with the result after 3 to 6 … Within the ankle, these lesions often occur on the talus, which is the bone that joins the foot and the leg together. For related articles, check out the archives at www.podiatrytoday.com. A patient with an osteochondral lesion will often feel a dull ache in the joint and may also experience a mild locking or clicking of their knee or ankle joint. Use the OATS system to remove the plug of damaged cartilage and bone to a depth of 1 cm or so, and utilize a replacement graft. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. The prevailing thinking is that magnetic resonance imaging (MRI) is better in cases of pure cartilage damage or for superficial lesions while computerized tomography (CT) is better for cystic lesions and lesions that involve both cartilage and bone injury. After surgery, weight should be kept off the affected knee or ankle for four to six weeks. The most common location of osteochondral lesions … We try to avoid drilling of these lesions as the superficial cartilage and bone are intact and stable. Use a cast to allow for healing of the lesion for six to eight weeks. We prefer the use of autograft and often harvest the material from either the calcaneus or distal tibia. Osteochondral Lesions of the Talus Sara Lyn Miniaci-Coxhead, MD Dr. Miniaci-Coxhead or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. periosteum from tibia taken and fitted to defect. An osteochondral lesion may also be known as an osteochondral defect. 108. Operative treatment might also be necessary if patients do not respond well to conservative treatment. Foot and Ankle International, May 2001; 22(5): 380-384. 109. The newest and most complicated treatment option is the use of retrograde drilling of the lesion. Treatment depends on the severity of the talar dome lesion. bone graft may be placed if underlying cyst and bone loss. Often, performing an injection of local anesthetic into the involved joint will reduce pain but clinicians should not rule out other problems such as loose bodies, synovitis and ligament injury. Operative Treatment . Continued. Over the next few years, one may be able to begin treating cartilage lesions with cartilage cell transplants through an injection and with cartilage caps. The most common cause is from a crush or injury to the surface of the bone during the abnormal motion of the ankle in a sprain. 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. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. A Stable lesion means that the cartilage overlying the bone is not damaged and the lesion is not likely to be lose. The size of the lesion … 1. One would perform an arthroscopy of the joint and identify the lesion. this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect. 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