Arthroscopic evaluation after osteochondral autogenous transfer with osteotomy of medial malleolus for osteochondral lesion of the talar dome

2021 ◽  
Author(s):  
Hideto Harada ◽  
Masahiko Kobayashi ◽  
Shuichi Matsuda ◽  
Hiroshi Fujita
Keyword(s):  
Osteochondral Lesion ◽  
Medial Malleolus ◽  
Talar Dome ◽  
Arthroscopic Evaluation

scholarly journals Access to the talar dome through the medial posterolateral approach: an anatomical study.

2021 ◽  
Vol 15 (3) ◽  
pp. 247-251
Author(s):  
Wellington Farias Molina ◽  
Lourenço Galizia Heitzmann ◽  
Guilherme Bottino Martins ◽  
Luiz Sergio Martins Pimenta ◽  
Giezy Rasfasky Fiorot ◽  
...  
Keyword(s):  
Osteochondral Lesion ◽  
Anatomical Study ◽  
Posterolateral Approach ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
Talar Dome ◽  
Chi Square ◽  
Left Limb ◽  
Significant Difference ◽  
Chi Square Test

Background: The osteochondral grafting has become a popular procedure for treating challenging talar dome lesions. However, the vast majority are treated through medial malleolus osteotomy. The aim of this study was to determine the posteromedial area of the talus that can be reached without malleolar osteotomy through the posteromedial approach. Study Design: Descriptive laboratory study. Evidence Level 4 Methods: Fifteen human cadaveric ankles were dissected in a standard fashion to expose the posteromedial talar dome. Seven approaches were used on the cadaver's left limb (46.7%). We did not observe any significant difference between the evaluated sides (chi-square test, p = 0.715).  Results: On average, 2,09 cm2 (range, 1,72-2,69) of the posteromedial talus dome or 15,27 % (range 12-20) of total talus dome can be accessed without osteotomy. Conclusion: If the osteochondral lesion is within the area accessible through PM approach (mean 2 cm2), as seen on magnetic resonance imaging, it is possible that it can be treated without a medial malleolus osteotomy. Keywords: talus; osteochondral lesions; osteotomy; arthrotomy; surgery

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

2005 ◽  
Vol 95 (1) ◽  
pp. 91-96 ◽  
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)

scholarly journals Patofisiologi dan Tatalaksana Osteochondral Lesion of the Talus

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

scholarly journals Retrograde Drilling for Osteochondral Lesion of the Talar Dome in Juvenile Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Yusuke Tsuyuguchi ◽  
Yuki Ota ◽  
Munekazu Kanemitsu ◽  
...  
Keyword(s):  
Growth Plate ◽  
High Intensity ◽  
Articular Surface ◽  
Osteochondral Lesion ◽  
Early Period ◽  
Fat Suppression ◽  
Talar Dome ◽  
Retrograde Drilling ◽  
The Mean

Category: Ankle, Arthroscopy Introduction/Purpose: Osteochondral lesion of the talar dome (OLT) is common condition that causes pain of ankle joint in juvenile patients. Several surgical options have been available such as excision of detached cartilage fragment, microfracture, autologous cancellous bone graft and osteochondral autografting depending on the status of OLT. Arthroscopic drilling including transmalleolar or retrograde technique could be a good option for OLT patients with stable osteochondral fragment with normal articular surface. Retrograde drilling has an advantage in preventing the iatrogenic articular cartilage injury. This study aimed to clarify the clinical outcome of the retrograde drilling for OLT in juvenile patients. Methods: Our retrospective analysis included 8 patients who underwent retrograde drilling for OLT, in 5 boys and 3 girls, with a mean age of 14.9 years (range, 11-19). Range of motion (ROM) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle- hindfoot score were evaluated as the clinical outcomes. OLTs were classified into 4 grades according to arthroscopic findings by international cartilage research society (ICRS) classification. Radiographic analysis was performed using preoperative and postoperative images. Growth plate was evaluated on plane radiographs, and the location and size of OLT were assessed on computed tomography. The high intensity area of the talus was also measured on T2 fat suppression images. Results: All 8 patients were followed with a mean follow-up period of 2 years, and they had no complication or revision surgery. The mean total ROM were 65.6° preoperatively and 67.1° postoperatively. AOFAS scale improved from 69.3 to 96.7 (p = 0.012). The ICRS 1 and 2 OLT lesions were identified arthroscopically in 5 and 3 patients, respectively. Growth plate remained open in 4 patients, and OLTs were located on the posteromedial in 7 patients, center in 1 patient. The mean size of OLT fragment was 9.8 mm, 6.8 mm and 3.5 mm in length, width and height. Coronal and sagittal T2 fat suppression images demonstrated that the high intensity area of 241.3 mm2, 554.5 mm2 at preoperative status and 190.9 mm2, 302.6 mm2 at final follow-up status. Conclusion: These findings revealed that the retrograde drilling remarkably improved clinical status in juvenile OLT patients. The high intensity area at the talus remained postoperatively, however, that did not affect clinical results. Retrograde drilling procedure should be considered for treating juvenile patients in the early period after detection of the OLT.

Clinical Results of the Multiple Drilling for Osteochondral Lesion of the Medial Talar Dome

2007 ◽  
Vol 42 (6) ◽  
pp. 750 ◽  
Author(s):  
Chung Soo Han ◽  
Duke Whan Chung ◽  
Jung Chul Hwang ◽  
Hyung Jun Cho
Keyword(s):  
Osteochondral Lesion ◽  
Clinical Results ◽  
Talar Dome

Influence of the Medial Malleolus Osteotomy on the Clinical Outcome of M-BMS + I/III Collagen Scaffold in Medial Talar Osteochondral Lesion (German Cartilage Register/Knorpelregister DGOU)

Cartilage ◽  
2020 ◽  
pp. 194760352096116
Author(s):  
Oliver Gottschalk ◽  
Sebastian Felix Baumbach ◽  
Sebastian Altenberger ◽  
Daniel Körner ◽  
Matthias Aurich ◽  
...  
Keyword(s):  
Treatment Options ◽  
Osteochondral Lesion ◽  
Collagen Scaffold ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Bone Marrow Stimulation ◽  
Medial Malleolar Osteotomy ◽  
Significant Difference

Objective Osteochondral lesions of the talus are common injuries, with one of the leading treatment options being the M-BMS (matrix-augmented bone marrow stimulation) + I/III collagen scaffold. Osteotomy of the medial malleolus is not unusual but presents the risk of malunion or irritation by hardware. The aim of the study was to analyze data from the German Cartilage Society (Knorpelregister DGOU) to evaluate the influence of medial malleolar osteotomy on clinical results of M-BMS + I/III collagen scaffold. Design The ankle module of the Cartilage Register includes a total of 718 patients, while 45 patients met the inclusion criteria. Patients were treated with an M-BMS + I/III collagen scaffold of the medial talus, 30 without and 15 with an osteotomy of the medial malleolus. The follow-up evaluations included FAAM (Foot and Ankle Ability Measure), FAOS (Foot and Ankle Outcome Score), and VAS (visual analogue scale). Results Forty-five patients (22 male, 23 female) aged between 18 and 69 years (mean: 34 years) were included in this study. Between preoperative and 12 months postoperative, we noted a significant improvement in FAAM-ADL (Activity of Daily Living) ( P = 0.004) as well as FAOS-Pain ( P = 0.001), FAOS-Stiffness ( P = 0.047), FAOS-ADL ( P = 0.002), FAOS-Sport ( P = 0.001), and FAOS Quality of Life ( P = 0.009). There was no significant difference between patients who underwent an osteotomy or not. Conclusion The results show a significant improvement in patients’ outcome scores following a M-BMS + I/III collagen scaffold. No statistical difference was noted among those undergoing medial malleolar osteotomy.

Investigation of factors related to the occurrence of osteochondral lesions of the talus by 3D bone morphology of the ankle

2018 ◽  
Vol 100-B (11) ◽  
pp. 1487-1490 ◽  
Author(s):  
A. Teramoto ◽  
H. Shoji ◽  
H. Kura ◽  
Y. Sakakibara ◽  
T. Kamiya ◽  
...  
Keyword(s):  
Surface Area ◽  
Osteochondral Lesion ◽  
Opening Angle ◽  
Control Group ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
3D Ct ◽  
Bone Morphology ◽  
The Mean ◽  
Area And Volume

Aims The aims of this study were to evaluate the morphology of the ankle in patients with an osteochondral lesion of the talus using 3D CT, and to investigate factors that predispose to this condition. Patients and Methods The study involved 19 patients (19 ankles) who underwent surgery for a medial osteochondral lesion (OLT group) and a control group of 19 healthy patients (19 ankles) without ankle pathology. The mean age was significantly lower in the OLT group than in the control group (27.0 vs 38.9 years; p = 0.02). There were 13 men and six women in each group. 3D CT models of the ankle were made based on Digital Imaging and Communications in Medicine (DICOM) data. The medial malleolar articular and tibial plafond surface, and the medial and lateral surface area of the trochlea of the talus were defined. The tibial axis-medial malleolus (TMM) angle, the medial malleolar surface area and volume (MMA and MMV) and the anterior opening angle of the talus were measured. Results The mean TMM angle was significantly larger in the OLT group (34.2°, sd 4.4°) than in the control group (29.2°, sd 4.8°; p = 0.002). The mean MMA and MMV were significantly smaller in the OLT group than in the control group (219.8 mm2, sd 42.4) vs (280.5 mm2, sd 38.2), and (2119.9 mm3, sd 562.5) vs (2646.4 mm3, sd 631.4; p < 0.01 and p = 0.01, respectively). The mean anterior opening angle of the talus was significantly larger in the OLT group than in the control group (15.4°, sd 3.9°) vs (10.2°, sd 3.6°; p < 0.001). Conclusion 3D CT measurements showed that, in patients with a medial osteochondral lesion of the talus, the medial malleolus opens distally, the MMA and MMV are small, and the anterior opening angle of the talus is large. This suggests that abnormal morphology of the ankle predisposes to the development of osteochondral lesions of the talus. Cite this article: Bone Joint J 2018;100-B:1487–90.

Anatomic feature of deltoid ligament attachment in posteromedial osteochondral lesion of talar dome

2017 ◽  
Vol 23 ◽  
pp. 18
Author(s):  
T. Nakasa ◽  
M. Sawa ◽  
Y. Ikuta ◽  
M. Yoshikawa ◽  
Y. Tsuyuguchi ◽  
...  
Keyword(s):  
Osteochondral Lesion ◽  
Deltoid Ligament ◽  
Talar Dome ◽  
Anatomic Feature

scholarly journals A Case of Osteochondral Autologous Graft Transplantation with Mosaicplasty for Osteochondral Lesion of the Talar Dome

2005 ◽  
Vol 54 (3) ◽  
pp. 488-492
Author(s):  
Yoko Katsushima ◽  
Etsuo Chosa ◽  
Ryuji Kuroki ◽  
Hiroaki Yano ◽  
Keitaro Yamamoto ◽  
...  
Keyword(s):  
Osteochondral Lesion ◽  
Talar Dome ◽  
Autologous Graft
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