Novel metallic implantation technique for osteochondral defects of the medial talar dome. Another objective is to allow the detached fragment to heal to the underlying and surrounding bone [45]. (A) Unstable medial talar dome osteochondral lesion of the talus. However, based on current literature, there is no specific conclusion regarding duration of non-operative treatment, method of immobilization, weight bearing status, the use of NSAIDs, and physical therapy protocol [13]. Chandran P KR, Nihal A. Osteochondral fracture of talus treated with bioabsorbable pins 2008. studied 15 patients with allograft transplantation, and they demonstrated significant improvement of the mean AOFAS scores from 38 to 83 and VAS from 8.5/10 to 3.3/10 at 54 months post-operatively. Impaired function, limited range of motion, stiffness, catching, locking an… Am J Sports Med 1984; 12(6): 460-3. Talar dome lesions are usually caused by … Irwin TA, Kou JX, Fortin PT. Recently, navigated retrograde drilling has been introduced by Richter et al. Experience in experimental and clinical research and surgery in orthopaedics with an academic degree. J Bone Joint Surg Am 1959; 41-A: 988-1020. Foot Ankle Int 2010; 31(1): 90-101. They reported significant pain relief (mean VAS was 6/10 pre-operatively and improved to 1/10 post-operatively) and mean post-operative AOFAS scores were 84 at final follow-up. Kappis M. Weitere beitrage zur traumatisch-mechanischen entstehung der “spontanen” knorpela biosungen. J Bone Joint Surg Am 2003; 85-A(Suppl. (67, 71). Osteochondral fractures of the talus (Osteochondritis Dissecans). Even though the bone marrow stimulation techniques have been proven to be effective treatment for symptomatic patients with small osteochondral lesions of the talus, the reparative tissue forming after the bone marrow stimulation is fribrocartilage (Type 1 collagen predominant) with less durability compared to normal hyaline cartilage (Type 2 collagen predominant). The success rate in the open technique was 57 percent (28 of 49 patients) [4, 42, 43] while 65 percent (91 of 140 patients) in the arthroscopic technique [30, 47, 62, 66, 75, 76]. [25] suggested that SPECT-CT is used in conjunction with MRI for the assessment of OLT. The lesion usually occurs in the anterolateral part of the talus and is associated with trauma [47]. The largest series has been reported by Kumai et al. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. 1995. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Gustillo RB. Foot Ankle Clin 2013; 18(1): 13-34. They reported that microfracture technique demonstrated significant improvement of functional outcomes as measured with VAS and AOFAS scores (mean pre-operative VAS 8.2/10 improved to 3.8/10 post-operatively and mean pre-operative AOFAS scores 42 improved to 68 points at 12 months post-operatively) [50]. The original radiographic classification system for OLT was developed by Berndt and Harty in 1959 [5] (Table 1 and Fig. J. G. The juxtoretroperoneal route in the operative treatment of fracture of the malleolus with posterior margin fragment. In this perspective, open access journals are instrumental in fostering researches and achievements. Management options are as numerous as the terms used to describe these lesions. They reported improvement of AOFAS score from 61 pre-operatively to 79 post-operatively; however, there was no improvement in SF-36 PCS and MCS subscale [132]. Pettine KA, Morrey BF. Osteochondral lesions of the talus. Foot Ankle Int 2007; 28(2): 154-61. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. DeLee et al. Radiographs showed a suspicious area on the lateral talar dome. The harvest typically yields a 200- to 300-mg specimen of cartilage and the cells are cultured for 6 to 8 weeks, resulting in 12 million cells available for implantation, at least a tenfold increase [106]. The defects cause deep ankle pain associated with weightbearing. The previous literature reported that the overall success rate of excision and curette was 63 percent (119 of 189 patients); however, the success rate varies between 47 to 89 percent from 9 studies [4, 30, 42, 43, 62, 66, 72, 75, 76]. Professor Malemud is on the editorial board of several rheumatology, immunology and musculoskeletal journals and is Editor-in-Chief of the Journal of Clinical and Cellular Immunology and Global Vaccines and Immunology. J Am Acad Orthop Surg 1996; 4(2): 63-73. Foot Ankle Int 1997; 18(10): 628-34. Indication for microfracture is recommended as a first-line treatment, especially in osteochondral defects of the talus measuring less than 1.5 cm2 [57, 80]. ", "In principle, all scientific journals should have open access, as should be science itself. This technique requires precise surgical technique because a protruding implant can injure the adjacent tibial plafond, while deepening of the implant leads to collapse of surrounding cartilage and subchondral bone [138]. Diagnosis of lesions is based on imaging. An osteochondral injury to the talar dome produces pain at the ankle and you will find … Mintz DN, Tashjian GS, Connell DA, Deland JT, O' Malley M, Potter HG. 2007;35(10): 1680-1687. Unfallchirurg 1993; 96(2): 75-81. Impaired function, limited range of motion, stiffness, catching, locking an… Prone position has been reported for the arthroscopic treatment for the osteochondral lesion located on the posterior part of the talus [63-65]. The surrounding cartilage and the subchondral bone defect require debridement until the cartilage rim is stable and no necrotic tissue remains on the osteochondral base. In addition, Reddy et al. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Current concept review: osteochondral lesions of the talus. demonstrated that MRI guidance has 100 percent accuracy, is safe, and technically feasible with no complications for retrograde drilling of OLTs [95]. J Bone Joint Surg Br 2002; 84(3): 369-74. Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. Baker CL Jr, Morales RW. first described this technique in 1999 through anterolateral and posterolateral approaches [90]. Am J Sports Med 2009; 37(Suppl. Medial lesions are usually deeper, and more likely to change into cystic lesions, while lateral lesions, shallower, and more likely to have an associated wafer or flake fracture. INTRODUCTION. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. It can accurately depict the grade of the lesions, except for early lesions, as these are defined by abnormalities in the articular cartilage which is not seen on CT [23]. 1) and determined only by plain radiographs. Moreover, MRI was used to evaluate OLT after arthroscopic microfracture in 22 patients by Kuni et al. Furthermore, Raikin et al. J Am Acad Orthop Surg 2009; 17(7): 407-14. 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