Comparison of Ankle Joint Visualization Between the 70° and 30° Arthroscopes: A Cadaveric Study

2017 ◽  
Vol 11 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Skin Incision ◽  
Surrounding Tissue ◽  
Osteochondral Lesions ◽  
Talar Dome ◽  
Kirschner Wires ◽  
Anterior Edge ◽  
Ankle Surgery ◽  
Anterior Ankle Impingement

Ankle arthroscopy is an important diagnostic and therapeutic tool. Arthroscopic ankle surgery for anterior ankle impingement or osteochondral lesions (OCLs) is mostly performed with a 30° arthroscope; however, visualization of lesions is sometimes difficult. This study sought to compare ankle joint visualization between 70° and 30° arthroscopes and clarify the effectiveness of 70° arthroscopy. Standard anterolateral and anteromedial portals were placed with 4-mm 70° or 30° angled arthroscopes in a fresh 77-year-old male cadaveric ankle. The medial ligament and surrounding tissue were dissected via a medial malleolar skin incision. Kirschner wires were inserted into the distal tibia anterior edge; 5-mm diameter OCLs were created on the medial talar gutter anteriorly, midway, and posteriorly. The talar dome and distal tibia anterior edge were visualized using both arthroscopes. The 70° arthroscope displayed the anterior edge of the distal tibia immediately in front of the arthroscope, allowing full visualization of the posterior OCL of the medial talar gutter more clearly than the 30° arthroscope. This study revealed better ankle joint visualization with the 70° arthroscope, and may enable accurate, safe, and complete debridement, especially in treatment of medial talar gutter posterior OCLs and removal of anterior distal tibial edge bony impediments. Levels of evidence: Level IV, Anatomic study

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

2019 ◽  
Vol 40 (8) ◽  
pp. 978-986 ◽  
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.

scholarly journals Osteochondral Lesions of the Talus – A Biomechanical Explanation for Larger OLT Shoulder Lesions Leading to Increased Patient Risk

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Peter Lawson ◽  
Pam Kumparatana ◽  
Todd Baldini ◽  
Shanthan Challa ◽  
Daniel Moon ◽  
...  
Keyword(s):  
Surface Area ◽  
Ankle Joint ◽  
Contact Area ◽  
Peak Pressure ◽  
Defect Size ◽  
Cartilage Tissue ◽  
Osteochondral Lesions ◽  
Talar Dome ◽  
Increased Risk ◽  
Donor Characteristics

Category: Ankle, Trauma Introduction/Purpose: Osteochondral lesions of the talus (OLT) are a common injury that can result in pain, disability, and risk ankle degeneration, with poor outcomes when not managed properly. Unconstrained ‘shoulder’ lesions on the medial edge of the talar dome present a particular challenge. The objective of this study was to assess the effect of increasing size of a medial OLT shoulder lesion on ankle joint contact mechanics and to determine a threshold size that would warrant bulk grafting of the defect. Our hypothesis is that larger defects will demonstrate increased pressure applied over a lesser surface area, with peak pressure progressing towards the rim of the defect, resulting in an increased risk for tissue damage and need for treatment. Methods: Nine cadaver ankle joints were dissected without disrupting the medial and lateral stabilizing ligaments. A Tekscan pressure sensor was inserted into the ankle joint. Intact specimens were axially compressed up to 800 N with the foot in neutral and again at 20° inversion, simulating ankle position during inversion injury. The specimens were then tested with progressively larger semicircular osteochondral lesions at diameters of 8, 10, 12, 14, and 16 mm that were centered on the edge of the medial talar dome, followed by a final ovoid lesion of 16x20 mm. After each lesion was created the specimens were retested. Linear mixed models adjusted for donor characteristics and assessed changes in peak pressure (MPa), contact area (mm2), peak pressure location (mm), and distance from peak pressure location to the lateral rim of the defect (mm) by defect size and ankle position. Results: For all defect sizes, mean peak pressures were significantly higher in inversion compared to neutral. Mean peak pressure magnitude progressively increased with defect size in both ankle positions. Donor characteristics did not significantly affect mean peak pressure. Contact area decreased in both positions as defect size increased, but inversion led to significantly lower contact areas than in neutral. In neutral positions, the location of peak pressure moved laterally on the talar dome but also moved closer to the defect rim as the size of the defect increased. The rim-peak pressure distance stabilized for defect sizes of 10 mm and above. In inversion, however, the rim-peak pressure distance remained unchanged at about 8 mm for all defect sizes. Conclusion: As OLT defect sizes increased, we observed an increase in peak pressure, a decrease in contact surface area, and a lateral translation of peak pressure location relative to the defect rim. Distance between location of peak pressure and defect rim decreased with neutral loading until a 10 mm defect but remained consistent in inversion loading. These findings suggest a biomechanical explanation for secondary injuries and treatment failures in larger OLT shoulder lesions due to maladaptive cartilage tissue on the dome of the talus. Larger defects (=10 mm) remain a critical point of interest with predictive clinical value for OLT outcomes.

Patient-Reported Outcomes After Structural Autograft for Large or Cystic Talar Dome Osteochondral Lesions

2020 ◽  
Vol 41 (5) ◽  
pp. 549-555
Author(s):  
Todd Kim ◽  
Andrew Haskell
Keyword(s):  
Patient Reported Outcomes ◽  
Distal Tibia ◽  
Case Series ◽  
Osteochondral Lesions ◽  
Measurement Information ◽  
Talar Dome ◽  
Level Of Evidence ◽  
Structural Bone Graft ◽  
Patient Reported

Background: While smaller talar dome osteochondral lesions (OCLs) are successfully treated with bone marrow stimulation techniques, the optimal treatment for large or cystic OCLs remains controversial. This study tested the hypothesis that transferring structural autograft bone from the distal tibia to the talus for large or cystic OCLs improves pain and function. Methods: Thirty-two patients with large or cystic OCLs underwent structural bone grafting from the ipsilateral distal tibia to the talar dome. Patients were assessed with subjective patient-centered tools and objective clinical outcomes. Average age was 48.6 ± 14.9 years, and average follow-up was 19.5 ± 13.3 months. Average lesion area was 86.2 ± 23.5 mm2, and average depth was 8.4 ± 3.0mm. Results: At final follow-up, improvement compared to preoperative scores was seen in American Orthopaedic Foot & Ankle Society (65.4 ± 21.2 to 86.9 ± 15.0, P < .05), Foot Function Index (48.9 ± 20.8 to 21.1 ± 18.9, P < .05), visual analog scale for pain (4.7 ± 3.0 to 1.4 ± 1.5, P < .05), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (40.4 ± 5.4 to 45.5 ± 7.4, P < .05) scores. There was no improvement in PROMIS pain interference (54.7 ± 18.1 to 52.4 ± 7.3, P > .05). Satisfaction with surgery was 8.4 ± 1.3/10, and 96% of patients would have the procedure again. Ninety-four percent of patients returned to work and/or play. One patient had a deep vein thrombosis 6 weeks postoperatively, and 1 patient underwent ankle fusion at 18 months postoperatively. Conclusion: This study demonstrates that structural bone graft harvested from the distal tibia transferred to the talus was a safe and effective treatment for large and cystic OCLs. Outcomes compare favorably to other described techniques for treatment of these injuries. Level of Evidence: Level IV, case series.

scholarly journals Surgical Treatment Approach for Pilon and Talar Dome Fracture

2020 ◽  
Vol 110 (4) ◽  
Author(s):  
Jin Park ◽  
Hyo Beom Lee ◽  
Gab Lae Kim ◽  
Kyu Hyun Yang
Keyword(s):  
Scientific Literature ◽  
Treatment Approach ◽  
Distal Tibia ◽  
Skin Incision ◽  
Anterolateral Approach ◽  
Pilon Fracture ◽  
Talar Dome ◽  
Plating Technique ◽  
Talar Fractures ◽  
Pilon Fractures

Talar injuries that are associated with pilon fractures include talar body fractures, osteochondral defects, and posterior process talar fractures. Pilon fractures, in combination with talar dome fractures, have not yet been reported in the scientific literature. We report the case of a 15-year-old boy who sustained a pilon fracture with a lateral talar dome fracture. The pilon fracture was initially fixed using a temporary external fixator for soft-tissue care. After the swelling subsided, definitive internal fixation was performed. First, the lateral talar dome fracture was directly reduced and fixed using a small anterolateral approach of the ankle. Then, the intra-articular portion of the pilon fracture was directly reduced using the same anterolateral approach and an additional small anteromedial approach, and the extra-articular metaphyseal portion of the pilon fracture was indirectly reduced. The pilon fracture was finally fixed with an anterolateral distal tibia plate, using a submuscular plating technique through the anterolateral approach and a separate proximal skin incision. A medial distal tibia plate was later added using a subcutaneous plating technique through the anteromedial approach and another proximal skin incision. Both the pilon fracture and the lateral talar dome fracture were addressed simultaneously through a combination of the small anterolateral and anteromedial approaches.

Anterior Distal Tibia Plafondplasty for Exposure of the Talar Dome

2012 ◽  
Vol 33 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Paul G. Peters ◽  
Brent G. Parks ◽  
Lew C. Schon
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Surface Area ◽  
Sagittal Plane ◽  
Distal Tibia ◽  
Osteochondral Lesions ◽  
Digital Analysis ◽  
Chondrocyte Transplantation ◽  
Talar Dome ◽  
Accessible Area

Background: It may be possible to avoid malleolar osteotomy for treatment of osteochondral talar lesions with chondrocyte transplantation techniques, where perpendicular approach to the talar surface is not required. We hypothesized that limited anterior distal tibial plafondplasty would allow access to most of the talar surface. We compared talar access with soft tissue exposure versus plafondplasty. Methods: Two soft tissue exposures (anteromedial and anterolateral) and two limited anterior distal tibial plafondplasties (anteromedial and anterolateral) were used on 12 cadaver lower-extremity specimens. Digital analysis was used to assess the accessible area. Results: Percentage of total talar dome surface area access increased significantly between soft tissue exposure and limited plafondplasty medially (22.3 ± 6.3% versus 37.9 ± 4.6%; p < 0.001) and laterally (22.4 ± 7.7% versus 37.9 ± 7.7%; p < 0.001). Percentage sagittal plane access also increased significantly between soft tissue exposure and limited plafondplasty medially 54.4 ± 12.0% versus 81.3 ± 9.7%; p < 0.001) and laterally (53.3 ± 14.5% versus 80.9 ± 12.8%; p < 0.001). Limited exposure to an additional 14.2 ± 5% of the total talar surface area was possible. The posterior 10.6 ± 8% was inaccessible. Conclusions: A soft tissue approach with limited plafondplasty provided adequate exposure for the majority of the medial and lateral talar surface. Only the central posterior 10% of the talus was not accessed by this method. Clinical Relevance: It may be possible to avoid malleolar osteotomy by using limited plafondplasty to access the talar dome for treatment of osteochondral lesions if perpendicular access to the talus is not required.

scholarly journals AB0858 TREATMENT ALGORITHM FOR ANKLE OSTEOCHONDRAL LESIONS AND DEFECTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1736.2-1736
Author(s):  
O. Burianov ◽  
L. Khimion ◽  
T. Omelchenko ◽  
E. Levitskyi ◽  
V. Lyanskorynsky
Keyword(s):  
Bone Marrow ◽  
Ankle Joint ◽  
Bone Marrow Cells ◽  
Traditional Approach ◽  
Treatment Algorithm ◽  
Main Group ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Traditional Treatment

Background:traumatic ankle joint osteochondral lesions and defects (OHLD) is frequent cause of OA, chronic pain and loss of joint function; results of traditional treatment strategy are often unsatisfyingObjectives:to develop treatment algorithm for OHLD based on evaluation of previously determined main prognostic factors.Methods:the analysis of long-term (36 ± 4.5 months) treatment results of 239 patients after traumatic ankle joint OHLD revealed the following factors with the greatest predictive value (defined by PC – prognostic coefficient) for good result of treatment (defined as AOFAS function score 75-100 points): age < 40 years (PC = 8.5); size of OHLD ≤ 1.0 cm2; volume ≤ 1.5 cm3(PC = 8.0); osteoarthritis stage ≤ II (PC = 7.2). Based on these factors, a step-by-step, discrete and alternative algorithm for the choice of treatment tactics was created. The algorithm includes use of arthroscopic or open debridement, abrasive chondroplasty, bone marrow regeneration stimulation (microfracturing or tunneling), mosaic osteochondroplasty, arthroplasty or arthrodesis, the use of cellular regenerative technologies (bone marrow cells, platelet riched plasma), and others. Patients of older age with advanced OA need complex, step up approach, surgical treatment combined with regenerative cell technologies. The effectiveness of the differentiated approach to treatment was studied in 72 patients with OHLD (main group) in comparing to 72 patients in whom traditional treatment approaches were used, based on the stage of injury according to the Berndt & Hardy classification (comparison group).Results:compared to the traditional approach, the developed algorithm and treatment system allowed to half terms of hospitalization, to reduce the intensity of pain syndrome (by NRS) and increase the functional activity (by AOFAS) by 25%. In 3 years after trauma good/excellent results of treatment demonstrated 86% patients of main group and 32,2% of patients from comparing group (p<0,05).Conclusion:implementation of the developed treatment algorithm increases the number of good and excellent long-term results by 2.6 times and reduces the number of complications and unsatisfactory results by 4.9 times.Disclosure of Interests:None declared

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)

Arthroscopic Talar Dome Access Using a Standard Versus Wire-Based Traction Method for Ankle Joint Distraction

2016 ◽  
Vol 32 (7) ◽  
pp. 1367-1374 ◽  
Author(s):  
Alexej Barg ◽  
Charles L. Saltzman ◽  
Timothy C. Beals ◽  
Kent N. Bachus ◽  
Brad D. Blankenhorn ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Talar Dome ◽  
Traction Method ◽  
Joint Distraction

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

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