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

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)

Diagnosis and treatment of anterior ankle impingement: state of the art

2020 ◽  
Vol 5 (5) ◽  
pp. 295-303
Author(s):  
Pedro Diniz ◽  
Duarte André Sousa ◽  
Jorge Pablo Batista ◽  
Nasef Abdelatif ◽  
Helder Pereira
Keyword(s):  
Soft Tissue ◽  
Conservative Treatment ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
X Rays ◽  
Ankle Pain ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

The aim of this paper is to discuss anterior ankle impingement (AAI) regarding diagnosis, interventions, techniques and future perspectives. AAI is a pain syndrome due to soft tissue or bony impingement. Impingement caused by soft tissues is frequently found in the anterolateral compartment of the ankle, whereas impingement caused by bony spurs is generally located in the anteromedial compartment. Typical complaints are chronic ankle pain, limited dorsiflexion and swelling. The most important feature is recognisable tenderness on palpation, which helps distinguish this condition from an osteochondral lesion, which is characterised with deep ankle pain. Although the diagnosis is mainly based on clinical assessment, imaging is helpful for differential diagnosis and preoperative planning. Standard X-rays, using anteroposterior, lateral and an anteromedial oblique view for detecting bony spurs, are sufficient to make the diagnosis. CT can be used to accurately assess the extent and size of a bony spur. MRI is useful to evaluate soft tissue lesions and exclude concomitant pathology, like osteochondral lesions or stress fractures. Conservative treatment is the first-line treatment. In cases where conservative treatment has been unsuccessful, surgery may be indicated. Arthroscopic debridement is considered the gold standard to treat AAI. Rehabilitation protocol includes full weight-bearing and exercises to stimulate active dorsiflexion-plantar flexion and avoid stiffness.

scholarly journals Management of Osteochondral Lesions of the Talar Dome

2017 ◽  
Vol 11 (1) ◽  
pp. 743-761 ◽  
Author(s):  
Chamnanni Rungprai ◽  
Joshua N. Tennant ◽  
Ryan D. Gentry ◽  
Phinit Phisitkul
Keyword(s):  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
Talar Dome ◽  
Joint Function ◽  
Bone Marrow Stimulation ◽  
Surgical Strategies ◽  
Restoration Techniques ◽  
Chondrocyte Implantation ◽  
History Of ◽  
Osteochondral Fragment

Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. While the natural history of the OLTs is not well understood, surgical treatment is often required especially in chronic cases and acute cases with displaced articular fragments. 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. In patients with a large lesion or after a failure of previous bone marrow stimulation, biologic restoration techniques including the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation may have role. This article summarizes the contemporary concepts in the clinical evaluation and treatment of OLTs with particular emphasis on surgical strategies.

scholarly journals Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement

2014 ◽  
Vol 1 (1) ◽  
pp. 34-37
Author(s):  
A Patel ◽  
J Mangwani ◽  
W Al-Jundi ◽  
A Askari ◽  
D Moore
Keyword(s):  
Case Report ◽  
Operative Technique ◽  
Osteochondral Lesion ◽  
Asia Pacific ◽  
Osteochondral Lesions ◽  
Arthroscopic Debridement ◽  
Talar Dome ◽  
Bone Marrow Stimulation ◽  
Talar Head

ABSTRACT Osteochondral lesions of the talar dome are well described. To our knowledge, there are no published reports of osteochondral lesion of the talar head. We report the case of a 16-year-old girl who presented with a nontraumatic osteochondral lesion of talar head, which was treated with arthroscopic debridement and bone marrow stimulation. At 6-month follow-up, the patient was symptom free and the radiograph showed signs of healing of the lesion. How to cite this article Mangwani J, Patel A, Al-Jundi W, Askari A, Moore D. Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):34-37.

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

Comparison of All Arthroscopic Implantation of Chitosan-Based Liquid Scaffold and Hyaluronan-Based Soft Scaffold in the Treatment of Condylar Osteochondral Lesions in the Knee

2021 ◽  
Author(s):  
Ramazan Akmeşe ◽  
Emre Anıl Özbek ◽  
Hakan Kocaoğlu ◽  
Mehmet Batu Ertan ◽  
İrem İnanç ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Osteochondral Lesion ◽  
Cartilage Regeneration ◽  
International Knee Documentation Committee ◽  
Osteochondral Lesions ◽  
Time Period ◽  
Significant Difference ◽  
Vas Scores ◽  
Retrospective Comparative Study ◽  
Clinical And Radiological Results

AbstractCell-free scaffolds used in cartilage regeneration are produced from different materials. The aim of this study is to compare the clinical and radiological results of two different scaffolds with hyaluronan- or chitosan-based structure used in the treatment of symptomatic condylar osteochondral lesions. The study comprises 69 patients who were operated for osteochondral lesion repair with hyaluronan- (n = 37) or chitosan-based (n = 32) scaffold. The International Knee Documentation Committee (IKDC), Lysholm Knee Scoring Scale and Visual Analog Scale (VAS) scores were collected for both groups at the preoperative and postoperative 3rd, 12th, and 24th months. Magnetic resonance imaging was performed between the 12th and 15th months postoperatively and this with magnetic resonance observation of cartilage repair tissue (MOCART) scoring were compared. Within group assessments demonstrate significant improvement in IKDC, Lysholm, and VAS scores at postoperative 3rd and 12th months. However, in both groups, IKDC, Lysholm and, VAS scores at the postoperative 24th month indicate no significant further improvement, compared with the 12th month results. There was no significant difference between the groups in terms of IKDC, Lysholm, VAS, and MOCART scores at any time period. This study shows that both scaffolds are useful in cartilage regeneration but have no clinical or radiological superiority to each other. Surgeons should select the method with which they feel comfortable. This is a level III, retrospective comparative study.

A Review of Various Machine Learning Techniques for Brain Tumor Detection from MRI Images

2020 ◽  
Vol 16 (8) ◽  
pp. 937-945
Author(s):  
Aaishwarya Sanjay Bajaj ◽  
Usha Chouhan
Keyword(s):  
Machine Learning ◽  
Brain Tumor ◽  
Ct Scan ◽  
Imaging Techniques ◽  
Critical Evaluation ◽  
Tumor Detection ◽  
Machine Learning Techniques ◽  
X Rays ◽  
Detection Techniques ◽  
The Brain

Background: This paper endeavors to identify an expedient approach for the detection of the brain tumor in MRI images. The detection of tumor is based on i) review of the machine learning approach for the identification of brain tumor and ii) review of a suitable approach for brain tumor detection. Discussion: This review focuses on different imaging techniques such as X-rays, PET, CT- Scan, and MRI. This survey identifies a different approach with better accuracy for tumor detection. This further includes the image processing method. In most applications, machine learning shows better performance than manual segmentation of the brain tumors from MRI images as it is a difficult and time-consuming task. For fast and better computational results, radiology used a different approach with MRI, CT-scan, X-ray, and PET. Furthermore, summarizing the literature, this paper also provides a critical evaluation of the surveyed literature which reveals new facets of research. Conclusion: The problem faced by the researchers during brain tumor detection techniques and machine learning applications for clinical settings have also been discussed.

scholarly journals Eighty Percent Survival of Resurfacing Implants in the Knee After 10 Years: A Nationwide Cohort Study on 379 Procedures from the Danish Knee Arthroplasty Registry

Cartilage ◽  
2021 ◽  
pp. 194760352110309
Author(s):  
Bjørn B. Christensen ◽  
Anders El-Galaly ◽  
Jens Ole Laursen ◽  
Martin Lind
Keyword(s):  
Cohort Study ◽  
Survival Rate ◽  
Cartilage Repair ◽  
Knee Arthroplasty ◽  
Treatment Method ◽  
Osteochondral Lesions ◽  
Free Survival ◽  
Secondary Osteoarthritis ◽  
Arthroplasty Registry ◽  
Cartilage Injuries

Objective Focal cartilage injuries are debilitating and difficult to treat. Biological cartilage repair procedures are used for patients younger than 40 years, and knee arthroplasties are generally reserved for patients older than 60 years. Resurfacing implants are well suited for patients in this treatment gap. The objective was to investigate the 10-year survival of resurfacing implants in the Danish Knee Arthroplasty Registry. Design In this retrospective cohort study, patients treated with resurfacing implants were followed longitudinally in the Danish Knee Arthroplasty Registry from 1997 to 2020. The primary endpoint was revision surgery. The survival of the resurfacing implants was analyzed by Kaplan-Meier method. Results A total of 379 resurfacing implant procedures were retrieved from the Danish Knee Arthroplasty Registry. The mean age and weight of patients were 50 years (SD = 11) and 84 kg (SD = 17), respectively. The indications for surgery were as follows: secondary osteoarthritis (42%), primary osteoarthritis (32%), and osteochondral lesions (20%). Within the follow-up period, 70 (19%) of the implants were revised to arthroplasties. The 1-, 5-, and 10-year revision-free survival estimation was 0.95 (95% CI 0.93-0.97), 0.84 (95% CI 0.80-0.88), and 0.80 (95% CI 0.75-0.84), respectively. The median time to revision was 2 years. Conclusion The 10-year revision-free survival rate for resurfacing implants was 80%. Based on the revision rates, this treatment offers a viable alternative to biological cartilage repair methods in patients aged 40 to 60 years with focal cartilage pathology. Improved patient selection could further improve the implant survival rate. Further studies are needed to investigate this treatment method.

scholarly journals A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Alessandro Casiraghi ◽  
Claudio Galante ◽  
Marco Domenicucci ◽  
Stefano Cattaneo ◽  
Andrea Achille Spreafico ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Articular Surface ◽  
Osteochondral Lesion ◽  
Hip Dislocation ◽  
Fracture Dislocation ◽  
Osteochondral Lesions ◽  
Femoral Head Fracture ◽  
Osteochondral Scaffold

AbstractThe aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold.An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema.The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head.Study Design: Case report.

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