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 Iatrogenic Osteochondral Kissing Lesion After Transmalleolar Drilling of the Talar Dome

2009 ◽  
Vol 99 (1) ◽  
pp. 54-57 ◽  
Author(s):  
Pieter D’Hooghe ◽  
Kevin Deschamps ◽  
Giovanni Matricali
Keyword(s):  
Case Report ◽  
Ankle Sprain ◽  
Clinical Presentation ◽  
Osteochondral Lesion ◽  
Ankle Injuries ◽  
Arthroscopic Treatment ◽  
Talar Dome ◽  
Retrograde Drilling ◽  
Arthroscopic Microfracture

Ankle injuries can lead to early osteoarthrosis when diagnosis is delayed. The clinical presentation of an osteochondral lesion of the talar dome is often difficult to diagnose in the initial setup of an ankle sprain or fracture. Once the lesion is adequately imaged and staged, open or arthroscopic treatment can be initiated. We discuss the arthroscopic treatment of a posteromedial talar dome lesion in this case report. Transmalleolar drilling was performed to treat an osteochondral lesion of the talar dome in a 24-year-old female. Her ankle evolved toward a severe clinical and radiologic condition in which a combined talar and tibial (kissing) lesion was seen during her follow-up. Therefore, we recommend the use of retrograde drilling or arthroscopic microfracture with minimal iatrogenic risk, instead of transmalleolar drilling, as the treatment of choice in these specific osteochondral lesion of the talar dome cases. (J Am Podiatr Med Assoc 99(1): 54–57, 2009)

scholarly journals Symptomatic Hypokalemia in a 19-Year-Old Student

2020 ◽  
Vol 63 (3) ◽  
pp. 137-140
Author(s):  
Sara Pereira ◽  
André Salgueiro ◽  
Paula Rosa ◽  
Carla Peixoto ◽  
Marta Ferreira ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Metabolic Alkalosis ◽  
Clinical Presentation ◽  
Adrenal Adenoma ◽  
Screening Tests ◽  
Common Cause ◽  
Confirmatory Tests ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Primary hyperaldosteronism (PA) is the most common cause of secondary arterial hypertension and is frequently undiagnosed. It affects all ages but is more frequent between 20 and 60 years old. The clinical presentation is variable, and the diagnosis is based on screening and, in equivocal cases, confirmatory tests. A 19-year-old student presented with complaints of extreme fatigue, arterial hypertension, hypokalemia and metabolic alkalosis, raising a high index of suspicion for PA. Screening tests were performed and its expressiveness excluded the need of confirmatory tests. CT-scan showed a unilateral adrenal adenoma and the patient was submitted to laparoscopic adenectomy without complications. Prompt diagnosis and treatment are essential to avoid long term complications of PA.

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.

Trigeminal Neuralgia: Microvascular Decompression is the Ultimate Answer

2019 ◽  
Vol 8 (2) ◽  
pp. 105-107
Author(s):  
Md Aminul Islam ◽  
Rajib Shahriar ◽  
Rukun Uddin Chowdhury ◽  
MAA Salek
Keyword(s):  
Trigeminal Neuralgia ◽  
Severe Pain ◽  
Clinical Presentation ◽  
Treatment Approach ◽  
Clinical History ◽  
Final Diagnosis ◽  
History Taking ◽  
Resonance Imaging ◽  
The Face ◽  
Trigger Zone

Trigeminal neuralgia also known as ‘Fothergill’s disease’ or ‘tic douloureux’ is a very peculiar disease. The severe pain is paroxystic and can be triggered by a mild cutaneous stimulus on the face or “trigger zone”. The disease has a wide variety of etiology and clinical presentation. The management will include both medical and a surgical approach. A 58-year-old female patient had reported with a complaint of pain for 8 years. On thorough history taking and clinical examination, we were able to confirm the final diagnosis as trigeminal neuralgia (TN). We present a case of trigeminal neuralgia of the maxillary and mandibular division along with clinical history, MRI (Magnetic Resonance Imaging) findings and treatment approach. Bang. J Neurosurgery 2019; 8(2): 105-107

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.

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