Osteochondral lesions of the talar dome: an up-to-date approach to multimodality imaging and surgical techniques

Open surgical exposure of the medial aspect of the talus is primarily indicated for osteochondral lesions of the talus and talar body fractures. Secondary to the difficulty of access, a variety of techniques have been described. The surgical techniques described in the literature include transmalleolar access windows, medial and anterior tibial osteotomies, and resection osteotomies (plafondoplasty). The purpose of this article is to describe the surgical technique for the bi-planar chevron osteotomy of the medial malleolus. This osteotomy can provide full exposure to the entire medial aspect of the talus. The orientation of the osteotomy allows for perpendicular placement of instrumentation on the medial half of the talus and is particularly useful for cartilage transplant procedures. The technique is reproducible and has a low complication rate when performed correctly.

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The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-005-0058-5 ◽

2005 ◽

Vol 126 (4) ◽

pp. 241-246 ◽

Cited By ~ 19

Author(s):

Peter Cornelius Kreuz ◽

Matthias Steinwachs ◽

Max Edlich ◽

Tim Kaiser ◽

Jörg Mika ◽

...

Keyword(s):

Anterior Approach ◽

Surgical Techniques ◽

Osteochondral Lesions

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Arthroscopy-Assisted Retrograde Drilling of Osteochondral Lesions of the Talar Dome

Journal of the American Podiatric Medical Association ◽

10.7547/0950091 ◽

2005 ◽

Vol 95 (1) ◽

pp. 91-96 ◽

Cited By ~ 11

Author(s):

Scott C. Nelson ◽

Darryl M. Haycock

Keyword(s):

Clinical Presentation ◽

Osteochondral Lesion ◽

Final Diagnosis ◽

Osteochondral Lesions ◽

Resonance Imaging ◽

Talar Dome ◽

Advanced Imaging ◽

Retrograde Drilling ◽

High Index Of Suspicion

Traumatic ankle conditions can lead to long-term sequelae if a pathologic process is misdiagnosed. The clinical presentation of an osteochondral lesion of the talar dome requires the clinician to have a high index of suspicion, and advanced imaging is often necessary to make the final diagnosis. Treatment should be initiated once the lesion is appropriately staged by radiologic or magnetic resonance imaging. We discuss the use of arthroscopy-assisted retrograde drilling of the medial talar dome that spares the articular cartilage within the talotibial articulation. (J Am Podiatr Med Assoc 95(1): 91–96, 2005)

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Patofisiologi dan Tatalaksana Osteochondral Lesion of the Talus

MEDICA ARTERIANA (Med-Art) ◽

10.26714/medart.1.2.2019.45-56 ◽

2019 ◽

Vol 1 (2) ◽

pp. 45

Author(s):

Maghrizal Roychan ◽

Andre Triadi Desnantyo

Keyword(s):

Ct Scan ◽

Cartilage Repair ◽

Osteochondral Lesion ◽

Operative Therapy ◽

Cartilage Regeneration ◽

Osteochondral Lesions ◽

X Rays ◽

Talar Dome ◽

Operative Techniques ◽

Reduced Space

ABSTRAKPenyakit Osteochondral Lesion of the Talus (OLT) adalah kelainan pada tulang talus di lapisan subchondral yang berupa lesi osteochondral pada talar dome dengan konsekuensi abnormalitas pada tulang rawan sendi talar. Pasien biasanya datang berobat ke tenaga kesehatan dengan keluhan yang tidak spesifik dan dengan gejala seperti nyeri pada pergelangan kaki, bengkak serta berkurangnya berkurangnya ruang gerak. Penegakan diagnosis bisa dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang sederhana seperti foto X-ray maupun pemeriksaan penunjang canggih seperti CT-Scan dan MRI. Tatalaksana OLT bervariasi. Tatalaksana pada OLT tergantung dari tahapan lesi, kronisitasnya, dan keluhan simtomatis yang menyertainya. Pasien dengan keluhan simtomatis yang akut dan non-displaced sering diberikan terapi nonoperatif biasanya berupa terapi konservatif dengan imobilisasi. Lesi yang tidak berhasil atau tidak menunjukkan perbaikan dalam keluhan simtomatisnya setelah 3 sampai 6 bulan, serta lesi dengan displacement dapat direncanakan untuk terapi operatif. Ada beberapa macam tehnik operatif yang dapat dilakukan untuk menyembuhkan OLT. Tehnik operatif ini dapat dikategorikan menjadi cartilage repair, cartilage regeneration dan cartilage replacement techniques.Kata kunci: osteochondral lesion of the talus, patofisiologi, tatalaksanaABSTRACTOsteochondral Lesion of the Talus (OLT) is an abnormality in the talus bone in the subchondral layer in the form of osteochondral lesions in the talar dome with consequent abnormalities in the talar joint cartilage. Patients usually come to a health care provider with nonspecific complaints and with symptoms such as pain in the ankles, swelling and reduced space for movement. The diagnosis can be made with a history, physical examination and simple investigations such as X-rays and sophisticated investigations such as CT-Scan and MRI. The management of OLT varies. The management of OLT depends on the stage of the lesion, its chronicity, and the accompanying symptomatic complaints. Patients with acute and non-displaced symptomatic complaints are often given nonoperative therapy usually in the form of conservative therapy with immobilization. Lesions that are unsuccessful or show no improvement in symptomatic complaints after 3 to 6 months, and lesions with displacement can be planned for operative therapy. There are several types of operative techniques that can be done to cure OLT. These operative techniques can be categorized into cartilage repair, cartilage regeneration and cartilage replacement techniques. Keywords: osteochondral lesion of the talus, patophysiology, treatment

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Outcome after HemiCAP; implantation for osteochondral lesions of the medial Talar dome

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.05.206 ◽

2016 ◽

Vol 22 (2) ◽

pp. 82

Author(s):

S. Ettinger ◽

H. Waizy ◽

L. Claassen ◽

Y. Noll ◽

D. Yao ◽

...

Keyword(s):

Osteochondral Lesions ◽

Talar Dome

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Relationship Between Bone Marrow Lesions on MRI and Cartilage Degeneration in Osteochondral Lesions of the Talar Dome

Foot & Ankle International ◽

10.1177/1071100718766596 ◽

2018 ◽

Vol 39 (8) ◽

pp. 908-915 ◽

Cited By ~ 10

Author(s):

Tomoyuki Nakasa ◽

Yasunari Ikuta ◽

Mikiya Sawa ◽

Masahiro Yoshikawa ◽

Yusuke Tsuyuguchi ◽

...

Keyword(s):

Bone Marrow ◽

Subchondral Bone ◽

Cartilage Degeneration ◽

Osteochondral Lesions ◽

Talar Dome ◽

Mankin Score ◽

Osteochondral Fragment ◽

The Mean ◽

And Cartilage ◽

Ct And Mri

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. All ankles underwent CT and MRI and had operative treatment. The ankles were divided into 2 groups, depending on the presence of bone sclerosis (ie, with or without) in the host bone just below the osteochondral fragment (nonsclerosis group and sclerosis group). The area of BML was compared between the 2 groups. Biopsies of the osteochondral fragment from 20 ankles were performed during surgery, and the correlation between the BML and cartilage degeneration was analyzed. The remaining 13 ankles had the CT and MRI compared with the arthroscopic findings. Results: The mean area of BML in the nonsclerosis group was significantly larger than that in the sclerosis group. In the histologic analysis, there was a significant and moderate correlation between the Mankin score and the area of BML. The mean Mankin score in the nonsclerosis group was significantly lower than that in the sclerosis group. Conclusions: This study revealed that a large area of BML on MRI exhibited low degeneration of cartilage of the osteochondral fragment, while a small area of BML indicated sclerosis of the subchondral bone with severe degeneration of cartilage. The evaluation of BML may predict the cartilage condition of the osteochondral fragment. Level of Evidence: Level III, comparative series.

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Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

Foot & Ankle International ◽

10.1177/1071100719847134 ◽

2019 ◽

Vol 40 (8) ◽

pp. 978-986 ◽

Cited By ~ 2

Author(s):

Lena Hirtler ◽

Katarina Schellander ◽

Reinhard Schuh

Keyword(s):

Minimally Invasive ◽

Ankle Joint ◽

Clinical Relevance ◽

Arthroscopic Treatment ◽

Osteochondral Lesions ◽

Neutral Position ◽

Matched Pairs ◽

Talar Dome ◽

Statistical Comparison ◽

Posterior Ankle Arthroscopy

Background: Osteochondral lesions of the talus are frequent pathologies of the ankle joint. Especially through arthroscopy, the treatment is kept as minimally invasive as possible. However, there are some drawbacks as to the reachability because of the high congruency of the ankle joint. Here, either noninvasive distraction or maximal dorsiflexion may be an option for better access to the lesion. The purpose of this study was to evaluate maximal dorsiflexion compared to neutral position or noninvasive distraction of the ankle joint in the arthroscopic reachability of the talar dome. The hypothesis of this study was that maximal dorsiflexion would allow for greater accessibility of the talar dome compared to neutral position or noninvasive distraction of the joint. Methods: Twenty matched pairs (n=40) of anatomical ankle specimens were used. The effects of neutral position, maximal dorsiflexion, and noninvasive distraction of the ankle joint on arthroscopic accessibility of the ankle joint were tested. After disarticulation of the talus, reach was measured and compared between the 3 positions. Results: In neutral position, 13.7±1.2 mm of the talar dome was reached laterally and 14.0±1.0 mm medially. In maximal dorsiflexion, the distance was 19.0±1.1mm laterally and 19.8±1.4 mm medially, and in noninvasive distraction it was 16.1±1.5 mm laterally and 15.7±1.0 mm medially. The statistical comparison showed a significantly better reach in dorsiflexion laterally ( P = .003) and medially ( P = .026). Conclusion: Accessibility of the talar dome in maximal dorsiflexion was superior to that in neutral position or noninvasive distraction. Clinical Relevance: Results of this study may allow for better planning in arthroscopic treatment of osteochondral lesions of the talus.

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